Spontaneous coronary artery dissection surgery: Difference between revisions

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==Surgery ==
==Surgery ==


Emergent CABG should be considered for patients with left main dissections, extensive dissections involving proximal arteries, or in patients in whom PCI failed or who are not anatomically suitable for PCI. Although many of this operations have been performed in case of emergency, good early outcomes following CABG have been reported in small observational studies.<ref name="pmid25294399">{{cite journal| author=Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D et al.| title=Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 5 | pages= 645-55 | pmid=25294399 | doi=10.1161/CIRCINTERVENTIONS.114.001760 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25294399  }} </ref> <ref name="pmid25406203">{{cite journal| author=Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS et al.| title=Spontaneous coronary artery dissection: revascularization versus conservative therapy. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 6 | pages= 777-86 | pmid=25406203 | doi=10.1161/CIRCINTERVENTIONS.114.001659 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25406203  }} </ref> <ref name="pmid25937347">{{cite journal| author=Lettieri C, Zavalloni D, Rossini R, Morici N, Ettori F, Leonzi O et al.| title=Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection. | journal=Am J Cardiol | year= 2015 | volume= 116 | issue= 1 | pages= 66-73 | pmid=25937347 | doi=10.1016/j.amjcard.2015.03.039 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25937347  }} </ref> Early graft failure was reported as 6% in a 20 patients series. <ref name="pmid25406203">{{cite journal| author=Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS et al.| title=Spontaneous coronary artery dissection: revascularization versus conservative therapy. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 6 | pages= 777-86 | pmid=25406203 | doi=10.1161/CIRCINTERVENTIONS.114.001659 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25406203  }} </ref> <ref name="pmid25937347">{{cite journal| author=Lettieri C, Zavalloni D, Rossini R, Morici N, Ettori F, Leonzi O et al.| title=Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection. | journal=Am J Cardiol | year= 2015 | volume= 116 | issue= 1 | pages= 66-73 | pmid=25937347 | doi=10.1016/j.amjcard.2015.03.039 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25937347  }} </ref> However long term results of CABG showed lower graft patency (27%) in a small series which is because of spontaneous arterial healing lead to competitive flow and graft thrombosis. <ref name="pmid22800851">{{cite journal| author=Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ et al.| title=Clinical features, management, and prognosis of spontaneous coronary artery dissection. | journal=Circulation | year= 2012 | volume= 126 | issue= 5 | pages= 579-88 | pmid=22800851 | doi=10.1161/CIRCULATIONAHA.112.105718 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22800851  }} </ref>
*Emergent [[CABG]] should be considered for patients with [[left main dissections]], [[extensive dissections]] involving [[proximal arteries]], or in patients in whom [[PCI]] failed or who are not anatomically suitable for [[PCI]].  
*Although many of this operations have been performed in case of emergency, good early outcomes following [[CABG]] have been reported in small observational studies.<ref name="pmid25294399">{{cite journal| author=Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D et al.| title=Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 5 | pages= 645-55 | pmid=25294399 | doi=10.1161/CIRCINTERVENTIONS.114.001760 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25294399  }} </ref> <ref name="pmid25406203">{{cite journal| author=Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS et al.| title=Spontaneous coronary artery dissection: revascularization versus conservative therapy. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 6 | pages= 777-86 | pmid=25406203 | doi=10.1161/CIRCINTERVENTIONS.114.001659 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25406203  }} </ref> <ref name="pmid25937347">{{cite journal| author=Lettieri C, Zavalloni D, Rossini R, Morici N, Ettori F, Leonzi O et al.| title=Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection. | journal=Am J Cardiol | year= 2015 | volume= 116 | issue= 1 | pages= 66-73 | pmid=25937347 | doi=10.1016/j.amjcard.2015.03.039 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25937347  }} </ref> Early graft failure was reported as 6% in a 20 patients series. <ref name="pmid25406203">{{cite journal| author=Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS et al.| title=Spontaneous coronary artery dissection: revascularization versus conservative therapy. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 6 | pages= 777-86 | pmid=25406203 | doi=10.1161/CIRCINTERVENTIONS.114.001659 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25406203  }} </ref> <ref name="pmid25937347">{{cite journal| author=Lettieri C, Zavalloni D, Rossini R, Morici N, Ettori F, Leonzi O et al.| title=Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection. | journal=Am J Cardiol | year= 2015 | volume= 116 | issue= 1 | pages= 66-73 | pmid=25937347 | doi=10.1016/j.amjcard.2015.03.039 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25937347  }} </ref> However long term results of CABG showed lower graft patency (27%) in a small series which is because of spontaneous arterial healing lead to competitive flow and graft thrombosis. <ref name="pmid22800851">{{cite journal| author=Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ et al.| title=Clinical features, management, and prognosis of spontaneous coronary artery dissection. | journal=Circulation | year= 2012 | volume= 126 | issue= 5 | pages= 579-88 | pmid=22800851 | doi=10.1161/CIRCULATIONAHA.112.105718 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22800851  }} </ref>




Indications for surgical revascularization ([[CABG]])<ref name="pmid20440039">{{cite journal |author=Shamloo BK, Chintala RS, Nasur A, ''et al.'' |title=Spontaneous coronary artery dissection: aggressive vs. conservative therapy |journal=[[The Journal of Invasive Cardiology]] |volume=22 |issue=5 |pages=222–8 |year=2010 |pmid=20440039 |doi= |url=}}</ref> include:
*Indications for [[surgical revascularization]] include: ([[CABG]])<ref name="pmid20440039">{{cite journal |author=Shamloo BK, Chintala RS, Nasur A, ''et al.'' |title=Spontaneous coronary artery dissection: aggressive vs. conservative therapy |journal=[[The Journal of Invasive Cardiology]] |volume=22 |issue=5 |pages=222–8 |year=2010 |pmid=20440039 |doi= |url=}}</ref> include:
* Multivessel involvement
* [[Multivessel]] involvement
* [[Left main coronary artery]] involvement
* [[Left main coronary artery]] involvement
* Progression/worsening of dissection so long as there is a distal target
* Progression/worsening of [[dissection]] so long as there is a distal target
* Significant narrowing of the arterial lumen
* Significant narrowing of the [[arterial]] lumen
* Refractory or recurrent [[myocardial ischemia]]
* Refractory or recurrent [[myocardial ischemia]]


Revision as of 06:16, 3 March 2021

Spontaneous Coronary Artery Dissection Microchapters

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Differentiating Spontaneous coronary artery dissection from other Diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A. Arzu Kalayci, M.D. [2]

Synonyms and keywords: SCAD

Overview

Coronary artery bypass graft (CABG) is an important reperfusion therapy in selected group of SCAD patients and also a rescue strategy in the management of failed PCI.

Surgery

  • Emergent CABG should be considered for patients with left main dissections, extensive dissections involving proximal arteries, or in patients in whom PCI failed or who are not anatomically suitable for PCI.
  • Although many of this operations have been performed in case of emergency, good early outcomes following CABG have been reported in small observational studies.[1] [2] [3] Early graft failure was reported as 6% in a 20 patients series. [2] [3] However long term results of CABG showed lower graft patency (27%) in a small series which is because of spontaneous arterial healing lead to competitive flow and graft thrombosis. [4]


In the event of severe refractory heart failure, heart transplantation may be considered.

References

  1. ↑ Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D; et al. (2014). "Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes". Circ Cardiovasc Interv. 7 (5): 645–55. doi:10.1161/CIRCINTERVENTIONS.114.001760. PMID 25294399.
  2. ↑ 2.0 2.1 Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS; et al. (2014). "Spontaneous coronary artery dissection: revascularization versus conservative therapy". Circ Cardiovasc Interv. 7 (6): 777–86. doi:10.1161/CIRCINTERVENTIONS.114.001659. PMID 25406203.
  3. ↑ 3.0 3.1 Lettieri C, Zavalloni D, Rossini R, Morici N, Ettori F, Leonzi O; et al. (2015). "Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection". Am J Cardiol. 116 (1): 66–73. doi:10.1016/j.amjcard.2015.03.039. PMID 25937347.
  4. ↑ Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ; et al. (2012). "Clinical features, management, and prognosis of spontaneous coronary artery dissection". Circulation. 126 (5): 579–88. doi:10.1161/CIRCULATIONAHA.112.105718. PMID 22800851.
  5. ↑ Shamloo BK, Chintala RS, Nasur A; et al. (2010). "Spontaneous coronary artery dissection: aggressive vs. conservative therapy". The Journal of Invasive Cardiology. 22 (5): 222–8. PMID 20440039.
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