Catheter-Induced Iatrogenic Coronary Artery Dissection in Patients With Spontaneous Coronary Artery Dissection

Prakash, Roshan; Starovoytov, Andrew; Heydari, Milad; Mancini, G.B. John; Saw, Jacqueline

doi:10.1016/j.jcin.2016.06.026

Cited by 137 publications

(90 citation statements)

References 4 publications

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“…Iatrogenic catheter-induced coronary artery dissection is reported to be increased in patients with SCAD; the reported overall prevalence is 3.4%, 139,140 whereas it is <0.2% for standard coronary angiography. 139,140 Underlying arterial fragility in patients with SCAD is believed to accentuate the risks for iatrogenic dissection.…”

Section: Diagnosismentioning

confidence: 99%

“…Despite the importance of intracoronary imaging for the diagnosis of SCAD, these tools have potential risks, including extending the coronary dissection with wire or imaging catheter, guide-catheter iatrogenic dissection, 139 catheter-induced occlusion of true lumen, and hydraulic extension with contrast injection for optical coherence tomography. With weighing of the risks and benefits, intracoronary imaging should be pursued only when coronary angiographic diagnosis is uncertain (eg, type 3 or unclear lesions) and when the vessel diameter is large enough for intracoronary imaging.…”

Section: Diagnosismentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Hayes¹,

Kim²,

Saw³

et al. 2018

Circulation

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937

1,344

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Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented.

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Hayes¹,

Kim²,

Saw³

et al. 2018

Circulation

Self Cite

937

1,344

View full text Add to dashboard Cite

show abstract

“…Where CT may have utility is to non-invasively confirm coronary healing in conservatively managed cases,47 especially given reports of iatrogenic dissections occurring during follow-up angiography 72…”

Section: Introductionmentioning

confidence: 99%

Spontaneous coronary artery dissection

Vrints

2017

Heart

190

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Learning objectives:• To recognise spontaneous coronary artery dissection as a cause of myocardial infarction in low risk, predominantly female, patients • To understand that although spontaneous coronary artery dissection is an important cause of peripartum myocardial infarction, ~90% of incident cases are not pregnant • To be aware that a visible dissection flap at angiography is absent in the majority of cases • To understand the rationale for an 'as conservative as possible' approach to revascularisation and key challenges in medical treatment

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“…Firstly, in most cases a predisposing pathology of arterial wall tissues is present and can favor a iatrogenic coronary dissection during intracoronary devices maneuvering; in a recent report a 3.4% rate of catheter-induced dissection was observed in patients with SCAD who underwent coronary angiography [66].…”

Section: Percutaneous Coronary Interventionmentioning

confidence: 99%

“…In the last years, several strategies and tricks have been proposed to reduce PCI complications and improve long-term results ( Table 1); for example, unlike general ACS recommendations, the femoral access should be preferred, even though associated with an increased bleeding risk, because the rate of radial access site failure is significantly higher in patients with SCAD [42,66]. In order to avoid IMH extension and eventual stent malapposition, many authors suggest to carefully assess the length of dissected segment and the true caliber of the vessel with intravascular imaging support (OCT or IVUS) [67].…”

Section: Percutaneous Coronary Interventionmentioning

confidence: 99%

How to Approach a Spontaneous Coronary Artery Dissection: An Up-To-Date

Pepe¹,

Cecere²,

Napodano³

et al. 2017

Interv Cardiol J

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AbstarctSpontaneous coronary artery dissection (SCAD) is a separation of the coronary wall layers, not related to trauma, medical procedures or atherosclerosis. The dissection causes the blood entry in the vascular wall with the consequent formation of a false lumen and intramural hematoma (IMH). Two pathogenetic mechanisms have been proposed to explain SCAD: a "primary" rupture of coronary endothelium or the rupture of the "vasa vasorum". Clinical presentation and severity of manifestations are variable, ranging from complete absence of symptoms to acute coronary syndrome (ACS), cardiogenic shock, cardiac arrest or sudden cardiac death. Despite coronary angiography is the first-line examination, by supplying two-dimensional images of the lumen, it does not always allow an incontrovertible diagnosis of SCAD. New intravascular imaging techniques, such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS), have been recently introduced and may be extremely helpful in assessing the coronary wall integrity, thus improving coronary angiography diagnostic accuracy.Because of the lack of large randomized trials comparing different strategies, the optimal treatment of SCAD is still controversial. The first-line approach is conservative and based on medical therapy. Nevertheless, in particular situations an invasive approach is necessary. In the last years, several new strategies have improved the way to perform percutaneous coronary interventions (PCI), such as new generation drug eluting stents (DES), bio-resorbable scaffolds (BRS), sirolimus self-expandable stent (SES), drug eluting balloons (DEB), and cutting balloon. Cardiac artery bypass graft (CABG) is an even more invasive method to restore coronary flow and should be considered in urgent/emergent settings when PCI is not feasible or has failed.Cause the therapeutic approach of SCAD can be substantially different from that of atherosclerotic coronary artery disease, an accurate diagnosis is crucial to set up the best treatment strategy.

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Catheter-Induced Iatrogenic Coronary Artery Dissection in Patients With Spontaneous Coronary Artery Dissection

Cited by 137 publications

References 4 publications

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Spontaneous coronary artery dissection

How to Approach a Spontaneous Coronary Artery Dissection: An Up-To-Date

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