Background: Type A aortic dissection (TAAD) involves a tear in the
intimal layer of the thoracic aorta proximal to the left subclavian
artery, and hence, carries a high risk of mortality and morbidity and
requires urgent intervention. This dissection can extend into the main
coronary arteries. Coronary artery involvement in TAAD can either be due
to retrograde extension of the dissection flap into the coronaries or
compression and/or blockage of these vessels by the dissection flap,
possibly causing myocardial ischaemia. Due to the emergent nature of
TAAD, coronary involvement is often missed during diagnosis, thereby
delaying the required intervention. Aims: The main scope of this review
is to summarise the literature on the incidence, mechanism, diagnosis,
and treatment of coronary artery involvement in TAAD. Methods: A
comprehensive literature search was performed using multiple electronic
databases, including PubMed, Ovid, Scopus and Embase, to identify and
extract relevant studies. Results: Incidence of coronary artery
involvement in TAAD was seldom reported in the literature, however, some
studies have described patients diagnosed either preoperatively,
intraoperatively following aortic clamping, or even during autopsy.
Among the few studies that reported on this matter, the treatment choice
for coronary involvement in TAAD was varied, with the majority
revascularizing the coronary arteries using coronary artery bypass
grafting or direct local repair of the vessels. It is well-established
that coronary artery involvement in TAAD adds to the already high
mortality and morbidity associated with this disease. Lastly, the right
main coronary artery was often more implicated than the left.
Conclusion: This review reiterates the significance of an accurate
diagnosis and timely and effective interventions to improve prognosis.
Finally, further large cohort studies and longer trials are needed to
reach a definitive consensus on the best approach for coronary
involvement in TAAD.