Catheter-induced coronary dissection is a tear in the coronary intima caused by catheter manipulation. What is the typical management?

• A. Tear in the intima managed with conservative medical therapy only.
• B. Tear in the intima; manage with prompt anticoagulation adjustment, balloon sealing, and often stent placement if needed.
• C. Full-thickness rupture requiring immediate surgery.
• D. Spontaneous resolution with observation.

Answer: (B)

Catheter-induced coronary dissection occurs when the catheter injures the vessel wall, creating a tear in the intima. The priority is to restore and preserve blood flow by sealing the dissection and preventing its propagation. The typical approach starts with adjusting anticoagulation promptly—often reversing heparin—to minimize further bleeding into the vessel wall. Then a balloon is used to seal the dissection by apposing the flap to the wall and re-expanding the true lumen. If the dissection still compromises flow or cannot be sealed with ballooning alone, placing a stent to cover the tear and stabilize the vessel is often necessary. Surgery is reserved for catastrophic situations such as a full-thickness rupture with ongoing instability. Observation alone isn’t appropriate because the dissection can extend and lead to myocardial ischemia.