Incidence, Management, and Immediate- and Long-Term Outcomes After Iatrogenic Aortic Dissection During Diagnostic or Interventional Coronary Procedures.

Autor:	Núñez-Gil IJ; 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., Bautista D; 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.)., Cerrato E; 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.)., Salinas P; 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.)., Varbella F; 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.)., Omedè P; 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.)., Ugo F; 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.)., Ielasi A; 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.)., Giammaria M; 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.)., Moreno R; 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.)., Pérez-Vizcayno MJ; 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.)., Escaned J; 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.)., De Agustin JA; 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.)., Feltes G; 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.)., Macaya C; 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.)., Fernández-Ortiz A; 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.).
Jazyk:	angličtina
Zdroj:	Circulation [Circulation] 2015 Jun 16; Vol. 131 (24), pp. 2114-9. Date of Electronic Publication: 2015 Apr 17.
DOI:	10.1161/CIRCULATIONAHA.115.015334
Abstrakt:	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. Methods and 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. (© 2015 American Heart Association, Inc.)
Databáze:	MEDLINE
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