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Unusual interventional treatment of spontaneous coronary artery dissection without stent implantation: a case series
Hiroshi Fujita1, Masashi Yokoi1, Tsuyoshi Ito1
1Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
Insights
Cutting balloon angioplasty is a potential treatment for spontaneous coronary artery dissection (SCAD), a cause of heart attack. This method showed positive long-term results in two SCAD patients, allowing them to discontinue antiplatelet therapy.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Spontaneous coronary artery dissection (SCAD) is an uncommon cause of myocardial infarction.
- Treatment decisions for SCAD depend on the patient's ischemic condition, with revascularization considered for those with ongoing ischemia or hemodynamic instability.
- Cutting balloon (CB) angioplasty is a recognized revascularization option, but its long-term effects in SCAD patients are not well-documented.
Observation:
- Two cases of SCAD treated with CB angioplasty were evaluated for chronic-phase angiographic outcomes.
- Case 1: A 46-year-old woman with SCAD in the left anterior descending artery (LAD) underwent successful CB angioplasty.
- Case 2: A 50-year-old woman with SCAD in the right coronary artery was treated with CB angioplasty, restoring coronary flow.
Findings:
- Follow-up angiography 15 months post-procedure in Case 1 showed no LAD stenosis, enabling discontinuation of antiplatelet therapy.
- Follow-up CT angiography 36 months post-procedure in Case 2 revealed a healed coronary artery, also allowing cessation of antiplatelet therapy.
Implications:
- CB angioplasty may be a viable treatment option for SCAD.
- Successful revascularization with CB angioplasty in SCAD patients can lead to favorable long-term outcomes and cessation of antiplatelet medication.
Background:
Spontaneous coronary artery dissection (SCAD) is a unique cause of myocardial infarction, and optimal treatment should be selected according to the ischaemic condition. Patients with ongoing ischaemia or haemodynamic instability may require revascularization. Cutting balloon (CB) angioplasty has been acknowledged as an option for revascularization. However, few observations of the coronary artery conditions after CB angioplasty in SCAD patients have been reported. Here, we demonstrate two cases in which we evaluated the angiographic morphology of targeted coronary arteries in the chronic phase after CB angioplasty.
Case Summary:
Patient 1 was a 46-year-old woman who presented at our hospital with chest pain. Electrocardiography suggested acute coronary syndrome and coronary angiography was performed. The coronary angiography and intravascular ultrasound (IVUS) examinations revealed SCAD in the left anterior descending artery (LAD). Revascularization with CB angioplasty was successful. Follow-up coronary angiography 15 months after the angioplasty showed no visible stenosis in the LAD. Accordingly, the patient no longer needed to antiplatelet therapy. Patient 2 was a 50-year-old woman who was transported to our hospital for ventricular tachycardia. Coronary angiography and IVUS revealed SCAD in the right coronary artery. Coronary flow was restored by CB angioplasty. Follow-up contrast-enhanced computed tomography angiography 36 months after angioplasty showed a healed appearance. Thus, she was able to discontinue antiplatelet therapy.
Discussion:
Cutting balloon angioplasty may be a possible method to treat SCAD.
