Disseção coronária espontânea – To stent or not to stent that is the question

Martins, José Luı́s; Silva, Joana; Paiva, Luís; Costa, Marco; Gonçalves, Lino

doi:10.1016/j.repc.2017.06.027

Cited by 3 publications

(4 citation statements)

References 18 publications

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“…To date, there are no established guidelines for the management of SCAD in the literature [ 1 ]. Management should be individualized depending upon clinical presentation and the concomitant angiographic findings and range from conservative medical management to emergent revascularization with PCI or CABG [ 11 ]. Revascularization is a feasible option in patients with unstable hemodynamics, arrhythmias such as ventricular tachycardia (VT) and/or fibrillation, recurrent or persistent chest pain indicative of ongoing ischemia, and left main CAD [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Management should be individualized depending upon clinical presentation and the concomitant angiographic findings and range from conservative medical management to emergent revascularization with PCI or CABG [ 11 ]. Revascularization is a feasible option in patients with unstable hemodynamics, arrhythmias such as ventricular tachycardia (VT) and/or fibrillation, recurrent or persistent chest pain indicative of ongoing ischemia, and left main CAD [ 11 ]. Recent observational studies suggested that medical management is recommended in stable SCAD patients as there have been reported high rates of angiographic healing of coronary dissection and favorable short-term outcomes [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Interventional Dilemma in a Young Woman With Spontaneous Coronary Artery Dissection Who Presented With High-Risk Non-ST-Elevation Myocardial Infarction (NSTEMI) Progressing to ST-Elevation Myocardial Infarction (STEMI)

Saleem¹,

Shah²,

Fox³

2022

Cureus

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Spontaneous coronary artery dissection (SCAD) is an infrequent presentation of acute myocardial infarction in young women and denotes the non-atherosclerotic separation of the coronary artery wall. Precipitating causes include fibromuscular dysplasia, postpartum hormonal changes, multiparity, connective tissue diseases like Marfan syndrome, autoimmune conditions, and hormonal therapy. It is often underdiagnosed due to a low index of suspicion based on age and gender bias as well as knowledge about different angiographic variants in SCAD. Intracoronary imaging with optical coherence tomography (OCT) or intravascular ultrasound (IVUS) is used for patients where coronary angiography fails to secure a diagnosis to increase the diagnostic yield. The mainstay of stable SCAD is conservative management. However, there are no definitive guidelines due to limited clinical experience. Treatment involving percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), fibrinolytic therapy, and mechanical hemodynamic support should be individualized depending upon clinical presentation, type, and extent of dissection, hemodynamic instability, critical anatomy involvement, and the extent of ischemic myocardium. We are presenting a case of a young female who presented with non-ST-elevation myocardial infarction (NSTEMI) that progressed to ST-elevation myocardial infarction (STEMI). A coronary angiogram showed a tortuous left anterior descending artery (LAD) with a distal 100% occlusion due to SCAD. PCI was attempted but the guidewire could not be navigated intraluminally past the occlusion. CABG was not pursued due to the distal location of the occlusion and lack of visualization of the distal vessel. Our case provides a useful learning opportunity for physicians who may come across similar clinical presentations. In patients with high-risk features of SCAD who are deemed inoperable, timely and appropriate medical management may be a useful alternative for PCI/CABG and the recurrence rates of SCAD are very low.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Interventional Dilemma in a Young Woman With Spontaneous Coronary Artery Dissection Who Presented With High-Risk Non-ST-Elevation Myocardial Infarction (NSTEMI) Progressing to ST-Elevation Myocardial Infarction (STEMI)

Saleem¹,

Shah²,

Fox³

2022

Cureus

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“…[1] The optimal treatment of SCAD is unclear and ranges from conservative therapy to emergency revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting. [9,10] Patients who present with acute myocardial infarction (AMI) and have either left main dissection or symptoms of continued ischemia or hemodynamic instability should be referred for emergent revascularization, as occurred in the patient presented. [10][11][12] In stable patients without the above mentioned features, long-term management with aspirin, beta blockers, and one year of dual antiplatelet therapy has been shown to lower the risk of recurrent SCAD (Figure 5).…”

Section: Discussionmentioning

confidence: 99%

“…[9,10] Patients who present with acute myocardial infarction (AMI) and have either left main dissection or symptoms of continued ischemia or hemodynamic instability should be referred for emergent revascularization, as occurred in the patient presented. [10][11][12] In stable patients without the above mentioned features, long-term management with aspirin, beta blockers, and one year of dual antiplatelet therapy has been shown to lower the risk of recurrent SCAD (Figure 5). [2] Prospective randomized studies are needed to further elucidate the optimal treatment modality in patients with SCAD, particularly those in the peripartum period.…”

Section: Discussionmentioning

confidence: 99%

Post-partum spontaneous coronary artery dissection refractory to conservative management

Etchill

Clarke

Giuliano

et al. 2020

gcsp

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This case report describes a 31-year-old female who was diagnosed with a spontaneous coronary artery dissection (SCAD) of her left anterior descending artery during the post-partum period. She failed nonoperative management and was found to have extensive propagation of the dissected vessel upon experiencing recurrent chest pain. She ultimately underwent coronary artery bypass grafting which restored perfusion and cardiac while motion. A brief discussion of the presentation, diagnosis, and management of SCAD follows.

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Spontaneous Coronary Artery Dissection: An Underdiagnosed Clinical Entity—A Primer for Cardiac Imagers

Aslam¹,

Stojanovska²,

Khokhar³

et al. 2021

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Disseção coronária espontânea – To stent or not to stent that is the question

Cited by 3 publications

References 18 publications

Interventional Dilemma in a Young Woman With Spontaneous Coronary Artery Dissection Who Presented With High-Risk Non-ST-Elevation Myocardial Infarction (NSTEMI) Progressing to ST-Elevation Myocardial Infarction (STEMI)

Interventional Dilemma in a Young Woman With Spontaneous Coronary Artery Dissection Who Presented With High-Risk Non-ST-Elevation Myocardial Infarction (NSTEMI) Progressing to ST-Elevation Myocardial Infarction (STEMI)

Post-partum spontaneous coronary artery dissection refractory to conservative management

Spontaneous Coronary Artery Dissection: An Underdiagnosed Clinical Entity—A Primer for Cardiac Imagers

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