Dunning type III aortocoronary dissection after percutaneous coronary intervention for chronic total occlusion. A case report

Vallejos-Barrientos A.; Centeno-Araujo A.; Davila-Flores D.; Rodríguez-Urtega Z. · Archivos Peruanos de Cardiologia y Cirugia Cardiovascular (2026) · DOI: 10.47487/apcyccv.v7i1.563

Resumen

Iatrogenic aorto-coronary dissection is an intimal tear that creates a false lumen and may propagate into the aorta. We report the case of a 68-year-old woman with a history of hypertension, obesity, a previous unrevascularised inferior transmural myocardial infarction, and limiting angina. Myocardial perfusion imaging demonstrated 15% ischaemia of the inferior wall, and coronary angiography revealed a chronic total occlusion of the right coronary artery with heterocoronary collateral circulation. The patient underwent percutaneous coronary intervention with implantation of three drug-eluting stents. A dissection flap originating in the right coronary sinus with extension into the aortic root was observed; contrast-enhanced computed tomography confirmed dissection of the ascending aorta with extension to the aortic arch and the brachiocephalic trunk. Medical therapy (beta-blockers, nitrates, and analgesia) was initiated, and surgery was deferred with close clinical and imaging surveillance. The clinical course was favourable, with a stable intramural haematoma of the ascending aorta and complete resorption at 7 months of follow-up.