Cutting Balloons in Patients with Spontaneous Coronary Artery Dissection Presented with STElevation Myocardial Infarction; A Review Article

Abstract

Spontaneous coronary artery dissection (SCAD) is defined as non-iatrogenic and non-traumatic dissection of the coronary artery which can lead to hematoma formation affecting the blood flow. Conservative management is preferred over revascularization in patients with SCAD and preserved blood flow, however, revascularization is recommended in patients with ongoing ischemia, left main artery involvement, or impaired blood flow. Since conventional revascularization is associated with an increased risk of stent misplacement, thrombosis, and hematoma propagation, new techniques including cutting balloons (CB) have been offered. Cutting balloon makes fenestrations in the wall of the hematoma and leads to drainage of the hematoma. Our study includes 25 published cases of SCAD who presented with ST-elevation myocardial infarction and underwent CB revascularization. Isolated CB resulted in thrombolysis in myocardial infarction (TIMI) 3 blood flow restoration in 15 patients and TIMI 2 blood flow in one patient. Eight patients required further stenting due to ongoing ischemia after using CB. One patient underwent coronary artery bypass graft (CABG) due to cardiogenic shock. Hematoma expansion was reported in 2 cases. Except for one patient, all cases remained asymptomatic at follow-up.