title: Incidence, Management, and Immediate- and Long-Term Outcomes After Iatrogenic Aortic Dissection During Diagnostic or Interventional Coronary Procedures.
abstract: BACKGROUND
  Aortic dissection type A is a disease with high mortality. Iatrogenic aortic dissection after interventional procedures is infrequent, and prognostic data are scarce. Our objective was to analyze its incidence, patient profile, and long-term prognosis.
  
  
  RESULTS
  Between 2000 and 2014, we retrospectively analyzed 74 patients with dissection of the ascending aorta. Clinical and procedural data were reviewed, and later, we performed a prospective clinical follow-up by telephone or in the office. The incidence of aortic dissection was 0.06%. Our patients, predominantly male (67.6%), had a mean age of 66.9±10.8 years. With multiple cardiovascular risk factors, the main reason for cardiac catheterization was an acute coronary syndrome (n=54). The complication was detected acutely in all, trying to engage the right coronary artery in 47 and the left main artery in 30 and after other maneuvers in 2, mostly complex therapeutic procedures (78.4%). A coronary artery was involved in 45 patients (60.8%). Thirty-five patients underwent an angioplasty and stent implantation; 3 had cardiac surgery; and 36 were managed conservatively. Two patients died of cardiogenic shock after the dissection. After a median follow-up of 51.2 months (range, 16.4-104.8 months), none of the remaining patients developed complications as a result of the dissection, progression, ischemia, pain, or dissection recurrence.
  
  
  CONCLUSIONS
  Iatrogenic catheter dissection of the aorta is a rare complication that carries an excellent short- and long-term prognosis with the adoption of a conservative approach. When a coronary artery is involved as an entry point, it usually can be safely sealed with a stent with good long-term outcomes.
authors.affiliation: From Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (I.J.N.-G. D.B., P.S., M.J.P.-V., J.E., C.M., A.F.O.); Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy (E.C., F.V.); Cardiogroup.org (E.C.); Division of Cardiology, Citta' della Salute e della Scienza di Torino, University of Turin, Italy (P.O.); Interventional Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy (F.U.); Cardiology Division, "Bolognini" Hospital, Seriate BG, Italy (A.I.); Cardiology Department, Maria Vittoria Hospital, Turin, Italy (M.G.); Interventional Cardiology, Hospital Universitario La Paz, Madrid, Spain (R.M.); and Cardiovascular Imaging, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.A.D.A., G.F.). ibnsky@yahoo.es.
authors.forename: Iván J
authors.initials: IJ
authors.lastname: Núñez-Gil
authors.affiliation: From Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (I.J.N.-G. D.B., P.S., M.J.P.-V., J.E., C.M., A.F.O.); Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy (E.C., F.V.); Cardiogroup.org (E.C.); Division of Cardiology, Citta' della Salute e della Scienza di Torino, University of Turin, Italy (P.O.); Interventional Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy (F.U.); Cardiology Division, "Bolognini" Hospital, Seriate BG, Italy (A.I.); Cardiology Department, Maria Vittoria Hospital, Turin, Italy (M.G.); Interventional Cardiology, Hospital Universitario La Paz, Madrid, Spain (R.M.); and Cardiovascular Imaging, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.A.D.A., G.F.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Bautista
authors.affiliation: From Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (I.J.N.-G. D.B., P.S., M.J.P.-V., J.E., C.M., A.F.O.); Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy (E.C., F.V.); Cardiogroup.org (E.C.); Division of Cardiology, Citta' della Salute e della Scienza di Torino, University of Turin, Italy (P.O.); Interventional Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy (F.U.); Cardiology Division, "Bolognini" Hospital, Seriate BG, Italy (A.I.); Cardiology Department, Maria Vittoria Hospital, Turin, Italy (M.G.); Interventional Cardiology, Hospital Universitario La Paz, Madrid, Spain (R.M.); and Cardiovascular Imaging, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.A.D.A., G.F.).
authors.forename: Enrico
authors.initials: E
authors.lastname: Cerrato
authors.affiliation: From Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (I.J.N.-G. D.B., P.S., M.J.P.-V., J.E., C.M., A.F.O.); Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy (E.C., F.V.); Cardiogroup.org (E.C.); Division of Cardiology, Citta' della Salute e della Scienza di Torino, University of Turin, Italy (P.O.); Interventional Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy (F.U.); Cardiology Division, "Bolognini" Hospital, Seriate BG, Italy (A.I.); Cardiology Department, Maria Vittoria Hospital, Turin, Italy (M.G.); Interventional Cardiology, Hospital Universitario La Paz, Madrid, Spain (R.M.); and Cardiovascular Imaging, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.A.D.A., G.F.).
authors.forename: Pablo
authors.initials: P
authors.lastname: Salinas
authors.affiliation: From Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (I.J.N.-G. D.B., P.S., M.J.P.-V., J.E., C.M., A.F.O.); Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy (E.C., F.V.); Cardiogroup.org (E.C.); Division of Cardiology, Citta' della Salute e della Scienza di Torino, University of Turin, Italy (P.O.); Interventional Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy (F.U.); Cardiology Division, "Bolognini" Hospital, Seriate BG, Italy (A.I.); Cardiology Department, Maria Vittoria Hospital, Turin, Italy (M.G.); Interventional Cardiology, Hospital Universitario La Paz, Madrid, Spain (R.M.); and Cardiovascular Imaging, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.A.D.A., G.F.).
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Varbella
authors.affiliation: From Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (I.J.N.-G. D.B., P.S., M.J.P.-V., J.E., C.M., A.F.O.); Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy (E.C., F.V.); Cardiogroup.org (E.C.); Division of Cardiology, Citta' della Salute e della Scienza di Torino, University of Turin, Italy (P.O.); Interventional Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy (F.U.); Cardiology Division, "Bolognini" Hospital, Seriate BG, Italy (A.I.); Cardiology Department, Maria Vittoria Hospital, Turin, Italy (M.G.); Interventional Cardiology, Hospital Universitario La Paz, Madrid, Spain (R.M.); and Cardiovascular Imaging, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.A.D.A., G.F.).
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.affiliation: From Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (I.J.N.-G. D.B., P.S., M.J.P.-V., J.E., C.M., A.F.O.); Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy (E.C., F.V.); Cardiogroup.org (E.C.); Division of Cardiology, Citta' della Salute e della Scienza di Torino, University of Turin, Italy (P.O.); Interventional Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy (F.U.); Cardiology Division, "Bolognini" Hospital, Seriate BG, Italy (A.I.); Cardiology Department, Maria Vittoria Hospital, Turin, Italy (M.G.); Interventional Cardiology, Hospital Universitario La Paz, Madrid, Spain (R.M.); and Cardiovascular Imaging, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.A.D.A., G.F.).
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ugo
authors.affiliation: From Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (I.J.N.-G. D.B., P.S., M.J.P.-V., J.E., C.M., A.F.O.); Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy (E.C., F.V.); Cardiogroup.org (E.C.); Division of Cardiology, Citta' della Salute e della Scienza di Torino, University of Turin, Italy (P.O.); Interventional Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy (F.U.); Cardiology Division, "Bolognini" Hospital, Seriate BG, Italy (A.I.); Cardiology Department, Maria Vittoria Hospital, Turin, Italy (M.G.); Interventional Cardiology, Hospital Universitario La Paz, Madrid, Spain (R.M.); and Cardiovascular Imaging, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.A.D.A., G.F.).
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ielasi
authors.affiliation: From Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (I.J.N.-G. D.B., P.S., M.J.P.-V., J.E., C.M., A.F.O.); Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy (E.C., F.V.); Cardiogroup.org (E.C.); Division of Cardiology, Citta' della Salute e della Scienza di Torino, University of Turin, Italy (P.O.); Interventional Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy (F.U.); Cardiology Division, "Bolognini" Hospital, Seriate BG, Italy (A.I.); Cardiology Department, Maria Vittoria Hospital, Turin, Italy (M.G.); Interventional Cardiology, Hospital Universitario La Paz, Madrid, Spain (R.M.); and Cardiovascular Imaging, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.A.D.A., G.F.).
authors.forename: Massimo
authors.initials: M
authors.lastname: Giammaria
authors.affiliation: From Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (I.J.N.-G. D.B., P.S., M.J.P.-V., J.E., C.M., A.F.O.); Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy (E.C., F.V.); Cardiogroup.org (E.C.); Division of Cardiology, Citta' della Salute e della Scienza di Torino, University of Turin, Italy (P.O.); Interventional Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy (F.U.); Cardiology Division, "Bolognini" Hospital, Seriate BG, Italy (A.I.); Cardiology Department, Maria Vittoria Hospital, Turin, Italy (M.G.); Interventional Cardiology, Hospital Universitario La Paz, Madrid, Spain (R.M.); and Cardiovascular Imaging, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.A.D.A., G.F.).
authors.forename: Raúl
authors.initials: R
authors.lastname: Moreno
authors.affiliation: From Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (I.J.N.-G. D.B., P.S., M.J.P.-V., J.E., C.M., A.F.O.); Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy (E.C., F.V.); Cardiogroup.org (E.C.); Division of Cardiology, Citta' della Salute e della Scienza di Torino, University of Turin, Italy (P.O.); Interventional Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy (F.U.); Cardiology Division, "Bolognini" Hospital, Seriate BG, Italy (A.I.); Cardiology Department, Maria Vittoria Hospital, Turin, Italy (M.G.); Interventional Cardiology, Hospital Universitario La Paz, Madrid, Spain (R.M.); and Cardiovascular Imaging, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.A.D.A., G.F.).
authors.forename: María José
authors.initials: MJ
authors.lastname: Pérez-Vizcayno
authors.affiliation: From Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (I.J.N.-G. D.B., P.S., M.J.P.-V., J.E., C.M., A.F.O.); Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy (E.C., F.V.); Cardiogroup.org (E.C.); Division of Cardiology, Citta' della Salute e della Scienza di Torino, University of Turin, Italy (P.O.); Interventional Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy (F.U.); Cardiology Division, "Bolognini" Hospital, Seriate BG, Italy (A.I.); Cardiology Department, Maria Vittoria Hospital, Turin, Italy (M.G.); Interventional Cardiology, Hospital Universitario La Paz, Madrid, Spain (R.M.); and Cardiovascular Imaging, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.A.D.A., G.F.).
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.affiliation: From Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (I.J.N.-G. D.B., P.S., M.J.P.-V., J.E., C.M., A.F.O.); Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy (E.C., F.V.); Cardiogroup.org (E.C.); Division of Cardiology, Citta' della Salute e della Scienza di Torino, University of Turin, Italy (P.O.); Interventional Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy (F.U.); Cardiology Division, "Bolognini" Hospital, Seriate BG, Italy (A.I.); Cardiology Department, Maria Vittoria Hospital, Turin, Italy (M.G.); Interventional Cardiology, Hospital Universitario La Paz, Madrid, Spain (R.M.); and Cardiovascular Imaging, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.A.D.A., G.F.).
authors.forename: José Alberto
authors.initials: JA
authors.lastname: De Agustin
authors.affiliation: From Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (I.J.N.-G. D.B., P.S., M.J.P.-V., J.E., C.M., A.F.O.); Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy (E.C., F.V.); Cardiogroup.org (E.C.); Division of Cardiology, Citta' della Salute e della Scienza di Torino, University of Turin, Italy (P.O.); Interventional Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy (F.U.); Cardiology Division, "Bolognini" Hospital, Seriate BG, Italy (A.I.); Cardiology Department, Maria Vittoria Hospital, Turin, Italy (M.G.); Interventional Cardiology, Hospital Universitario La Paz, Madrid, Spain (R.M.); and Cardiovascular Imaging, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.A.D.A., G.F.).
authors.forename: Gisela
authors.initials: G
authors.lastname: Feltes
authors.affiliation: From Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (I.J.N.-G. D.B., P.S., M.J.P.-V., J.E., C.M., A.F.O.); Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy (E.C., F.V.); Cardiogroup.org (E.C.); Division of Cardiology, Citta' della Salute e della Scienza di Torino, University of Turin, Italy (P.O.); Interventional Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy (F.U.); Cardiology Division, "Bolognini" Hospital, Seriate BG, Italy (A.I.); Cardiology Department, Maria Vittoria Hospital, Turin, Italy (M.G.); Interventional Cardiology, Hospital Universitario La Paz, Madrid, Spain (R.M.); and Cardiovascular Imaging, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.A.D.A., G.F.).
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.affiliation: From Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (I.J.N.-G. D.B., P.S., M.J.P.-V., J.E., C.M., A.F.O.); Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy (E.C., F.V.); Cardiogroup.org (E.C.); Division of Cardiology, Citta' della Salute e della Scienza di Torino, University of Turin, Italy (P.O.); Interventional Cardiology Department, San Giovanni Bosco Hospital, Turin, Italy (F.U.); Cardiology Division, "Bolognini" Hospital, Seriate BG, Italy (A.I.); Cardiology Department, Maria Vittoria Hospital, Turin, Italy (M.G.); Interventional Cardiology, Hospital Universitario La Paz, Madrid, Spain (R.M.); and Cardiovascular Imaging, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.A.D.A., G.F.).
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández-Ortiz
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis; D000368:Aged; D000784:Aortic Dissection / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D000925:Anticoagulants / Q000009:adverse effects; D001011:Aorta / Q000293:injuries*; D001014:Aortic Aneurysm / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D006328:Cardiac Catheterization / Q000009:adverse effects*; D016208:Databases, Factual; D005060:Europe / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality; D015607:Stents; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents
keywords: aortic aneurysm, familial thoracic 4; aortic diseases; cardiac catheterization; iatrogenic disease; prognosis