Published date: Dec 08 2024

Journal Title: Dubai Medical Journal

Issue title: Dubai Medical Journal (DMJ): Volume 7 Issue 3

Pages: 193 - 200

DOI: 10.18502/dmj.v7i3.17734

Nadia NadeemDepartment of Internal Medicine, Rashid Hospital, Dubai Health Authority, Dubai

Vetha Irene Sanjanairenesanjana@gmail.comDepartment of Internal Medicine, Rashid Hospital, Dubai Health Authority, Dubai

Geili AbdallaCardiology Interventional Department, Rashid Hospital, Dubai Health Authority, Dubai

Anas MusaCardiology Interventional Department, Rashid Hospital, Dubai Health Authority, Dubai

Introduction: Iatrogenic acute aortic dissection resulting from coronary interventions can have fatal consequences. Although it is an uncommon complication during percutaneous coronary interventions (PCI), it can arise from various factors. Our case report aims to address this rare presentation further, seeking to enhance preprocedural planning which can result in better outcomes.

Case Report: We describe an intriguing case of an elderly female patient with multiple cardiovascular risk factors who came to our emergency department presenting with chest pain. Her Electrocardiogram revealed an inferior ST-elevation myocardial infarction (STEMI) for which she underwent successful primary PCI of the right coronary artery (RCA). Four days later, she had an infero-posterior STEMI, which necessitated immediate coronary angiography. Angiography revealed thrombosis of the stent placed earlier in the RCA. On attempting recanalization of the vessel, an acute aortic dissection was identified and was successfully managed by ostial stenting. Follow-up imaging showed no residual dissection, and the patient was found to be comfortable and stable post-procedure.

Conclusion: We recommend optimizing blood pressure and performing rapid ostial stenting in these cases, irrespective of the dissection’s origin. This will facilitate effective sealing of the entry site and prevent further progression of the dissection. Our report highlights the favorable results achieved with immediate ostial stenting while discussing the conservative approach to managing such cases.

Keywords: Stent thrombosis, hyperacute, stenting, coronary intervention, aortic dissection, acute coronary syndrome, interventional cardiology, pre-procedure planning

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