Spontaneous coronary artery dissection percutaneous coronary intervention: Difference between revisions
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==Percutaneous Coronary Intervention== | ==Percutaneous Coronary Intervention== | ||
[[PCI]] is indicated in the presence of ongoing [[myocardial ischemia]] or [[myocardial infarction]].<ref name="pmid21041853">{{cite journal |author=Adlam D, Cuculi F, Lim C, Banning A |title=Management of spontaneous coronary artery dissection in the primary percutaneous coronary intervention era |journal=[[The Journal of Invasive Cardiology]] |volume=22 |issue=11 |pages=549–53 |year=2010 |month=November |pmid=21041853 |doi= |url=}}</ref> [[Drug eluting stent]]s (DES) are routinely used in the management of SCAD. However, their impact on long-term outcomes has not been assessed yet in clinical studies. | [[PCI]] is indicated in the presence of ongoing [[myocardial ischemia]] or [[myocardial infarction]].<ref name="pmid21041853">{{cite journal |author=Adlam D, Cuculi F, Lim C, Banning A |title=Management of spontaneous coronary artery dissection in the primary percutaneous coronary intervention era |journal=[[The Journal of Invasive Cardiology]] |volume=22 |issue=11 |pages=549–53 |year=2010 |month=November |pmid=21041853 |doi= |url=}}</ref> [[Drug eluting stent]]s (DES) are routinely used in the management of SCAD. However, their impact on long-term outcomes has not been assessed yet in clinical studies. | ||
{| class="wikitable" style="width: 80%; text-align: justify;" | |||
! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Challenges and Suggestions With SCAD PCI}} | |||
|- | |||
! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Challenges during PCI of SCAD}} | |||
|- | |||
| Risk of iatrogenic catheter-induced dissection | |||
|- | |||
| Difficulty advancing coronary wire into distal true lumen | |||
|- | |||
| Propagating IMH anterograde and retrograde with angioplasty/ stenting, extending dissection and further compromising true lumen arterial flow | |||
|- | |||
| Dissection tends to extend into distal arteries, which are too small for stents | |||
|- | |||
| Often extensive dissected segments require long stents, increasing stent restenosis | |||
|- | |||
| Risk of stent malapposition after resorption of IMH, with risk of late stent thrombosis | |||
|- | |||
! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Suggestions if PCI is pursued for SCAD}} | |||
|- | |||
| Meticulous guide catheter manipulation, preferably through femoral access approach | |||
|- | |||
| OCT/IVUS guidance to ensure wire in true lumen (or over-the-wire catheter injections) and optimize stent apposition | |||
|- | |||
| Long stents covering 5 10 mm of proximal and distal edges of IMH | |||
|- | |||
| Placing short stents at proximal and distal edges first, before placing long stent in the middle | |||
|- | |||
| Consider bioabsorbable stents (temporary scaffold to avoid long- term malapposition) | |||
|- | |||
| Possible and careful use of cutting balloon (to fenestrate IMH) | |||
|- | |||
| Consider follow-up OCT to assess for malapposed/uncovered struts before stopping DAPT | |||
|- | |||
| colspan="2" | DAPT 1⁄4 dual antiplatelet therapy; IMH 1⁄4 intramural hematoma; IVUS 1⁄4 intra- vascular ultrasound; PCI 1⁄4 percutaneous coronary intervention. <ref name="pmid27417009">{{cite journal| author=Saw J, Mancini GBJ, Humphries KH| title=Contemporary Review on Spontaneous Coronary Artery Dissection. | journal=J Am Coll Cardiol | year= 2016 | volume= 68 | issue= 3 | pages= 297-312 | pmid=27417009 | doi=10.1016/j.jacc.2016.05.034 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27417009 }} </ref> | |||
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==References== | ==References== | ||
Revision as of 19:51, 29 November 2017
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Spontaneous Coronary Artery Dissection Microchapters |
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Differentiating Spontaneous coronary artery dissection from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Type 1 Type 2A Type 2B Type 3 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A.
Synonyms and keywords: SCAD
Overview
Percutaneous Coronary Intervention
PCI is indicated in the presence of ongoing myocardial ischemia or myocardial infarction.[1] Drug eluting stents (DES) are routinely used in the management of SCAD. However, their impact on long-term outcomes has not been assessed yet in clinical studies.
| Challenges and Suggestions With SCAD PCI | |
|---|---|
| Challenges during PCI of SCAD | |
| Risk of iatrogenic catheter-induced dissection | |
| Difficulty advancing coronary wire into distal true lumen | |
| Propagating IMH anterograde and retrograde with angioplasty/ stenting, extending dissection and further compromising true lumen arterial flow | |
| Dissection tends to extend into distal arteries, which are too small for stents | |
| Often extensive dissected segments require long stents, increasing stent restenosis | |
| Risk of stent malapposition after resorption of IMH, with risk of late stent thrombosis | |
| Suggestions if PCI is pursued for SCAD | |
| Meticulous guide catheter manipulation, preferably through femoral access approach | |
| OCT/IVUS guidance to ensure wire in true lumen (or over-the-wire catheter injections) and optimize stent apposition | |
| Long stents covering 5 10 mm of proximal and distal edges of IMH | |
| Placing short stents at proximal and distal edges first, before placing long stent in the middle | |
| Consider bioabsorbable stents (temporary scaffold to avoid long- term malapposition) | |
| Possible and careful use of cutting balloon (to fenestrate IMH) | |
| Consider follow-up OCT to assess for malapposed/uncovered struts before stopping DAPT | |
| DAPT 1⁄4 dual antiplatelet therapy; IMH 1⁄4 intramural hematoma; IVUS 1⁄4 intra- vascular ultrasound; PCI 1⁄4 percutaneous coronary intervention. [2] | |
References
- ↑ Adlam D, Cuculi F, Lim C, Banning A (2010). "Management of spontaneous coronary artery dissection in the primary percutaneous coronary intervention era". The Journal of Invasive Cardiology. 22 (11): 549–53. PMID 21041853. Unknown parameter
|month=ignored (help) - ↑ 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.