16 Iatrogenic catheter induced coronary artery dissection: incidence, management and outcomes

Background Iatrogenic catheter induced coronary artery dissection is a rare but life threatening complication. The incidence has been reported to be 0.1%. Objective To estimate the incidence, management options, outcomes and long term prognosis of this rare complication. Methods The procedural records of 43 359 patients undergoing coronary angiography (diagnostic and percutaneous coronary intervention) from April 2008 to August 2016 were reviewed using Centricity (local database) and BCIS records. Results Iatrogenic catheter induced coronary artery dissection occurred in 36/43,359 cases (0.083%). The mean age was 64 years and 52.8% were females. Nineteen cases (52.8%) were during elective procedures; twenty-four cases (66.7%) were performed through radial approach and RCA dissections accounted for 58.3% of cases. Two-thirds (66.7%) of the cases involved a guide catheter engagement (p=0.0451). The majority was managed percutaneously with bail-out stenting (80.5%), three patients with CABG and the remaining four were treated conservatively. In-hospital outcomes were favourable with 34/36 patients discharged (one died on the way to theatre and one following percutaneous coronary intervention). Kaplan-Meier cumulative survival estimated 6.1% mortality at one year (all early) but no further events out to 5 years. Conclusion Iatrogenic catheter induced coronary artery dissection is rare but serious complication of coronary angiography. Timely recognition and prompt bail-out stenting is a feasible option and should be considered early to facilitate good outcomes.