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Case 2: SCAD-Spontaneous coronary artery dissection

Case Presentation

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.

Angio Pre

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.

Post run20

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.

ModelBurst (ATM)Diameter (mm)Balloon Length (mm)              
681215202530
MINI TREK (CTO INDICATED)1.271.2
1.561.5
2.172✓*✓*
TREK2.372.25
2.672.5
2.912.75
3.113
3.53.25
3.73.5
3.943.75
4.324
4.864.5
5.365
*Only available as RX, not as OTW. Other sizes available in both versions.
Retrieved on April 07 2022 from Abbott product ordering information. Please look at the company's files for the latest available data on device configurations and avilability in your area.

Left Main DK Crush Video ID