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Exclusion of a left main pseudo aneurysm complicating SCAD by two overlapping DES - a case report

A Mace1, C Beaufort2, J Abrial3

  • 1Department of Cardiology, Service de cardiologie, CHU Poitiers, Poitiers University Hospital, 2 rue de la milletrie 86000, Poitiers, France. antoinemace@hotmail.fr.

The International Journal of Cardiovascular Imaging
|October 18, 2024
PubMed

Insights

Spontaneous Coronary Artery Dissection (SCAD) can cause heart attacks in women. This case study explores managing a complex SCAD case with a pseudoaneurysm using drug-eluting stents.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Spontaneous Coronary Artery Dissection (SCAD) is an increasingly recognized cause of Acute Coronary Syndrome (ACS), particularly in women.
  • Current treatment often involves conservative management, aiming for complete resolution, but this is not always systematic.
  • Limited data exists on identifying patients at risk for SCAD progression and optimizing therapeutic strategies.

Purpose of the Study:

  • To present a complex case of SCAD involving the left main coronary artery and its branches.
  • To discuss the management of a large left main pseudoaneurysm secondary to SCAD.
  • To evaluate the therapeutic strategy, including the use of drug-eluting stents (DES) for pseudoaneurysm exclusion.

Main Methods:

  • A 36-year-old woman presented with ST-elevation myocardial infarction (STEMI) due to SCAD.
  • The SCAD extended from the left main (LM) to the mid-left anterior descending (LAD) and circumflex arteries.
  • Computed Tomography (CT) and Intravascular Ultrasound (IVUS) were used for evaluation, followed by DES implantation for pseudoaneurysm exclusion.

Main Results:

  • The patient developed a large left main pseudoaneurysm under initial medical treatment.
  • Successful exclusion of the pseudoaneurysm was achieved by implanting two overlapping DES.
  • The case highlights a deviation from standard conservative treatment due to the extensive nature of the SCAD and pseudoaneurysm.

Conclusions:

  • This case underscores the challenges in managing SCAD, especially when complicated by pseudoaneurysm formation.
  • The use of overlapping DES for LM pseudoaneurysm exclusion presents a viable, albeit debatable, therapeutic option.
  • Further research is needed to refine treatment guidelines for complex SCAD presentations and associated pseudoaneurysms.

Keywords:
AngioplastyCoronary computed tomography angiographyCoronary pseudo aneurysmIntravascular UltrasoundSpontaneous coronary artery dissection

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