Aortic Dissection and Injury

Abstract

Iatrogenic injury to the ascending aorta (Type A, Stanford Classification) or aortic valve is a rare but serious complication of percutaneous coronary intervention (PCI). Trauma to the ascending aorta is most commonly caused by retrograde dissection extending from one of the coronary arteries. This is the key difference in mechanism between iatrogenic aortic dissection (IAD) of the ascending aorta during PCI, and spontaneous aortic dissection (SAD). IAD can extend proximally to involve the aortic valve causing aortic valvular regurgitation and/or cardiac tamponade, or distally to threaten the head and neck vessels as well as the descending aorta. Iatrogenic injury to the ascending aorta and aortic valve can also be caused by direct trauma from guide catheters; however this is very rare. The management of aortic IAD depends upon establishing the extent of the dissection, including whether there is involvement of the aortic valve, as a limited IAD can often be effectively managed in the catheterisation laboratory by sealing of the entry point of the dissection with a stent.