title: Frequency and outcomes of aortocoronary dissection during percutaneous coronary intervention of chronic total occlusions: a case series and systematic review of the literature.
abstract: BACKGROUND
  Aortocoronary dissection can complicate percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs).
  
  
  METHODS
  We retrospectively examined the frequency and outcomes of aortocoronary dissection among 336 consecutive CTO PCIs performed at our institution between 2005 and 2012 and performed a systematic review of the published literature.
  
  
  RESULTS
  Aortocoronary dissection occurred in six patients (1.8%, 95% confidence intervals 0.7%, 3.8%). All aortocoronary dissections occurred in the right coronary artery (CTO target vessel in five patients and donor vessel in one patient). The baseline clinical characteristics of patients with and without aortocoronary dissection were similar. Compared to patients without, those with aortocoronary dissection were more likely to undergo crossing attempts using the retrograde approach (25% vs. 67%, P = 0.036) and experience a major complication (2.4% vs. 33.3%, P = 0.008). Technical and procedural success rates were similar in both groups. Of the six patients with aortocoronary dissection one underwent emergency coronary bypass graft surgery (CABG), four were treated with ostial stenting, and one was treated conservatively without subsequent adverse clinical outcomes. Systematic literature review provided 107 published cases of aortocoronary dissection during PCI, that occurred mainly in the right coronary artery (74.8%) and were treated with stenting (49.5%), emergency CABG (29%), or conservatively (21.5%).
  
  
  CONCLUSIONS
  Aortocoronary dissection is an infrequent complication of CTO PCI and although it can be treated with stents in most patients, it may infrequently require emergency CABG.
authors: VA North Texas Healthcare System, Dallas, Texas; University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Deborah
authors: D
authors: Shorrock
authors: Tesfaldet T
authors: TT
authors: Michael
authors: Vishal
authors: V
authors: Patel
authors: Anna
authors: A
authors: Kotsia
authors: Bavana V
authors: BV
authors: Rangan
authors: Shuaib A
authors: SA
authors: Abdullah
authors: Jerrold M
authors: JM
authors: Grodin
authors: Avantika
authors: A
authors: Banerjee
authors: Emmanouil S
authors: ES
authors: Brilakis
mesh_terms: D000368:Aged; D001011:Aorta / Q000293:injuries; D002908:Chronic Disease; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects; D054059:Coronary Occlusion / Q000175:diagnosis / Q000628:therapy*; D003331:Coronary Vessels / Q000293:injuries / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery / Q000628:therapy*
keywords: aortocoronary dissection; chronic total occlusion; complications; percutaneous coronary intervention