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Stent mal-apposition with resorption of intramural hematoma with spontaneous coronary artery dissection

Mathieu Lempereur1, Anthony Fung1, Jacqueline Saw1

  • 1Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.

Cardiovascular Diagnosis and Therapy
|September 3, 2015
PubMed

Insights

Spontaneous coronary artery dissection (SCAD), a cause of acute coronary syndrome, can be challenging to treat with percutaneous coronary intervention. Optical coherence tomography (OCT) revealed stent mal-apposition in three SCAD cases treated with drug-eluting stents (DES).

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome (ACS).
  • While conservative management is usual, revascularization may be needed for persistent ischemia or anatomical issues.
  • Percutaneous coronary intervention (PCI) for SCAD presents unique challenges.

Purpose of the Study:

  • To investigate the utility of intracoronary imaging with optical coherence tomography (OCT) in managing SCAD treated with percutaneous coronary intervention (PCI).
  • To assess acute results and identify potential long-term adverse events related to stenting in SCAD patients using OCT.
  • To report on stent mal-apposition findings in SCAD patients treated with drug-eluting stents (DES) and followed by OCT.

Main Methods:

  • Retrospective analysis of three SCAD cases undergoing PCI with drug-eluting stent (DES) implantation.
  • Intracoronary imaging using optical coherence tomography (OCT) for acute assessment and follow-up.
  • Evaluation of stent apposition and other morphological features via OCT at various time points.

Main Results:

  • Optical coherence tomography (OCT) identified stent mal-apposition in all three reported cases of SCAD treated with drug-eluting stents (DES).
  • Stent mal-apposition was observed at different stages during the follow-up period.
  • The findings highlight potential challenges and long-term considerations for stenting in SCAD.

Conclusions:

  • Intracoronary imaging, particularly OCT, is valuable for optimizing PCI results in SCAD.
  • Stent mal-apposition is a potential finding in SCAD patients treated with DES, requiring careful monitoring.
  • Further research is needed to clarify the clinical significance and optimal management of OCT-detected stent mal-apposition in SCAD.

Keywords:
Angiographyarterial occlusive diseasecoronary artery diseaseoptical coherence tomography (OCT)percutaneous coronary intervention (PCI)

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