Beyond the Incision: Understanding Catheter Induced Coronary Artery Dissection

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Abstract Purpose of Review Catheter Induced Coronary Artery Dissection (CICAD) is a rare but potentially life-threatening complication of cardiac catheterization and percutaneous coronary intervention (PCI). This review explores CICAD, covering its incidence, pathophysiology, risk factors, clinical presentation, management strategies, and clinical outcomes. This review aims to enhance cardiovascular clinicians in their understanding of CICAD, aiding in improving prevention, management strategies, and clinical outcomes for all patients. Recent Findings Incidence estimates were variable, with potential underreporting and underestimation. Patient independent risk factors included catheter types, catheter sizes, and procedural complexities. Patient dependent risk factors include hypertension, diabetes mellitus, hyperlipidemia, and female sex. Clinical presentations of CICAD encompassed a spectrum from asymptomatic cases to life-threatening emergencies. Preventative methods include catheter selection, catheter placement, limiting torque, and careful use of contrast injection. Trans-radial approach (TRA) compared to the transfemoral access (TFA) showed no increased risk in years when the TRA was the predominant selection. Management strategies have varied over time with the development of new technologies and operator experience, but range from conservative approaches to stenting and surgical interventions. As interventional techniques and devices continue to develop there seems to be limited scenarios where stenting is not the preferred option to treat CICAD. Summary This review emphasizes the importance of understanding CICAD for enhancing patient safety during invasive cardiovascular procedures. A compelling need arises for large-scale, diverse studies to provide more precise estimates of CICAD incidence, refine our understanding of risk profiles, and facilitate the development of evidence-based strategies for its prevention and management.

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