scholarly journals Conservative Management of Extensive Iatrogenic Aortic Dissection

Aorta ◽  
2016 ◽  
Vol 04 (06) ◽  
pp. 229-231
Author(s):  
Derrick Tam ◽  
Amine Mazine ◽  
Asim Cheema ◽  
Bobby Yanagawa
Keyword(s):  
Aortic Dissection ◽  
Conservative Management ◽  
Rare Complication ◽  
Case Series ◽  
Current Evidence ◽  
Iatrogenic Aortic Dissection ◽  
Percutaneous Coronary ◽  
Reasonable Approach ◽  
St Elevation ◽  
The Right

AbstractIatrogenic aortic dissection (IAD) is a rare complication of percutaneous coronary interventions (PCI). There are no clear guidelines for IAD management, and limited data are available. Registry data and case series combined with extrapolations from our experience with spontaneous Type-A dissections suggest that very limited dissections are often managed conservatively with coronary stenting of the entry tear when possible, while more extensive dissections are managed surgically. We present a case report of a 50-year-old woman who underwent PCI for an ST-elevation myocardial infarction that resulted in an extensive IAD from the ostium of the right coronary artery to the aortic root, ascending aorta, and aortic arch. While the current evidence strongly supports surgical management of such extensive dissection, our patient was successfully managed conservatively with complete resolution according to short-term computed tomography imaging. This case suggests that conservative management may be a reasonable approach for select patients with extensive IAD.

scholarly journals Iatrogenic aortic dissection during percutaneous coronary intervention: A case report and review of the literature

2017 ◽  
Vol 46 (1) ◽  
pp. 526-532 ◽  
Author(s):  
Jia-Chen Li ◽  
Xin-Liang Guan ◽  
Ming Gong ◽  
Hong-Jia Zhang
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Aortic Dissection ◽  
Right Coronary Artery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Ascending Aorta ◽  
Iatrogenic Aortic Dissection ◽  
Percutaneous Coronary ◽  
The Right

A 64-year-old female complaining of unrelieved chest pain for 2 days was admitted to the Emergency Room of the Beijing Anzhen Hospital, Beijing, China. After definitive diagnosis, a percutaneous coronary intervention was implemented, but immediately after embedding the stent in the distal area of the right coronary artery, an acute coronary and aortic dissection was found. Cardiologists immediately gave the patient conservative management. At the same time, another smaller stent was immediately embedded in the proximal area of the right coronary artery and plunged into the ascending aorta by 2 mm, with the intention of covering the tear of the dissection. Repeated coronary angiography showed that a 40% stricture of the distal right coronary artery remained and less contrast agent had been extravasated. The patient was then transferred to the Department of Cardiac Surgery and received emergency surgery consisting of right coronary artery bypass grafting and ascending aorta replacement. The patient remained in the intensive care unit for 18 days after the surgery. The patient recovery was acceptable and she was discharged with a small amount of bilateral hydrothorax, moderate malnutrition oedema and iron deficiency anaemia.

P2426Validating the diagnostic value of a machine learning algorithm for STEMI detection

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Mehta ◽  
R Botelho ◽  
F Fernandez ◽  
C Villagran ◽  
A Frauenfelder ◽  
...  
Keyword(s):  
Medical Information ◽  
Learning Algorithm ◽  
Artery Bypass ◽  
Hospital Setting ◽  
Coronary Intervention ◽  
Diagnostic Value ◽  
Retrospective Case ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
The Right

Abstract Background We have previously reported the use of Artificial Intelligence (AI) guided EKG analysis for detection of ST-Elevation Myocardial Infarction (STEMI). To demonstrate the diagnostic value of our algorithm, we compared AI predictions with reports that were confirmed as STEMI. Purpose To demonstrate the absolute proficiency of AI for detecting STEMI in a standard12-lead EKG. Methods An observational, retrospective, case-control study. Sample: 5,087 EKG records, including 2,543 confirmed STEMI cases obtained via feedback from health centers following appropriate patient management (thrombolysis, primary Percutaneous Coronary Intervention (PCI), pharmacoinvasive therapy or coronary artery bypass surgery). Records excluded patient and medical information. The sample was derived from the International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes by wavelet system, segmentation of each EKG into individual heartbeats (53,667 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented, “STEMI” and “Not-STEMI” classes were considered for each heartbeat, individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample were used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVIDIA GTX 1070 GPU, 8GB RAM. Results The model yielded an accuracy of 97.2%, a sensitivity of 95.8%, and a specificity of 98.5%. Conclusion(s) Our AI-based algorithm can reliably diagnose STEMI and will preclude the role of a cardiologist for screening and diagnosis, especially in the pre-hospital setting.

scholarly journals Healthy farmer presenting with chest pain and bradycardia during peak COVID season

2020 ◽  
Vol 4 (1) ◽  
pp. 1
Author(s):  
Siu SSY ◽  
Norwood A ◽  
Varma MC
Keyword(s):  
Chest Pain ◽  
Coronary Intervention ◽  
Protective Measures ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
New Variables ◽  
The Right ◽  
Pacemaker Insertion ◽  
Onset Atrial Fibrillation ◽  
New Onset

This was a patient who got admitted with three related cardiological presentations during the same admission. Initially he presented with an Inferior ST-elevation myocardial infarction (STEMI) and bradycardia. Following primary percutaneous coronary intervention (PPCI) to the right coronary artery (RCA), he was found to be in complete heart block and new onset atrial fibrillation was noted. This case proved to be interesting and challenging at the same time in view of constantly evolving factors during the peak coronavirus disease (COVID-19) pandemic. There was a great deal of uncertainty over the course of patient's illness not only due to cardiological issues, particularly arrhythmias relating to COVID, but also due to high levels of staff illness, rapidly evolving clinical guidance and emergence of data introducing new variables to consider. The clinical team not only dealt with his initial presenting symptom (chest pain- PPCI) promptly and effectively, but also carefully evaluated his subsequent new unexpected symptoms (bradycardia- pacemaker insertion) and new onset angina (further PCI to LAD) with equal vigour and seriousness, resulting in excellent final results for all of his three conditions with complete and total resolution of all symptoms. We therefore managed to discharge him successfully in spite of unusual challenges noted due to the pandemic situation. We managed to observe highest level protective measures, preventing him from acquiring COVID whilst surrounded by COVID positive and suspected patients and staff.

Iatrogenic Aortic Dissection Complicating Percutaneous Coronary Intervention for Chronic Total Occlusion

2015 ◽  
Vol 31 (3) ◽  
pp. 320-327 ◽  
Author(s):  
Marouane Boukhris ◽  
Salvatore Davide Tomasello ◽  
Francesco Marzà ◽  
Salvatore Azzarelli ◽  
Alfredo Ruggero Galassi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Aortic Dissection ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Iatrogenic Aortic Dissection ◽  
Percutaneous Coronary

scholarly journals Massive Iatrogenic Aortic Dissection During Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
Toraaki Okuyama ◽  
Tomoki Maehara ◽  
Takahito Kamba ◽  
Keisuke Fukushima ◽  
Ritsu Yoshida ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Aortic Dissection ◽  
Coronary Intervention ◽  
Iatrogenic Aortic Dissection ◽  
Percutaneous Coronary

scholarly journals A rare complication of STEMI: Anaphylactic shock post-fibrinolytic

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Teddy Arnold Sihite ◽  
◽  
Muhammad H afizh Dewantara ◽  
Mega Febrianora ◽  
◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Anaphylactic Shock ◽  
Myocardial Infarct ◽  
Rare Complication ◽  
Coronary Intervention ◽  
Stemi Patient ◽  
Fibrinolytic Therapy ◽  
First Line ◽  
Percutaneous Coronary ◽  
St Elevation

ST-Elevation Myocardial Infarct (STEMI) is the most common emergency condition that causes sudden death. The revascularization speed of the occluded coronary artery is the key to success in STEMI management in both aspects of reducing morbidity and mortality. Primary Percutaneous Coronary Intervention (PCI) is the first line of reperfusion management in the treatment of STEMI patients, but in some conditions, such actions cannot be performed then pharmaco-invasive strategies should be done. There are several complications of STEMI after fibrinolytic therapy. In this case report, we presented a rare complication of anaphylactic shock in STEMI patient underwent fibrinolytic therapy. Keywords: Anaphylactic shock; Fibrinolytic; PCI; STEMI.

scholarly journals Interventional Strategies in Thrombus Management for ST Elevation Myocardial Infarction

2015 ◽  
Vol 10 (1) ◽  
pp. 35
Author(s):  
Michael Tsang ◽  
Sanjit Jolly ◽  
◽  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Randomised Trial ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Current Evidence ◽  
Thrombus Aspiration ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Distal Embolisation

The major limitation of modern primary percutaneous coronary intervention (PPCI) is distal embolisation of thrombus and microvascular obstruction. Microvascular flow, as measured by myocardial blush grade (MPG), predicts mortality after PPCI. Despite initial enthusiasm, current evidence does not support routine use of Intracoronary over intravenous glycoprotein 2b3a inhibitors during PPCI for ST elevation myocardial infarction (STEMI) to improve clinical outcomes. Manual thrombectomy (MT) improves MPG and reduces distal embolisation in meta-analyses of small trials. A single-centre trial (N=1071), the Thrombus aspiration during percutaneous coronary intervention in acute myocardial infarction study (TAPAS) trial showed a mortality reduction, which led guidelines to recommend routine manual aspiration. However, the largest randomised trial (Thrombus aspiration in ST-elevation myocardial infarction in Scandinavia [TASTE] trial, N=7021) showed no difference in mortality and only trends towards reduction in myocardial infarction (MI) and stent thrombosis. The TASTE trial had much lower than expected mortality and so was likely underpowered for modest but important treatment effects (20–30 % RRR). The Thrombectomy with PCI versus PCI alone in patients with STEMI undergoing primary PCI (TOTAL) trial (N=10,700) will determine if MT reduces important clinical events during PPCI. Thrombus management remains an important area of research in STEMI.

scholarly journals Spontaneous Early Resolution of an Iatrogenic Type A Aortic Dissection Following Coronary Angiography

Aorta ◽  
2018 ◽  
Vol 06 (06) ◽  
pp. 142-144
Author(s):  
Yavuzer Koza ◽  
Uğur Kaya ◽  
Hakan Taş ◽  
Enise Koza
Keyword(s):  
Coronary Angiography ◽  
Aortic Dissection ◽  
Medical Therapy ◽  
Ascending Aorta ◽  
Artery Dissection ◽  
Coronary Artery Dissection ◽  
Type A Aortic Dissection ◽  
Hemodynamic Compromise ◽  
Iatrogenic Aortic Dissection ◽  
St Elevation

AbstractA 74-year-old man was admitted with the diagnosis of non–ST-elevation myocardial infarction. During right coronary angiography, a coronary artery dissection extending into the proximal ascending aorta was noticed without hemodynamic compromise. Immediate computed tomography angiography showed no evidence of dissection in the ascending aorta. The patient remained hemodynamically stable with medical therapy alone. This case report highlights the importance of medical therapy in patients with uncomplicated iatrogenic aortic dissection.

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