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Catheter-induced coronary artery dissection (CICAD) is a rare but very serious complication of invasive diagnostics and percutaneous treatment of coronary artery disease. The incidence of CICAD is < 0.1% [1]. CICAD is usually treated with stent deployment, less often conservatively and only a small percentage of patients require surgical intervention [1, 2]. In this article, we present the case of a patient with CICAD who, after initial conservative therapy, underwent intravascular ultrasound-guided percutaneous coronary intervention (IVUS-guided PCI).

Iatrogenic aortic dissection (IAD) is a rare complication of catheter-based coronary procedures. It occurs with a frequency of 0.006% during coronary angiography and 0.098% during interventional procedures [1]. It more often concerns the right coronary artery (RCA) and patients with acute coronary syndrome. In 2000, Dunning et al. divided IAD into 3 types [2]. Class 1 was limited to the aortic sinus, class 2 involved less than 4 cm of the ascending aorta and class 3, the most dangerous, exceeded 4 cm in length. Therapeutic recommendations for IAD are still scarce, but recent reports suggest that even class 3 IAD can be treated conservatively or by placing a stent [1, 3]. We would like to present a case of iatrogenic aortic dissection (Dunning class 3) as a complication of RCA angioplasty.