Spontaneous coronary artery dissection percutaneous coronary intervention
|
Spontaneous Coronary Artery Dissection Microchapters |
|
Differentiating Spontaneous coronary artery dissection from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Type 1 Type 2A Type 2B Type 3 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A.
Synonyms and keywords: SCAD
Overview
Percutaneous Coronary Intervention
PCI is indicated in the presence of ongoing myocardial ischemia or myocardial infarction.[1] Drug eluting stents (DES) are routinely used in the management of SCAD. However, their impact on long-term outcomes has not been assessed yet in clinical studies.
| Challenges and Suggestions With SCAD PCI | |
|---|---|
| Challenges during PCI of SCAD | |
| * Risk of iatrogenic catheter-induced dissection | |
| * Difficulty advancing coronary wire into distal true lumen | |
| * Propagating IMH anterograde and retrograde with angioplasty/ stenting, extending dissection and further compromising true lumen arterial flow | |
| * Dissection tends to extend into distal arteries, which are too small for stents | |
| * Often extensive dissected segments require long stents, increasing stent restenosis | |
| * Risk of stent malapposition after resorption of IMH, with risk of late stent thrombosis | |
| Suggestions if PCI is pursued for SCAD | |
| * Meticulous guide catheter manipulation, preferably through femoral access approach | |
| * OCT/IVUS guidance to ensure wire in true lumen (or over-the-wire catheter injections) and optimize stent apposition | |
| * Long stents covering 5 10 mm of proximal and distal edges of IMH | |
| * Placing short stents at proximal and distal edges first, before placing long stent in the middle | |
| * Consider bioabsorbable stents (temporary scaffold to avoid long- term malapposition) | |
| * Possible and careful use of cutting balloon (to fenestrate IMH) | |
| * Consider follow-up OCT to assess for malapposed/uncovered struts before stopping DAPT | |
| DAPT= dual antiplatelet therapy; IMH= intramural hematoma; IVUS= intravascular ultrasound; PCI= percutaneous coronary intervention. [2] | |
References
- ↑ Adlam D, Cuculi F, Lim C, Banning A (2010). "Management of spontaneous coronary artery dissection in the primary percutaneous coronary intervention era". The Journal of Invasive Cardiology. 22 (11): 549–53. PMID 21041853. Unknown parameter
|month=ignored (help) - ↑ Saw J, Mancini GBJ, Humphries KH (2016). "Contemporary Review on Spontaneous Coronary Artery Dissection". J Am Coll Cardiol. 68 (3): 297–312. doi:10.1016/j.jacc.2016.05.034. PMID 27417009.