Spontaneous coronary artery dissection treated with biovascular scaffolds: Old riddle, novel approach

Introduction: Spontaneous coronary artery dissection (SCAD) is a rare, poorly understood disease (incidence 0.1–1.1%). Management modalities vary and are mostly based on consensus from relatively some study results. Percutaneous intervention (PCI) with conventional drug eluting stents (DES), though acceptable treatment for complicated cases, has a widely variable rate of success (65–90%), hence the search for alternative solutions. Case Report: We present the case of a premenopausal female with no known cardiac risk factor, admitted with a non-ST elevation myocardial infarction (NSTEMI), who, on cardiac angiogram, was found to have had a spontaneous coronary artery dissection (SCAD). Conservative management is the consensus treatment for uncomplicated cases, but failed in this case. Biovascular scaffolds were then deployed and 12 months post procedure, have proven to be a successful treatment option for this rare disease. Conclusion: This case highlights the difficulties posed by this rare disease and the potential for better results for PCI in complicated cases when biovascular scaffolds are employed. Failure of conservative management necessitated the novel approach with biovascular scaffolds which have been shown to not only restore coronary flow in the interim, but also reduce the risk of restenosis while promoting vascular restoration. Bioresorbable stents should be considered for management of certain complicated cases.