CONGRESS ABSTRACT

Type A aortic dissection is a devastating disease that requires a multidisciplinary approach and it is associated with high mortality if surgical repair is not immediately performed. The etiology of aortic dissection is often spontaneous but it may develop as an intimal injury during invasive procedures such as cardiac surgery and coronary angiography. We present the case of a 60 year old male without cardiovascular risk factors was admitted to the Emergency Department for ACS-STEMI. The coronary angiography showed a 90% stenosis of the proximal LAD and embolic occlusion of the distal LAD. After balloon dilation of the lesion, a dissection of the LAD occurred, leading to a PCI with the implantation of DES on the left main-left anterior descending artery and a DES on the circumflex artery, using the T and small protrusion (TAP) technique. At the end of the procedure the patient developed a grade 3 Dunning iatrogenic aortic dissection, so the patient was centralized to our CICU localized in a tertiary level hospital with cardiac surgery. Despite the extensive nature of the dissection, involving the aorta from the ascending tract to the carrefour with multiple communications between the true and false lumen along the entire ascending, arch and descending aorta, the patient was hemodynamically stable without splanchnic malperfusion and managed conservatively [Figure 1,2]. The cardiac surgery was not the first choice due to the critical anatomy of the aortic root with an intimal tear at the level of the left coronary sinus [Figure 3], to the presence of multiple coronary stents that can complicate CABG strategy and to the ongoing DAPT. Close hemodynamic monitoring, aggressive blood pressure control with labetalol and nitroprusside, and DAPT were employed to preserve coronary perfusion, to maintain hemodynamic stability and to prevent adverse remodeling. The patient remained asymptomatic with stable echocardiographic (no pericardial effusion, moderate aortic regurgitation, partial recovery of EF 50%) and CT findings during hospitalization. This case highlights the feasibility of a conservative approach in selected cases of extensive iatrogenic aortic dissection, emphasizing the importance of individualized treatment strategies and multidisciplinary decision-making.