Abstract
Iatrogenic type A aortic dissection (IAAD) is a rare but life-threatening complication of percutaneous coronary intervention (PCI), often presenting significant therapeutic challenges. A looped guidewire between the right subclavian artery and brachiocephalic artery during coronary angiography (CAG) via right radial artery access can complicate catheter manipulation. This report discusses the case of a 58-year-old hypertensive female patient who developed aortic dissection during PCI, specifically due to wire manipulation at the brachiocephalic loop. The dissection extended retrogradely into the ascending aorta. Despite the severity, the patient remained hemodynamically stable and free from myocardial ischemia. Given her stability, conservative management focusing on blood pressure control was chosen. Serial CT imaging confirmed stabilization of the dissection. The patient underwent successful PCI via the femoral approach at a later date and was discharged the following day. This case underscores the potential for conservative management in select IAAD cases, emphasizing individualized treatment strategies.