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The role of intravascular ultrasound in the management of spontaneous coronary artery dissection.

ABSTRACT: Primary or spontaneous coronary artery dissection (SCAD) is an unusual but increasingly recognized cause of acute myocardial ischemia and sudden cardiac death. Typically, SCAD presents in younger patients without conventional risk factors for coronary artery disease. It occurs more commonly in women than in men, and frequently during pregnancy or the postpartum period. Its pathophysiology is poorly understood, and there is considerable controversy regarding the optimal management of patients with SCAD-related myocardial ischemia. Therapeutic approaches include conservative medical therapy, coronary artery bypass graft surgery and percutaneous coronary intervention (PCI). We present four cases of SCAD to illustrate specific aspects of the presentation and management of this condition, with particular reference to the importance of intravascular ultrasound (IVUS) to aid diagnosis and guide subsequent PCI.

SUBMITTER: Arnold JR

PROVIDER: S-EPMC2429898 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Percutaneous Coronary Intervention in Spontaneous Coronary Artery Dissection: Role of Intravascular Ultrasound.

Project description:Spontaneous coronary artery dissection (SCAD) is a rare, life-threatening condition that usually manifests as an acute myocardial infarction. Diagnosing SCAD with conventional coronary angiogram can be challenging, particularly if the true lumen is severely narrowed. Our case highlights the challenges in performing successful percutaneous coronary intervention (PCI) in patients with SCAD. Intravascular ultrasound can prove to be a pivotal tool in the diagnosis and successful management of such cases by establishing the anatomic site of dissection, and confirming stent placement in the true lumen following PCI.

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Spontaneous Coronary Artery Dissection: Mechanisms, Diagnosis and Management.

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Successful Percutaneous Coronary Intervention Using Intravascular Ultrasound-Guided Rewiring Technique in a Case of Spontaneous Coronary Artery Dissection Involving Left Main Bifurcation.

Project description:We herein describe a 49-year-old woman without significant cardiovascular risk factors who was transferred to our hospital with sudden onset of chest pain. The patient was diagnosed with non-ST-elevation acute myocardial infarction, and coronary angiography revealed a dissection at the proximal site of the left anterior descending artery (LAD) extending from the left main trunk (LMT) suggestive of spontaneous coronary artery dissection (SCAD). Because coronary flow was impaired after contrast injection and the patient had chest pain with ST elevation, urgent percutaneous coronary intervention was performed. The first guide wire was initially introduced from the LMT to the distal LAD, but intravascular ultrasound (IVUS) imaging revealed that the guide wire had passed through the true lumen of the left coronary artery ostium, false lumen at the ostium of the left circumflex artery, and true lumen of the distal LAD. We then reinserted another guide wire using an IVUS-guided rewiring technique from the true lumen of the LMT to the distal LAD. Finally, a drug-eluting stent was deployed to cover the dissected segment, and final coronary angiography revealed acceptable results with a patent left circumflex artery. This case report highlights that physicians should consider SCAD among the differential diagnoses in patients presenting with acute coronary syndrome, particularly in young women. In the present case, IVUS played a pivotal role in not only detecting the arterial dissection but also correctly introducing the guide wire into the true lumen.

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Project description: Not available

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