Journal of Invasive Cardiology

After the intracoronary dissection is stabilized, attention should be turned to evaluation of the extent of aortic dissection. This can be accomplished immediately in the cath lab with TEE. If initial evaluation demonstrates only localized dissection without flow into the false lumen, then serial evaluation with either TEE, CT or magnetic resonance imaging (MRI) seems most appropriate. However, if initial evaluation demonstrates extensive dissection, particularly if it propagates to an adjacent coronary ostium or into the great vessels or if it is associated with aortic insufficiency, then surgical repair should be considered.
In the reports reviewed, only Bae et al. make mention of their use of anticoagulants. They administered ticlid (Bristol-Myers Squibb/Sanofi Pharmaceuticals) and aspirin beginning 1 day post-PCI. In our case, because the dissection was not extensive and flow into the dissection was prevented by stenting, we chose not to reverse the anticoagulation and treated the patient with a standard regimen of Plavix and aspirin.