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Catheter-induced coronary artery and aortic dissections. A study of the mechanisms, risk factors, and propagation causes
Abstract
Background: Only the incidence, management, and prognosis of catheter-induced coronary artery and aortic dissections have been systematically studied until now. We sought to evaluate their mechanisms, risk factors, and propagation causes. Methods: Electronic databases containing 76,104 procedures and complication registries from 2000– –2020 were searched and relevant cineangiographic studies adjudicated. Results: Ninety-six dissections were identified. The overall incidence was 0.126%, and 0.021% for aortic injuries. The in-hospital mortality rate was 4.2%, and 6.25% for aortic dissections. Compared to the non-complicated population, patients with dissection were more often female (48% vs. 34%, p = 0.004), with a higher prevalence of comorbidities such as hypertension (56% vs. 25%, p < 0.001) or chronic kidney disease (10% vs. 4%, p = 0.002). They more frequently presented with acute myocardial infarction (72% vs. 43%, p < 0.001), underwent percutaneous coronary intervention (85% vs. 39%, p < 0.001), and were examined with a radial approach (77% vs. 65%, p = 0.011). The most prevalent predisposing factor was small ostium diameter and/or atheroma. Deep intubation for support, catheter malalignment, and vessel prodding were the most frequent precipitating factors. Of the three dissec- tion mechanisms, ‘wedged contrast injection’ was the commonest (the exclusive mechanism of aortic dissections). The propagation rate was 30.2% and led to doubling of coronary occlusions and aortic extensions. The most frequent progression triggers were repeat injections and unchanged catheter. In 94% of cases, dissections were inflicted by high-volume operators, with ≥ 5-year experience in 84% of procedures. The annual dissection rate increased over a 21-year timespan. Conclusions: Catheter-induced dissection rarely came unheralded and typically occurred during ur- gent interventions performed in high-risk patients by experienced operators. (Cardiol J) Key words: catheter-induced coronary dissection, iatrogenic aortocoronary dissection, percutaneous coronary intervention complications
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Authors (6)
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Jacek Klaudel
- St. Adalbert’s Hospital in Gdansk, Copernicus, Gdansk
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Michał Glaza
- St. Vincent de Paul Hospital in Gdynia
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Wojciech Trenkner
- St. Adalbert’s Hospital in Gdansk, Copernicus, Gdansk
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Marek Szołkiewicz
- St. Vincent de Paul Hospital in Gdynia
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Full text
- Publication version
- Accepted or Published Version
- DOI:
- Digital Object Identifier (open in new tab) 10.5603/CJ.a2022.0050
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Details
- Category:
- Articles
- Type:
- artykuły w czasopismach
- Published in:
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Cardiology Journal
no. 31,
pages 398 - 408,
ISSN: 1897-5593 - Language:
- English
- Publication year:
- 2024
- Bibliographic description:
- Klaudel J., Glaza M., Klaudel B., Trenkner W., Pawłowski K., Szołkiewicz M.: Catheter-induced coronary artery and aortic dissections. A study of the mechanisms, risk factors, and propagation causes// Cardiology Journal -Vol. 31,iss. 3 (2024), s.398-408
- DOI:
- Digital Object Identifier (open in new tab) 10.5603/cj.a2022.0050
- Sources of funding:
-
- Free publication
- Verified by:
- Gdańsk University of Technology
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