0468: OCT management of iatrogenic coronary artery dissections

Iatrogenic coronary artery dissection is rare but severe complication of coronary angiography and angioplasty. It might lead to a definitive vessel occlusion with its short (myocardial infarction and arrhythmias) and long-term (heart failure) consequences. We hypothesized that OCT imaging could be helpful to manage this complication. we made an exhaustive analysis of iatrogenic coronary dissection appeared between January 2012 and December 2013 in Clermont-Ferrand University Hospital and leading to the modification of the initial procedure. Medical records were retrospectively reviewed with angiographic and endocoronary examination. We compared OCT and non-OCT management. 49 cases were recorded with 8 using OCT imaging. Most frequent causes were the stent (35%) and the approach catheter (35%). Most of the dissections were classified D. Every patient treated with OCT imaging had a severe dissection (D, E or F type) and in particular when the operator had not the certitude of positioning the guide wire in the true lumen. Stent implantation was the most used therapy (72%). All patients treated with OCT benefited of a successful stent implantation, without lesion aggravation after highpressured contrast injection. Results are similar in both groups despite more severe dissections and more complex procedures in OCT group. OCT imaging seems to be a secure and reliable technique for endovascular treatment when it comes to management of iatrogenic dissections.