Drug-Coated Balloons and Bioresorbable Scaffolds in Spontaneous Coronary Artery Dissections

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomaterials Science

Background:

• Spontaneous coronary artery dissection (SCAD) is a key cause of acute coronary syndromes, particularly in young women lacking traditional risk factors.
• SCAD's unique pathophysiology and vessel fragility present significant revascularization challenges.
• While conservative management is often preferred, percutaneous coronary intervention (PCI) is necessary in select cases.

Purpose of the Study:

• To review current limitations and pitfalls in SCAD percutaneous coronary intervention (PCI).
• To explore the application of drug-coated balloons (DCB) and bioresorbable scaffolds (BRS) as "leave-nothing-behind" strategies in SCAD.
• To identify future research priorities for optimizing SCAD interventional management.

Main Methods:

• Review of contemporary literature on SCAD management and interventional devices.
• Analysis of mechanistic underpinnings and procedural applications of DCB and BRS in SCAD.
• Discussion of intracoronary imaging (OCT/IVUS) role in SCAD interventions.

Main Results:

• Drug-coated balloons (DCB) offer antiproliferative therapy without permanent vessel caging.
• Bioresorbable scaffolds (BRS) provide temporary scaffolding with potential for biomechanical restoration upon resorption.
• Both DCB and BRS present advantages and disadvantages, requiring careful patient selection.

Conclusions:

• Optimal device strategies for SCAD-PCI remain under-researched, with current data being largely observational.
• DCB and BRS are attractive alternatives in selected SCAD cases, offering "leave-nothing-behind" benefits.
• Future research should prioritize head-to-head trials of DCB and evaluation of next-generation BRS for standardized, imaging-guided SCAD interventional algorithms.