Spontaneous coronary artery dissection percutaneous coronary intervention
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Spontaneous Coronary Artery Dissection Microchapters |
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Differentiating Spontaneous coronary artery dissection from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Type 1 Type 2A Type 2B Type 3 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arzu Kalayci, M.D. [2] Nate Michalak, B.A.
Synonyms and keywords: SCAD
Overview
Conservative management should be first choice if emergent revascularization is not necessary. [1]
- However, optimal management is in question due to insufficient clinical experience.
- There are some treatment options including conservative management, emergency revascularization (PCI or CABG), fibrinolytic therapy, mechanical hemodynamic support, and even cardiac transplantation have been reported.
- Preference of the approach should be tailored to patient’s clinical status. [2] [3] [4] [5]
Intervention
Conservative management should be first choice if emergent revascularization is not necessary. [1]
- However, optimal management is in question due to insufficient clinical experience.
- There are some treatment options including conservative management, emergency revascularization (PCI or CABG), fibrinolytic therapy, mechanical hemodynamic support, and even cardiac transplantation have been reported.
- Preference of the approach should be tailored to patient’s clinical status. [2] [3] [4] [5]
Percutaneous Coronary Intervention
- Revascularization should be considered in case of acute myocardial infarction with symptoms or haemodynamic instability. [2]
- However, PCI is technically quite difficult with a high risk of complications.[6] [7]
- Therefore, conservative management is recommended in patients with non-occlusive luminal obstruction, TIMI grade 3 flow, and a stable clinical condition.
- Performing PCI in SCAD is technically very difficult due to the arterial fragility.
- It can be quite challenging to keep the guidewire within the true lumen while crossing the lesion.
- Any instruments using in each stage such as wiring, angioplasty or stenting can enlarge the dissection and block side branches.
- In addition, these lesions are mostly require long stents resulting in higher rates of in stent restenosis.
- Furthermore, resorption of the intramural hematoma may lead to late stent malapposition and stent thrombosis.
- Therefore, stent implantation should only be performed in a strong clinical indication.
- It would be beneficial to perform procedure under the guidance of intracoronary imaging (IVUS, OCT).
- Although there is no evidence about the benefits of bioabsorbable stents, theoretically it seems to have advantages.[8]
| Challenges and Suggestions With SCAD PCI | |
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| Challenges during PCI of SCAD | |
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| Suggestions if PCI is pursued for SCAD | |
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| DAPT= dual antiplatelet therapy; IMH= intramural hematoma; IVUS= intravascular ultrasound; PCI= percutaneous coronary intervention. [9] | |
References
- ↑ 1.0 1.1 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.
- ↑ 2.0 2.1 2.2 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.
- ↑ 3.0 3.1 Saw J, Aymong E, Mancini GB, Sedlak T, Starovoytov A, Ricci D (2014). dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24726091 "Nonatherosclerotic coronary artery disease in young women" Check
|url=value (help). Can J Cardiol. 30 (7): 814–9. doi:10.1016/j.cjca.2014.01.011. PMID 24726091. - ↑ 4.0 4.1 Alfonso F, Paulo M, Lennie V, Dutary J, Bernardo E, Jiménez-Quevedo P; et al. (2012). "Spontaneous coronary artery dissection: long-term follow-up of a large series of patients prospectively managed with a "conservative" therapeutic strategy". JACC Cardiovasc Interv. 5 (10): 1062–70. doi:10.1016/j.jcin.2012.06.014. PMID 23078737.
- ↑ 5.0 5.1 Higgins GL, Borofsky JS, Irish CB, Cochran TS, Strout TD (2013). "Spontaneous peripartum coronary artery dissection presentation and outcome". J Am Board Fam Med. 26 (1): 82–9. doi:10.3122/jabfm.2013.01.120019. PMID 23288285.
- ↑ 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.
- ↑ Vrints CJ (2010). "Spontaneous coronary artery dissection". Heart. 96 (10): 801–8. doi:10.1136/hrt.2008.162073. PMID 20448134.
- ↑ Vijayaraghavan R, Verma S, Gupta N, Saw J (2014). "Pregnancy-related spontaneous coronary artery dissection". Circulation. 130 (21): 1915–20. doi:10.1161/CIRCULATIONAHA.114.011422. PMID 25403597.
- ↑ 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.