How is a coronary dissection managed during catheterization?

How is a coronary dissection managed during catheterization?

• A. Immediate thrombolysis with alteplase
• B. Prolonged balloon inflation or deployment of a stent; reversal of anticoagulation as needed; stop if required
• C. Observation only
• D. Increase anticoagulation without intervention

Answer: (B)

When a coronary dissection occurs during catheterization, the priority is to restore and maintain true-lumen flow by physically sealing the dissection. The most effective approach is mechanical: use prolonged balloon inflation to compress and seal the flap, or deploy a stent to cover the entry tear and re-establish a continuous true lumen. If needed, reverse anticoagulation (for example, with protamine after heparin) to reduce ongoing bleeding into the vessel wall and hematoma, and stop antithrombotic therapy as appropriate. This direct, mechanical correction addresses the advancing dissection and preserves myocardial perfusion, whereas simply escalating anticoagulation or using thrombolysis would worsen the dissection and bleeding and is not indicated in this scenario.

When a coronary dissection occurs during catheterization, the priority is to restore and maintain true-lumen flow by physically sealing the dissection. The most effective approach is mechanical: use prolonged balloon inflation to compress and seal the flap, or deploy a stent to cover the entry tear and re-establish a continuous true lumen. If needed, reverse anticoagulation (for example, with protamine after heparin) to reduce ongoing bleeding into the vessel wall and hematoma, and stop antithrombotic therapy as appropriate. This direct, mechanical correction addresses the advancing dissection and preserves myocardial perfusion, whereas simply escalating anticoagulation or using thrombolysis would worsen the dissection and bleeding and is not indicated in this scenario.