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Case 2: Spontaneous coronary artery dissection

Case Presentation

A 40-year old female (one month postpartum) underwent PCI two months prior due to chest pain and SOB. SCAD was detected and treated with two stents placed in the LM and mid LAD. One week following previous PCI, patient experienced NSTEMI and was treated medically. The patient was transferred to our center for SCAD management with peak troponin level 25 and decompensated HF.

Angio Pre

IVUS showing SCAD

Coronary angiography followed by IVUS imaging confirmed the presence of a double lumen of the known SCAD from the proximal LM stent to the mid LAD stent. The distal end of the coronary artery dissection was covered with the mid LAD stent, and the entry site was detected distal to the LM stent. Based on the IVUS findings, a 4.0mm × 23mm DES was selected to seal the dissection with a small overlap with previously deployed stents. A 2.0mm × 20mm non-compliant balloon was used for pre dilatation followed by a 4.5mm × 12mm NC balloon for post dilatation. Within the LM, dilatation with a 4.5mm × 12mm NC balloon was performed to improve apposition of the existing stent. Final angiogram demonstrated good flow and elimination of the false lumen.

Angio Post

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. IVUS is useful for identifying and characterizing SCAD.

Left Main DK Crush Video ID