Spontaneous coronary artery dissection percutaneous coronary intervention: Difference between revisions
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* Difficulty advancing coronary wire into distal true lumen | * Difficulty advancing coronary wire into distal true lumen | ||
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| * Propagating IMH anterograde and retrograde with angioplasty/ stenting, extending dissection and further compromising true lumen arterial flow | | | ||
* Propagating IMH anterograde and retrograde with angioplasty/ stenting, extending dissection and further compromising true lumen arterial flow | |||
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| * Dissection tends to extend into distal arteries, which are too small for stents | | | ||
* Dissection tends to extend into distal arteries, which are too small for stents | |||
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| * Often extensive dissected segments require long stents, increasing stent restenosis | | | ||
* Often extensive dissected segments require long stents, increasing stent restenosis | |||
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| * Risk of stent malapposition after resorption of IMH, with risk of late stent thrombosis | | | ||
* Risk of stent malapposition after resorption of IMH, with risk of late stent thrombosis | |||
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! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Suggestions if PCI is pursued for SCAD}} | ! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Suggestions if PCI is pursued for SCAD}} | ||
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| * Meticulous guide catheter manipulation, preferably through femoral access approach | | | ||
* Meticulous guide catheter manipulation, preferably through femoral access approach | |||
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| * OCT/IVUS guidance to ensure wire in true lumen (or over-the-wire catheter injections) and optimize stent apposition | | | ||
* OCT/IVUS guidance to ensure wire in true lumen (or over-the-wire catheter injections) and optimize stent apposition | |||
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| * Long stents covering 5-10 mm of proximal and distal edges of IMH | | | ||
* Long stents covering 5-10 mm of proximal and distal edges of IMH | |||
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| * Placing short stents at proximal and distal edges first, before placing long stent in the middle | | | ||
* Placing short stents at proximal and distal edges first, before placing long stent in the middle | |||
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| * Consider bioabsorbable stents (temporary scaffold to avoid long- term malapposition) | | | ||
* Consider bioabsorbable stents (temporary scaffold to avoid long- term malapposition) | |||
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| * Possible and careful use of cutting balloon (to fenestrate IMH) | | | ||
* Possible and careful use of cutting balloon (to fenestrate IMH) | |||
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| * Consider follow-up OCT to assess for malapposed/uncovered struts before stopping DAPT | | | ||
* Consider follow-up OCT to assess for malapposed/uncovered struts before stopping DAPT | |||
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| colspan="2" | '''DAPT=''' dual antiplatelet therapy; '''IMH=''' intramural hematoma; '''IVUS=''' intravascular ultrasound; '''PCI=''' 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> | | colspan="2" | '''DAPT=''' dual antiplatelet therapy; '''IMH=''' intramural hematoma; '''IVUS=''' intravascular ultrasound; '''PCI=''' 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> |
Revision as of 20:22, 29 November 2017
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: 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 | |
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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. [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.
- ↑ 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.