Conservative Management of Iatrogenic Subclavian Artery Dissection During a Percutaneous Coronary Interventional Procedure Manejo conservador de una disección yatrogénica de la arteria subclavia durante un intervencionismo coronario

Iatrogenic dissection of the subclavian artery during cardiac catheterization is a subject that is seldom referred to in the literature, probably because of the low incidence and the possible existence of publication bias due to the fact that it concerns a complication. Our patient is a 75-year-old woman with hypercholesterolemia, hypertension, and a history of heart disease affecting the left main coronary artery and 3 coronary vessels. In 2002, she had undergone surgical treatment with triple bypass, from saphenous vein to obtuse marginal branch, saphenous vein to posterolateral branch of circumflex artery (left dominance), and left internal mammary artery to anterior descending artery. Asymptomatic from the cardiovascular point of view, she was admitted to the hospital in June 2010 due to prolonged angina at rest, with a high troponin level. She underwent coronary angiography via left radial artery, which revealed occlusion of proximal anterior descending, circumflex, and right coronary arteries, with patency of the grafts but severe lesion in the anastomosis between mammary coronary and anterior descending arteries. After consultation with the attending physician and the patient, the decision was made to perform a percutaneous interventional procedure in said lesion. The intervention was carried out via a left radial approach using a 6-Fr Judkins Right 4 guiding catheter. After balloon dilatation of the anastomotic stricture, during a follow-up injection we observed spiral dissection of the subclavian artery (Fig. 1A) that affected the origins of the vertebral artery and the thyrocervical trunk, with contrast retention under vacuum conditions (Fig. 1B). The patient reported mild pain in the left clavicular region, with no other symptoms. Angioplasty was completed by implantation of a