Case 2: SCAD-Spontaneous coronary artery dissection
40-year-old female underwent PCI two months prior, one month postpartum, due to chest pain and SOB. SCAD was detected and treated with two stents placed in the LMT and mid LAD. One week following previous PCI, patient experienced NSTEMI and was treated medically. The patient was transferred to MSH for SCAD management with peak troponin level 25 with decompensated HF.
IVUS Pre run1
Coronary angiography shows the presence of a double lumen of the known SCAD from the proximal LMT stent to the proximal LAD stent. Based on IVUS findings, a 4.0 × 23 mm DES was selected to slightly overlap the LMT and LAD stents where the majority of the false lumen was located. A 2.0 × 20 mm non-compliant balloon was used for pre dilatation followed by a 4.5 × 12 mm NC balloon for post dilatation. Within the LMT, dilatation with a 4.5×12 mm NC balloon was performed to improve apposition of the existing stent. Angiographic results below show good flow and that the false lumen was excluded.
In this case, the distal end of coronary artery dissection ends with a LAD mid stent, but the entry site is within the proximal LMT stent. Attention should be paid to PCI for SCAD because there is a risk that the guide wire may enter the false lumen and the extent of dissection may be widened by stent placement. Since IVUS is useful for identifying the entry site of dissection, observation with IVUS may be more preferable when the lesion is long.