Ravi Sankar Tulluru | Iatrogenic Aortocoronary Dissection: Management and Outcomes

Ravi Sankar Tulluru, Christian Medical College and hospital, India Title: Iatrogenic Aortocoronary Dissection: Management and Outcomes Abstract: Iatrogenic aortocoronary dissection (IACD) is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI) or diagnostic coronary angiography, with an estimated incidence ranging from 0.02% to 0.10%, and is often underreported. In 2024, we managed four patients who developed IACD at our institute, with the right coronary artery being the most affected vessel and type III dissection representing the predominant variant. Presentations varied from chest discomfort to transient hemodynamic instability, but none required surgical intervention. Management strategies were individualized, with two patients (50%) undergoing stenting to seal the dissection entry point and prevent progression, while the remaining two (50%) were managed conservatively with close monitoring and medical therapy. All patients remained stable during hospitalization and were doing well at follow-up. This case series offers valuable insights into the procedural risk factors, angiographic patterns, and clinical presentations associated with IACD, underscoring the need for heightened awareness of procedural factors and prompt recognition during interventions. Our experience further demonstrates that both stenting and conservative management can be effective depending on patient stability and dissection severity, with surgical intervention being avoidable in most cases through careful decision-making and operator expertise. We propose an algorithmic approach for managing IACD to guide interventionalists in decision-making during emergencies. Early diagnosis, tailored treatment approaches, and vigilant monitoring remain key to optimizing patient outcomes and ensuring procedural success in complex coronary interventions. Biography: Ravi Sankar Tulluru completed his MD in General Medicine from Kurnool Medical College, Andhra Pradesh, and DM in Cardiology from Christian Medical College, Vellore. He is currently serving as an Associate Professor at CMC Vellore. He is actively involved in interventional cardiology and has made significant contributions to research in coronary interventions. He has published multiple papers in reputed journals, including two recent articles in JACC, and has presented at several national conferences. He also served as a panelist at India Live 2025. Dr.Tulluru is dedicated to advancing cardiovascular care and mentoring future cardiologists.