Tulluru Ravi Sankar, Gopinath Karthik, E John Jose, Thomson Viji Samuel, George Ommen K
Department of Cardiology, Christian Medical College and Hospital, Vellore, India.
Department of Cardiology, Christian Medical College and Hospital, Vellore, India.
JACC Case Rep. 2025 Sep 3;30(26):104888. doi: 10.1016/j.jaccas.2025.104888.
Iatrogenic aortocoronary dissection (IACD) is a rare but potentially life-threatening complication of percutaneous coronary intervention or diagnostic angiography. The increasing complexity of interventions, especially cases involving chronic total occlusions, calcified lesions, and aggressive balloon dilation, has heightened the risk of IACD. It is often underreported, with an estimated incidence of 0.02% to 0.10%.
We present 4 patients with IACD who were managed at our institute in 2024. The right coronary artery was the most frequently involved vessel, and type III IACD was the most common variant. Management strategies included stenting for 50% of patients and conservative management for 50%; no patient required surgical intervention.
All patients remained stable and were doing well at follow-up. Our case series provides valuable insights into the risk factors, clinical presentation, and management of IACD, highlighting the importance of prevention, early recognition, and tailored treatment strategies to optimize patient outcomes.
医源性主动脉冠状动脉夹层（IACD）是经皮冠状动脉介入治疗或诊断性血管造影的一种罕见但可能危及生命的并发症。介入治疗的复杂性不断增加，尤其是涉及慢性完全闭塞、钙化病变和积极球囊扩张的病例，增加了IACD的风险。该并发症常报告不足，估计发病率为0.02%至0.10%。
我们报告了2024年在我院接受治疗的4例IACD患者。右冠状动脉是最常受累的血管，III型IACD是最常见的类型。治疗策略包括50%的患者接受支架置入术，50%的患者接受保守治疗；无一例患者需要手术干预。
所有患者在随访时均保持稳定且情况良好。我们的病例系列为IACD的危险因素、临床表现和治疗提供了有价值的见解，强调了预防、早期识别和量身定制治疗策略以优化患者预后的重要性。
