Lots of interesting abstracts and cases were submitted for TCTAP 2022. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!

TCTAP C-098

Horrible Injection !!! " Aorto-Coronary Dissection "

By Ramy Mohamed Atlm, Salma Elshokafy

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Presenter

Salma Mohamed E-lshokafy

Authors

Ramy Mohamed Atlm¹, Salma Elshokafy¹

Affiliation

Tanta University Hospital, Egypt¹,

View Study Report

TCTAP C-098

CORONARY - Complications

Horrible Injection !!! " Aorto-Coronary Dissection "

Ramy Mohamed Atlm¹, Salma Elshokafy¹

Tanta University Hospital, Egypt¹,

Clinical Information

Patient initials or Identifier Number

A S

Relevant Clinical History and Physical Exam

´ Female patient aged 61 years old , Known diabetic ,Hypertensive , Dyslipidemic . ´ Cardiac history started 2 years ago with recurrentanginal attacks and admission with acute coronary syndrome , But the patientwas refusing any invasive procedures .´ During the last 2 months patient complained ofcrescendo angina with agonizing pain even at rest , for which she was admittedat our CCU with Non-STEMI .Ø Generally : No signs or symptoms of heartfailure Ø Local ex: Audible HS with no addedmurmurs Ø Bl pr : 140 / 90Ø RBS : 300

Relevant Test Results Prior to Catheterization

Ø ECG shows : Sinus Rhythm with T waveinversion and ST depression in infero-lateral leads Ø Echo shows : ischemic heart disease withfair systolic function , segmental wall motion in the form of mid and basalinferior , infero-septal and inferolateral wall hypokinesia with no significantvalvular lesions Ø All laboratory investigations were unremarkableexcept for Positive Troponin , Elevated CKMB and un controlleddiabetes Markedly ( elevated HBA1C )

Relevant Catheterization Findings

According to Esc guidelines for Risk Stratification of NON-STEMI patients Our patient isconsidered high risk

* Dynamic ECG changes
* Elevated cardiac enzymes

So, Early invasive PCI in the first 24 hours was indicatedRCA total occlusion in an NON-STEMI patient with inferior territory ECGand ECHO changes So, We decided to gofor PCI RCA

Series_004_Coro 2020.wmv

Interventional Management

Procedural Step

Engagement of RCA with JR 4 Guiding catheter

Wiring of RCA with PT2 MS guide wire over a 2 * 15 mm semi-complaint balloonsupportDeeply engaged catheter induced aorto-coronary dissection extending from proximal RCA into sinus ofValsalva and the ascending aorta Suddenly the patient complained of sever chest pain and developedhypotension and bradycardia Rapidly we introduced an osteal stent to seal the entry site
of the dissection and to stop blood flow into false lumen We saved the ostium and closed the mouth of dissectionFollowed by pre-dilation and stenting of RCA with Overlapping stents upto distal segment to cover dissectionAnother distal stent was deployedØ Now , patient is doing well .Ø Chest pain improved markedly with regaining of hemodynamics to normal .Ø Follow up of patient by CT aortography showed completeresolution of dissection with a small intramural hematoma

horrible injection , Aorto coronary dissection.pptx

Series_007_Coro 2020.wmv

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Case Summary

´ Iatrogenic Catheter induced aorto-coronary dissection is rare but life threatening complication during PCI .´ The management depends on the patency of the distal vessel and the extent of propagation of the dissection .´ Its mechanisms involve vigorous contrast injections or during balloon dilatation or non coaxial engagements of catheters .´ Immediate coronary ostial stenting of the entry point of coronary dissection to seal off the dissection is feasible initial management .´ Localized aortic dissection carries an excellent prognosis with the adoption of conservative approach.

Case

TCTAP C-098