Acute Abdominal Aortic Dissection during Invasive Coronary Assessment in a Patient with Glucose-6-Phosphate Dehydrogenase Deficiency

Case Report

Austin Cardio & Cardiovasc Case Rep. 2022; 7(1): 1047.

Acute Abdominal Aortic Dissection during Invasive Coronary Assessment in a Patient with Glucose-6-Phosphate Dehydrogenase Deficiency

Mehrpooya M¹*, Ghasemi M¹, Gerayeli B¹, Sherafati A² and Dashti S³

¹Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran

²Department of Cardiovascular Medicine, Mayo Clinic, USA

³Department of Pharmacy, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran

*Corresponding author: Maryam Mehrpooya, Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tohid Square, Tehran, Iran

Received: July 30, 2022; Accepted: August 29, 2022; Published: September 05, 2022

Abstract

Background: Glucose-6-Phosphate Dehydrogenase (G6PD) is an X-linked recessive disorder. Acute hemolytic anemia can occur in these patients if they are exposed to certain foods or drugs. Iatrogenic Isolated Acute Abdominal Aortic Dissection (IAAAD) is an uncommon complication during diagnostic or interventional coronary procedures. Endovascular intervention for abdominal aortic dissection is mandatory in some patients.

Case Summary: A 58-years-old man with a history of G6PD deficiency underwent primary percutaneous coronary intervention for the right coronary artery. He was discharged with aspirin 80 milligrams daily as well as clopidogrel. The patient stopped taking aspirin immediately after discharge. He was admitted again for an invasive physiologic study of the left anterior descending artery. Due to the risk of stent thrombosis, we reinitiated aspirin. During his scheduled intervention, iatrogenic AAAD happened. Endovascular intervention was performed, and a self-expandable stent was implanted successfully at the site of dissection. Regarding some laboratory evidence of hemolysis with aspirin, the drug was discontinued on the tenth day after the procedure, and he was discharged in good general condition.

Discussion: Hemolytic anemia can occur with a low dose of aspirin in patients with G6PD deficiency. Endovascular intervention is a practical therapeutic approach to iatrogenic IAAAD.

Keywords: Abdominal aortic dissection; G6PD deficiency; IAAAD; Endovascular intervention

History of Presentation

A 58-years-old man was admitted due to acute inferior STSegment Elevation Myocardial Infarction (STEMI). He underwent primary Percutaneous Coronary Intervention (PCI) for the Right Coronary Artery (RCA) He had a history of Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency. He was discharged on the fourth day after the index event with aspirin 80 mg daily as well as clopidogrel 75 mg daily. Regarding multiple moderate coronary lesions in the Left Anterior Descending artery (LAD), he was scheduled for an invasive physiologic study of LAD. He presented for his scheduled procedure after a month. He stated that he had stopped taking aspirin after his discharge from the hospital due to fear of G6PD crisis but had continued clopidogrel.

Past Medical History

His past medical history was significant for G6PD deficiency, type 2 diabetes mellitus and hypertension.

Differential Diagnosis

Due to the discontinuation of aspirin, there was a concern about sub acute stent thrombosis.

Investigations

He was hospitalized and after consultation with clinical pharmacologists and an extensive literature review, aspirin appeared to be safe in low doses. Therefore, aspirin was reinitiated for him with a dose of 80 mg daily. Coronary angiogram showed a patent stent in the RCA. For the physiologic study of LAD, an instantaneous wave-free ratio (iFR ) wire was passed through the LAD. However, as soon as the wire crossed the LAD, the patient complained of severe back pain. He had a stable heart rhythm and hemodynamics. There was no sign of dissection or occlusion in the LAD, so the iFR wire was removed. We performed an aortic injection immediately. There was no sign of dissection in aortic root, but a 10-mmdissection was evident in the abdominal aorta before the aortic bifurcation (Figure 1, Video 1, Video 2). Due to the stable hemodynamics, we terminated the procedure. Aortic dissection was confirmed by CT angiography with a calculated size of 10 mm (Figure 2).