Percutaneous coronary intervention strategy for acute coronary syndrome caused by spontaneous coronary artery dissection for relieving ongoing ischemia—Case series and literature review

Coronary angioplasty in spontaneous coronary artery dissection—Strategy and outcomes

“…In one of our cases balloon dilatation resulted in optimal flow and we chose defer stenting owing to the small size of the vessel (Obtuse marginal). Yamanaga et al suggest the novel concept of providing diastolic augmentation of coronary blood flow after balloon dilatation to preserve the patency of the true lumen 15 . In guide catheter induced iatrogenic dissections, where there is an unequivocal single proximal propagation point of the dissection, reports suggest that it is possible to seal the dissection entry point with a single stent meticulously placed in the aorto ostial location 16 , 17 …”

Editorial: Spontaneous coronary artery dissection: Left-off clinical phenotype in acute coronary syndrome

“…In this issue of the Journal, Yamanaga et al reported three SCAD cases with ongoing ischemia who were treated with different therapeutic strategies: plain-old balloon angioplasty (POBA), stent implantation, or medical therapy [10] . As they mentioned in the report, PCI is feasible in cases with evident ischemia and diseased vessels suitable for PCI.…”

“…As they mentioned in the report, PCI is feasible in cases with evident ischemia and diseased vessels suitable for PCI. Tips of PCI techniques in SCAD cases described in their paper are helpful for interventionists [10] . In the procedure of PCI, it is important to cross the guide wire in the true lumen and to cover the entry point of dissection completely.…”

“…In the intramural hematoma cases, POBA and stent should be avoided if antegrade coronary flow is preserved, for fear of hematoma shift. When false lumen compresses the true lumen and disturbs coronary flow, POBA using long length balloon, as the authors chose, is appropriate [10] . PCI procedure for SCAD is difficult compared to the usual ACS cases due to atherosclerosis, and the success rate was only 65% according to previous literature [3] .…”

“…Recurrence rate of SCAD is estimated as 10–30% 3 , 7 ; therefore, careful monitoring is necessary. In cases with suspected vasospasm, it appears to be important to administer nitrate or calcium channel blocker to prevent recurrence of SCAD as Yamanaga et al [10] described.…”