Postpartum Multivessel Spontaneous Coronary Artery Dissection

A lesson from intravascular imaging: insights for recognizing a spontaneous coronary artery dissection

“…This typical sign is absent in >70% of SCAD and only intravascular imaging may help to verify arterial wall integrity (2,3); (II) however, IVUS could not clearly show a SCAD, mostly in a suspect case and operators with poor confidence with this technique in this particular setting, due to its spatial resolution (about 1/10 vs. OCT). Two interesting cases in which the two different endovascular imaging approaches were previously reported, thus comparing the differences in spatial resolution (12,13); (III) this is a rare case of multivessel SCAD in which the entire coronary tree is totally involved presenting with an inexplicable collateral circulation between two of three arteries. Although SCAD is usually an acute lesion, in our opinion the presence of collaterals in absence of clear signs of ongoing dissection (intimal flap/false lumen) could represent a previous dissection virtually "cronicized"; (IV) three-dimensional lumen view by OCT is an interesting tool in this setting for study the flap extension and behavior as well as contemporary acquisition of OCT/ angiography; (V) probably, a bioresorbable vascular scaffold could be an intriguing solution in this setting with a low atherosclerotic burst (14), anyway, in this case, a DES strategy was preferred because of ongoing symptoms during A B C D acute coronary syndrome, the wide-spread extension of the dissection and due to low experience on these "newer" devices in this setting; (VI) in the literature a similar case was described in 2015 showing how intracoronaric did not unrevealed the SCAD presence and only the guidewire positioning allowed the diagnosis of a wide-spread dissection involving LM, LAD with a large diagonal and intermediate branches (15).…”