Iatrogenic Coronary Dissection: From an Unexpected Diagnosis to a Lifesaving Intervention

TL;DR

A rare coronary artery complication during heart procedures is described, highlighting successful treatment and the importance of careful technique.

Contribution

A case of successful thrombolytic treatment for iatrogenic coronary dissection is reported, emphasizing diagnostic and management challenges.

Findings

Iatrogenic dissection occurred during angioplasty due to improper catheter placement in the right coronary artery.

Immediate stenting was required after confirming the dissection via follow-up angiography.

The RCA's susceptibility is linked to anatomical features and risk factors like female sex and deep intubation.

Abstract

Iatrogenic coronary dissection occurs when the wall of a coronary artery is mechanically ruptured during coronary angiography or angioplasty. Although this complication is uncommon, it can be dangerous and may rapidly progress to a life-threatening condition. We describe the successful thrombolytic treatment of a 62-year-old ex-smoker who was admitted with an antero-septo-apical ST-elevation myocardial infarction. During the procedure, an extra backup 3.5 guiding catheter was inadvertently engaged in the ostium of the right coronary artery (RCA), causing an iatrogenic dissection that required immediate stenting, as confirmed by follow-up coronary angiography. This case illustrates the challenges in diagnosing and managing this condition. While angiography remains the primary diagnostic tool for identifying the intimal flap, treatment should be tailored to the patient’s clinical presentation. Management options range from simple observation to stenting or, in severe cases, bypass surgery. The RCA is particularly susceptible to this complication because of its anatomical features and risk factors, such as female sex and deep intubation. This case underscores the importance of meticulous technique during endovascular procedures and maintaining a high level of vigilance for any unusual post-procedural presentation.

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