Author + information
- Received October 8, 2013
- Accepted October 24, 2013
- Published online July 1, 2014.
- Gunasekaran Sengottuvelu, MD, DM∗ ( and )
- Ravindran Rajendran, MD, DM
- ↵∗Reprint requests and correspondence:
Dr. Sengottuvelu, Cardiology Department, Apollo Hospital, 21, Greams Lane, Chennai 600006, India.
A 58-year-old-man was referred to us after thrombolysis for acute inferior wall myocardial infarction. A coronary angiogram showed intraluminal filling defects extending from the proximal to distal right coronary artery (RCA) suggestive of spontaneous coronary artery dissection (SCAD) with thrombus (Fig. 1A, Online Video 1). He was managed with intravenous tirofiban infusion along with oral antiplatelets. A check angiogram after 4 days showed mild clearing of the filling defects (Fig. 1B, Online Video 2). Optical coherence tomography run from the distal to proximal RCA showed dissection flaps (asterisk) along with organized and recanalized thrombus (hash mark) extending all the way from the proximal to distal RCA (Figs. 1C to 1E). Three 3 × 28-mm bioresorbable vascular scaffolds (BVS) (Absorb, Abbott Vascular, Santa Clara, California) were deployed from the distal to proximal RCA, and another 3.5 × 18-mm BVS was deployed in the proximal RCA covering the ostium to establish good Thrombolysis In Myocardial Infarction flow grade III (Fig. 1F, Online Video 3). There were no risk factors for SCAD in this patient.
SCAD is a rare cause of acute coronary syndrome, with an incidence of 0.2% among those who come for coronary angiography (1). Thrombolysis in SCAD could lead to propagation of the hematoma and the tear, which could be the reason for the long-segment tear in our case (2). Nonocclusive tears can be managed conservatively because spontaneous healing is common (3). For long-segment tears, percutaneous coronary intervention covering the entire dissected segment is preferred over spot stenting because the latter could lead to squeezing of the hematoma and extension of the dissection. Because the tendency for healing in SCAD is high, temporary scaffolding with BVS can be preferred over stents, especially for long segments, so as to avoid a full metal jacket.
For supplemental videos, please see the online version of this article.
Drs. Sengottuvelu and Rajendran have reported that they have no relationships relevant to the contents of this paper to disclose. Both authors contributed equally to this paper.
- Received October 8, 2013.
- Accepted October 24, 2013.
- American College of Cardiology Foundation
- Vanzetto G.,
- Berger-Coz E.,
- Barone-Rochette G.,
- et al.
- Alfonso F.,
- Paulo M.,
- Lennie V.,
- et al.