Case reports of antegrade and retrograde iatrogenic coronary spiral dissection complicating percutaneous coronary intervention: Keep calm and carry on!

Abstract

Iatrogenic dissection during PCI represents one of the most fearing complication of interventional cardiology, since abrupt hemodynamic instability and patient compromise may occur related to coronary occlusion. In this emergency situation, different hemodynamic support devices and interventional skills, are needed in order to promptly recover the patient from cardiogenic shock, especially when the left coronary three is involved by the dissection. We report herein two different iatrogenic retrograde, and antegrade dissections, one involving both left anterior descending artery, left circumflex and aortic bulb and the second characterized by abrupt closure of left main associated with severe hemodynamic compromise and ventricular fibrillation storm which required continuous DC shocks, Impella and ECMO devices support to stabilize the patient. Both cases were successfully managed percutaneously. Different techniques and tricks in order to re-open the vessels are described. We conclude that in case of iatrogenic coronary dissection, a “keep calm and carry on” strategy should be adopted by the interventional cardiologist team in order to solve such dramatic complication.