Disección aortocoronaria Dunning clase III luego de intervención percutánea de oclusión coronaria total crónica. Reporte de un caso

Alexis Vallejos-Barrientos; Alessandra Centeno-Araujo; Diego Davila-Flores; Zoila Rodríguez-Urtega

doi:10.47487/apcyccv.v7i1.563

Authors

Alexis Vallejos-Barrientos Instituto Nacional CardiovascularINCOR, EsSalud, Lima, Perú. https://orcid.org/0009-0009-0885-6763
Alessandra Centeno-Araujo Instituto Nacional CardiovascularINCOR, EsSalud, Lima, Perú. https://orcid.org/0000-0002-0820-015X
Diego Davila-Flores Instituto Nacional CardiovascularINCOR, EsSalud, Lima, Perú. https://orcid.org/0000-0001-5084-6547
Zoila Rodríguez-Urtega Instituto Nacional CardiovascularINCOR, EsSalud, Lima, Perú. https://orcid.org/0000-0002-6565-8917

DOI:

https://doi.org/10.47487/apcyccv.v7i1.563

Keywords:

Aortic Dissection, Coronary Angiography, Iatrogenic Diseases

Abstract

Iatrogenic aorto-coronary dissection is an intimal tear that creates a false lumen and may propagate into the aorta. We report the case of a 68-year-old woman with a history of hypertension, obesity, a previous unrevascularised inferior transmural myocardial infarction, and limiting angina. Myocardial perfusion imaging demonstrated 15% ischaemia of the inferior wall, and coronary angiography revealed a chronic total occlusion of the right coronary artery with heterocoronary collateral circulation. The patient underwent percutaneous coronary intervention with implantation of three drug-eluting stents. A dissection flap originating in the right coronary sinus with extension into the aortic root was observed; contrast-enhanced computed tomography confirmed dissection of the ascending aorta with extension to the aortic arch and the brachiocephalic trunk. Medical therapy (beta-blockers, nitrates, and analgesia) was initiated, and surgery was deferred with close clinical and imaging surveillance. The clinical course was favourable, with a stable intramural haematoma of the ascending aorta and complete resorption at 7 months of follow-up.

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