Background:Guide catheter-induced iatrogenic coronary artery dissection is a rare but feared complication. When it occurs, bailout stenting is widely performed; however, its prognosis and the impact of stent type remains unclear.

Methods and Results:The study population consisted of 77,257 consecutive patients (coronary angiography, 55,864; percutaneous coronary intervention, 21,393) between 2000 and 2015. We investigated the incidence, clinical outcomes, and angiographic results after bailout stenting and compared by stent type: bare-metal stent (BMS) and drug-eluting stent (DES). Iatrogenic coronary artery dissection occurred in 105 patients (incidence rate, 0.14%). All cases of iatrogenic coronary artery dissection that were recognized as requiring bailout procedure could be managed by stent implantation, and no patients died during bailout procedure. The 5-year cumulative incidences of cardiac death, target lesion revascularization, and major adverse cardiac events were 11.3%, 10.3%, and 21.0%, respectively. The binary restenosis rate was 10.4%, and it was not significantly different between BMS and DES implantation. In lesions with preprocedural stenosis, however, it was significantly lower in the DES group than in the BMS group. On the other hand, coronary artery dissection recurred in 8 patients, which was observed only after DES implantation.

Conclusions:The immediate and long-term outcomes of bailout stenting for iatrogenic coronary artery dissection were acceptable. Although DES may be favorable for stenotic lesions, coronary artery dissection can recur after DES implantation.

背景：导管导引的医源性冠状动脉夹层术是一种罕见但令人担忧的并发症。当发生这种情况时，可以广泛使用紧急救援支架。然而，其预后和支架类型的影响尚不清楚。

方法和结果：研究人群包括2000年至2015年之间的77257例连续患者（冠状动脉造影55,864例；经皮冠状动脉介入治疗21,393例）。我们调查了救助支架置入后的发生率，临床结局和血管造影结果，并按支架类型进行了比较： BMS）和药物洗脱支架（DES）。105例患者发生医源性冠状动脉夹层（发生率0.14％）。所有被确认需要进行救助程序的医源性冠状动脉夹层病例都可以通过支架植入进行治疗，并且没有患者在救助程序期间死亡。心脏死亡，靶病变血运重建和严重不良心脏事件的5年累积发生率分别为11.3％，10.3％和21.0％。二元再狭窄率为10.4％，BMS和DES植入之间没有显着差异。然而，在具有术前狭窄的病变中，DES组明显低于BMS组。另一方面，8例患者复发了冠状动脉夹层，仅在DES植入后才观察到。

结论：医源性冠状动脉夹层的紧急救援支架的近期和长期结果是可以接受的。尽管DES可能对狭窄病变有利，但DES植入后可再次发生冠状动脉夹层。