Author + information
- Lakshmi Nambiar and
- Edward Terrien
Spontaneous coronary artery dissection (SCAD) has emerged as an increasingly common etiology of myocardial infarction (MI). Although conservative therapy is recommended for stable patients, there is limited data to guide the management of unstable patients.
A 48-year-old man with no cardiac risk factors was found unresponsive at home. Following CPR and multiple shocks for ventricular fibrillation, he was resuscitated. On arrival to our facility, the patient was in cardiogenic shock and his EKG showed anterolateral ST elevation MI (Fig 1C). He was emergently taken to the catheterization laboratory. He was found to have complex dissections involving the left main, circumflex and left anterior descending arteries (Fig 1A).
As the patient was hemodynamically unstable with ongoing ischemia, left main dissection and multi-vessel proximal dissections, the decision was made to perform complete percutaneous revascularization with Impella support. Due to the extent of dissection, there were no targets amenable to bypass grafting. The patient had excellent angiographic results (Fig 1B) with full recovery. Testing for connective tissue disorders, fibromuscular dysplasia, vasculitis and inflammatory disease was unremarkable.
Patients with extensive SCAD should be considered for Impella-guided percutaneous revascularization if they have high-risk features including ventricular arrhythmia, shock or left main dissection.
Posters Hall_Hall A
Saturday, March 28, 2020, 3:45 p.m.-4:30 p.m.
Session Title: FIT Clinical Decision Making: Interventional Cardiology 3
Abstract Category: Interventional Cardiology
Presentation Number: 1227-390
- 2020 American College of Cardiology Foundation