Spontaneous Coronary Artery Dissection: Suggesting a Reproducible Stepwise Approach for a Successful PCI

Although conservative therapy is usually preferred, percutaneous interventions may be required in cases of ongoing ischemia or vessel occlusion during spontaneous coronary artery dissection (SCAD).

We report the case of a 46-year-old woman with no cardiovascular risk factors presenting with anterior ST-segment elevation myocardial infarction. Angiography showed acute occlusion of the mid left anterior descending artery. After wiring with a low tip load wire and under intravascular ultrasound guidance, a "cuttering" technique was applied.

Percutaneous coronary intervention when indicated in SCAD yields poor outcomes and frequent complications. The lowest tip load wire must be used to avoid extending the dissection. Intravascular ultrasound recognizes the area of maximum compression and helps choose the adequate size of the cutting balloon. Inflation of this balloon is not sufficient, and the "cuttering" technique can be effective for fenestrating and compressing the hematoma.

In this case report, we suggest a reproducible stepwise approach that can maximize the chance to manage ST-segment elevation myocardial infarction caused by an occlusive SCAD.