Catheter-Induced Coronary Artery and Aortic Dissections: Mechanisms, Risk Factors and Propagation

This large retrospective analysis examined catheter-induced coronary and aortic dissections — a rare but potentially catastrophic complication of invasive cardiac procedures — across more than 76,000 procedures.

Catheter-induced dissections occurred in 0.126 percent of cases. Propagation — extension of the initial dissection — occurred in 30 percent of events and represented the most dangerous trajectory. Identifiable risk factors included procedural urgency, anatomical vulnerability at the coronary ostium or aortic root, and specific catheter configurations; notably, most events occurred at the hands of experienced operators, underscoring that skill does not eliminate this risk.

The practical value is risk awareness and early recognition. Understanding which anatomical configurations and procedural settings carry highest dissection risk allows catheterization teams to anticipate the complication and respond before propagation occurs. The finding that experienced operators are not immune reinforces the value of systematic vigilance over operator experience alone.

We rate the evidence moderate. A well-powered retrospective registry study providing clinically useful incidence and risk factor data for a serious, rare complication of invasive coronary procedures.