Spontaneous Coronary Artery Dissection With Perfusion Balloon Angioplasty

Spontaneous coronary artery dissection (SCAD) is a rare but clinically important cause of acute coronary syndrome. An optimal percutaneous treatment strategy for SCAD has not yet been established.

A 50-year-old woman presented with ST-elevation myocardial infarction and underwent urgent coronary angiography. Severe stenosis was identified in the proximal to mid-left anterior descending artery. Intravascular ultrasound demonstrated an intramural hematoma, confirming the diagnosis of SCAD. Balloon angioplasty using a perfusion balloon catheter was performed to seal the dissection entry point. Postprocedural angiography indicated restored coronary flow without any complications. Three months after the emergency revascularization, coronary computed tomography angiography revealed complete healing of the dissection.

The perfusion balloon catheter features a unique design that enables prolonged balloon inflation without interrupting coronary blood flow. Although the device has traditionally been used for managing coronary perforations, the current case suggests that it may also be a viable treatment option for SCAD.

Balloon angioplasty using a perfusion balloon catheter could be considered as a percutaneous coronary intervention strategy for patients with SCAD.