Aortocoronary dissection during percutaneous coronary interventions for chronic total occlusion: Insights from the PROGRESS‐CTO registry

• Published in: Catheterization and cardiovascular interventions 2023-07, Vol.102 (1), p.56-63
• Main Authors: Kostantinis, Spyridon, Rempakos, Athanasios, Simsek, Bahadir, Karacsonyi, Judit, Allana, Salman S., Alaswad, Khaldoon, Basir, Mir Babar, Krestyaninov, Oleg, Khelimskii, Dmitrii, Gorgulu, Sevket, Davies, Rhian E., Benton, Stewart M., Khatri, Jaikirshan J., Poommipanit, Paul, Choi, James W., Jaber, Wissam A., Rinfret, Stephane, Nicholson, William, Aygul, Nazif, Altunkeser, Bulent Behlul, ElGuindy, Ahmed M., Abi Rafeh, Nidal, Goktekin, Omer, Mastrodemos, Olga C., Rangan, Bavana V., Sandoval, Yader, Burke, M. Nicholas, Brilakis, Emmanouil S.
• Format: Article
• Language: English
• Subjects: aortocoronary dissection; Chronic Disease; chronic total occlusion; complications; Coronary Angiography; Coronary artery; Coronary Occlusion - diagnostic imaging; Coronary Occlusion - etiology; Coronary Occlusion - therapy; Dissection; Dyslipidemia; Heart surgery; Humans; Implants; Occlusion; Patients; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Registries; Restenosis; Risk Factors; Treatment Outcome
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.30680

Background Aortocoronary dissection is a potentially serious complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods We examined the incidence, mechanisms, treatment, and outcomes of aortocoronary dissection among 12,117 CTO PCIs performed between 2012 and 2022 in a large multicenter CTO PCI registry. Results The incidence of aortocoronary dissection was 0.2% (n = 27). Most aortocoronary dissections occurred in the right coronary artery (96.3%, n = 26). The baseline clinical characteristics of patients with and without aortocoronary dissection were similar, except for dyslipidemia, which was less common in patients with aortocoronary dissection (70.4% vs. 86.0%; p = 0.019). The retrograde approach was used more commonly among cases complicated by aortocoronary dissection (59.3% vs. 31.0%; p = 0.002). Technical (74.1% vs. 86.6%; p = 0.049) and procedural (70.4% vs. 85.2%; p = 0.031) success rates were lower among aortocoronary dissection cases, with a similar incidence of in‐hospital major adverse cardiovascular events (3.7% vs. 2.0%; p = 0.541). Of the 27 patients with aortocoronary dissection, 19 (70.4%) were treated with ostial stenting and 8 (29.6%) were treated conservatively without subsequent adverse clinical outcomes. No patients required emergency surgery. Follow‐up was available for 22 patients (81.5%): during a mean follow up of 767 (±562) days, the incidence of in‐stent restenosis was 11.1% (n = 3). Conclusions Aortocoronary dissection occurred in 0.2% of CTO PCIs performed by experienced operators, was associated with lower technical and procedural success, and was treated most commonly with ostial stenting. None of the patients required emergency cardiac surgery.