Sağ Radial Yoldan Koroner Anjiografi İşlemi Sonrasında Gelişen Brakiosefalik Arterin Disseksiyonu ve Tedavisi
Özet
Bu çalışmada, göğüs ağrısı şikayetiyle başvuran ve sağ transradial yoldan elektif koroner anjiyografi (KAG) uygulanan 69 yaşında bir erkek hastada gelişen nadir bir iatrojenik brakiyosefalik arter diseksiyonu vakası sunulmaktadır. Hastanın yapılan anjiyografisinde çok damar hastalığı saptanarak koroner arter baypas greft cerrahisi (CABG) önerilmiştir. Ancak işlem sonrası serviste takibi sırasında sağ boyun bölgesinde ani şişlik ve ağrı gelişen hastaya çekilen kontrastlı boyun BT anjiyografisinde, trunkus brakiyosefalikus proksimalinden başlayıp sağ karotis boyunca uzanan diseksiyon, aktif kanama ve hematom tespit edilmiştir. Hasta acilen operasyona alınarak aorta-safen-RCA, aorta-safen CX-OM1 ve LIMA-LAD baypas işlemlerinin yanı sıra diseksiyon onarımı başarıyla gerçekleştirilmiştir. Ameliyat sonrası 24. saatte çekilen tomografide diseksiyon veya hematom izlenmeyen hasta, komplikasyonsuz olarak taburcu edilmiştir. Katetere veya kılavuz tele bağlı gelişen iatrojenik diseksiyonlar hayatı tehdit edici olup, kılavuzlanmış standart bir tedavi protokolü bulunmadığından vaka bazlı yönetim gerektirir. Bu tür katastrofik komplikasyonların önlenmesinde risk faktörlerinin tanınması, uygun kateter seçimi, koaksiyal hizalanma ve erken teşhis hayati önem taşımaktadır.
This study presents a rare case of iatrogenic brachiocephalic artery dissection in a 69-year-old male patient who underwent elective coronary angiography (CAG) via the right transradial approach due to chest pain. Angiography revealed multi-vessel disease, and coronary artery bypass graft surgery (CABG) was recommended. However, during follow-up, the patient developed sudden swelling and pain in the right neck area. Contrast-enhanced neck CT angiography urgently performed demonstrated a dissection extending from the proximal truncus brachiocephalicus to the right carotid bifurcation, accompanied by active bleeding and a hematoma within the carotid sheath. The patient was immediately operated on, successfully undergoing aorta-saphenous-RCA, aorta-saphenous CX-OM1, and LIMA-LAD bypass procedures along with surgical dissection repair. No residual dissection or hematoma was observed on the post-operative 24-hour CT scan, and the patient was discharged without any complications. Catheter or guidewire-induced iatrogenic dissections are life-threatening events that require case-based management since no standardized treatment guidelines exist. Recognizing risk factors, selecting appropriate catheters, ensuring coaxial alignment, and prompt diagnosis are crucial to preventing such catastrophic complications.
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