Lóc tách động mạch chủ trong quá trình can thiệp động mạch vành

1. Aortic Dissection in PCI
Ravi S. Hira, MD, FACC, FAHA, FSCAI
Assistant Professor of Medicine, University of Washington
Director, Acute Cardiac & Cardiac Catheterization Service,
Harborview Medical Center

2. Outline
• Incidence
• Predictors
• Mechanism of decompensation
• Management options
• Cases

3. Incidence
• Higher during PCI – 0.03%
• Diagnostic < 0.01%

4. Predictors
• Heavy calcification at the
ostium
• Aggressive guide, non-
coaxial
• Stiff wires
• Ostial/proximal CTO
• Retrograde wiring that wraps
around in the aortic wall
• FORCEFUL INJECTION

5. Mechanism of decompensation
• With perforation into pericardium and
tamponade
• Occlusion of the ostium or contralateral
ostium with hematoma
• Propagation of dissection into arch vessels
and descending aorta

6. Classification
• Class I - staining is limited to the coronary
cusp
• Class II - contrast extends < 40�mm up the
aortic wall
• Class III - contrast extends > 40�mm up the
aortic wall.
Dunning et al. Catheter Cardiovasc Interv. 2000 Dec;51(4):387-

7. Management options
• Stop injecting
• Conservative management
• Stenting of ostium
• Surgery – suggested for Class III
dissections (>40 mm) or clinical
decompensation (stroke or propagation to
descending aorta)
• Reversal of anticoagulation
• Pericardiocentesis if tamponade

8. Case 1

10. Case 2

16. Summary
• Recognize early
• STOP Injecting
• Stent ostium
• Consider surgery if hemodynamic
compromise

17. Thank you