Invasive percutaneous management of iatrogenic aortic dissection during percutaneous coronary intervention of right coronary artery: a case series.

Background: Iatrogenic aortic dissection can occur during diagnostic and interventional coronary procedures that can involve both right and left coronaries and ascends to the aorta. Catastrophic complication is when surgical intervention is needed. Our case series gives an insight into the ability to manage Dunning Class 2 and 3 iatrogenic aortic dissections by using stents to seal the point of entry instead of an open surgical approach. Case summary: During percutaneous coronary intervention (PCI) of the right coronary artery (RCA) in three of our patients, there was iatrogenic dissection of RCA that progressed back to the aorta (Dunning Class 2 to 3). We intervened after taking cardiac surgeons on board by stenting up to the ostium of the artery, hence sealing the entry point into the dissection plane. Patients were observed closely in the intensive care and followed with computed tomography scan. All remained stable and were discharged to outpatient follow-up 3-6 monthly. Discussion: We have found similar cases reported in the literature over many years, but the number is not large as it is a rare complication. We concluded that stenting (PCI) can be an acceptable alternative to surgery in larger Dunning dissections and can avoid major surgery. Our case series can add valuable information to literature and remodel the management of such iatrogenic aortic dissections.