Spontaneous coronary artery dissection percutaneous coronary intervention: Difference between revisions
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==Overview== | ==Overview== | ||
Conservative management should be first choice if emergent [[revascularization]] is not necessary. <ref name="pmid25406203">{{cite journal| author=Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS et al.| title=Spontaneous coronary artery dissection: revascularization versus conservative therapy. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 6 | pages= 777-86 | pmid=25406203 | doi=10.1161/CIRCINTERVENTIONS.114.001659 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25406203 }} </ref> | |||
*However, optimal [[management]] is in question due to insufficient [[clinical]] experience. | |||
* There are some treatment options including conservative management, emergency revascularization ([[PCI]] or [[CABG]]), [[fibrinolytic]] therapy, [[mechanical hemodynamic support]], and even [[cardiac transplantation]] have been reported. | |||
* Preference of the approach should be tailored to patient’s clinical status. <ref name="pmid25294399">{{cite journal| author=Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D et al.| title=Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 5 | pages= 645-55 | pmid=25294399 | doi=10.1161/CIRCINTERVENTIONS.114.001760 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25294399 }} </ref> <ref name="pmid24726091">{{cite journal| author=Saw J, Aymong E, Mancini GB, Sedlak T, Starovoytov A, Ricci D| title=Nonatherosclerotic coronary artery disease in young women. | journal=Can J Cardiol | year= 2014 | volume= 30 | issue= 7 | pages= 814-9 | pmid=24726091 | doi=10.1016/j.cjca.2014.01.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24726091 }} </ref> <ref name="pmid23078737">{{cite journal| author=Alfonso F, Paulo M, Lennie V, Dutary J, Bernardo E, Jiménez-Quevedo P et al.| title=Spontaneous coronary artery dissection: long-term follow-up of a large series of patients prospectively managed with a "conservative" therapeutic strategy. | journal=JACC Cardiovasc Interv | year= 2012 | volume= 5 | issue= 10 | pages= 1062-70 | pmid=23078737 | doi=10.1016/j.jcin.2012.06.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23078737 }} </ref> <ref name="pmid23288285">{{cite journal| author=Higgins GL, Borofsky JS, Irish CB, Cochran TS, Strout TD| title=Spontaneous peripartum coronary artery dissection presentation and outcome. | journal=J Am Board Fam Med | year= 2013 | volume= 26 | issue= 1 | pages= 82-9 | pmid=23288285 | doi=10.3122/jabfm.2013.01.120019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23288285 }} </ref> | |||
==Intervention== | |||
Conservative management should be first choice if emergent [[revascularization]] is not necessary. <ref name="pmid25406203">{{cite journal| author=Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS et al.| title=Spontaneous coronary artery dissection: revascularization versus conservative therapy. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 6 | pages= 777-86 | pmid=25406203 | doi=10.1161/CIRCINTERVENTIONS.114.001659 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25406203 }} </ref> | Conservative management should be first choice if emergent [[revascularization]] is not necessary. <ref name="pmid25406203">{{cite journal| author=Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS et al.| title=Spontaneous coronary artery dissection: revascularization versus conservative therapy. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 6 | pages= 777-86 | pmid=25406203 | doi=10.1161/CIRCINTERVENTIONS.114.001659 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25406203 }} </ref> | ||
*However, optimal [[management]] is in question due to insufficient [[clinical]] experience. | *However, optimal [[management]] is in question due to insufficient [[clinical]] experience. |
Revision as of 12:37, 3 March 2021
Spontaneous Coronary Artery Dissection Microchapters |
Differentiating Spontaneous coronary artery dissection from other Diseases |
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Diagnosis |
Treatment |
Case Studies |
Type 1 Type 2A Type 2B Type 3 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arzu Kalayci, M.D. [2] Nate Michalak, B.A.
Synonyms and keywords: SCAD
Overview
Conservative management should be first choice if emergent revascularization is not necessary. [1]
- However, optimal management is in question due to insufficient clinical experience.
- There are some treatment options including conservative management, emergency revascularization (PCI or CABG), fibrinolytic therapy, mechanical hemodynamic support, and even cardiac transplantation have been reported.
- Preference of the approach should be tailored to patient’s clinical status. [2] [3] [4] [5]
Intervention
Conservative management should be first choice if emergent revascularization is not necessary. [1]
- However, optimal management is in question due to insufficient clinical experience.
- There are some treatment options including conservative management, emergency revascularization (PCI or CABG), fibrinolytic therapy, mechanical hemodynamic support, and even cardiac transplantation have been reported.
- Preference of the approach should be tailored to patient’s clinical status. [2] [3] [4] [5]
Percutaneous Coronary Intervention
- Revascularization should be considered in case of acute myocardial infarction with symptoms or haemodynamic instability. [2]
- However, PCI is technically quite difficult with a high risk of complications.[6] [7]
- Therefore, conservative management is recommended in patients with non-occlusive luminal obstruction, TIMI grade 3 flow, and a stable clinical condition.
- Performing PCI in SCAD is technically very difficult due to the arterial fragility.
- It can be quite challenging to keep the guidewire within the true lumen while crossing the lesion.
- Any instruments using in each stage such as wiring, angioplasty or stenting can enlarge the dissection and block side branches.
- In addition, these lesions are mostly require long stents resulting in higher rates of in stent restenosis.
- Furthermore, resorption of the intramural hematoma may lead to late stent malapposition and stent thrombosis.
- Therefore, stent implantation should only be performed in a strong clinical indication.
- It would be beneficial to perform procedure under the guidance of intracoronary imaging (IVUS, OCT).
- Although there is no evidence about the benefits of bioabsorbable stents, theoretically it seems to have advantages.[8]
Challenges and Suggestions With SCAD PCI | |
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Challenges during PCI of SCAD | |
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Suggestions if PCI is pursued for SCAD | |
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DAPT= dual antiplatelet therapy; IMH= intramural hematoma; IVUS= intravascular ultrasound; PCI= percutaneous coronary intervention. [9] |
References
- ↑ 1.0 1.1 Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS; et al. (2014). "Spontaneous coronary artery dissection: revascularization versus conservative therapy". Circ Cardiovasc Interv. 7 (6): 777–86. doi:10.1161/CIRCINTERVENTIONS.114.001659. PMID 25406203.
- ↑ 2.0 2.1 2.2 Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D; et al. (2014). "Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes". Circ Cardiovasc Interv. 7 (5): 645–55. doi:10.1161/CIRCINTERVENTIONS.114.001760. PMID 25294399.
- ↑ 3.0 3.1 Saw J, Aymong E, Mancini GB, Sedlak T, Starovoytov A, Ricci D (2014). dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24726091 "Nonatherosclerotic coronary artery disease in young women" Check
|url=
value (help). Can J Cardiol. 30 (7): 814–9. doi:10.1016/j.cjca.2014.01.011. PMID 24726091. - ↑ 4.0 4.1 Alfonso F, Paulo M, Lennie V, Dutary J, Bernardo E, Jiménez-Quevedo P; et al. (2012). "Spontaneous coronary artery dissection: long-term follow-up of a large series of patients prospectively managed with a "conservative" therapeutic strategy". JACC Cardiovasc Interv. 5 (10): 1062–70. doi:10.1016/j.jcin.2012.06.014. PMID 23078737.
- ↑ 5.0 5.1 Higgins GL, Borofsky JS, Irish CB, Cochran TS, Strout TD (2013). "Spontaneous peripartum coronary artery dissection presentation and outcome". J Am Board Fam Med. 26 (1): 82–9. doi:10.3122/jabfm.2013.01.120019. PMID 23288285.
- ↑ Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ; et al. (2012). "Clinical features, management, and prognosis of spontaneous coronary artery dissection". Circulation. 126 (5): 579–88. doi:10.1161/CIRCULATIONAHA.112.105718. PMID 22800851.
- ↑ Vrints CJ (2010). "Spontaneous coronary artery dissection". Heart. 96 (10): 801–8. doi:10.1136/hrt.2008.162073. PMID 20448134.
- ↑ Vijayaraghavan R, Verma S, Gupta N, Saw J (2014). "Pregnancy-related spontaneous coronary artery dissection". Circulation. 130 (21): 1915–20. doi:10.1161/CIRCULATIONAHA.114.011422. PMID 25403597.
- ↑ Saw J, Mancini GBJ, Humphries KH (2016). "Contemporary Review on Spontaneous Coronary Artery Dissection". J Am Coll Cardiol. 68 (3): 297–312. doi:10.1016/j.jacc.2016.05.034. PMID 27417009.