Key result
Conservative medical management paired with temporary mechanical circulatory support using an Impella device resulted in full clinical recovery and complete angiographic resolution of multivessel SCAD.
Why the study?
Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome with debated optimal treatment in the setting of cardiogenic shock.
Case Report (n=1)
No
Hemodynamic support with a pLVAD (Impella) combined with conservative medical therapy (single antiplatelet therapy and heparin) is a viable, life-saving strategy for multivessel SCAD complicated by profound cardiogenic shock where revascularization is deemed unfeasible.
May support Impella-assisted conservative therapy in multivessel SCAD shock; hypothesis-generating and requires prospective validation before wider use.
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome with debated optimal treatment in the setting of cardiogenic shock (CS). We report a case of a middle-aged woman presenting with out-of-hospital cardiac arrest due to extensive multivessel SCAD. Without evidence for transmural ischemia, we chose conservative treatment with single antiplatelet therapy and heparin. Due to deteriorating hemodynamics, a temporary left ventricular assist device (Impella) was implanted, stabilizing the patient. After weaning the device and initiating heart failure therapy, the patient recovered completely. This case highlights several important considerations for the management of SCAD patients with CS.
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Grüter et al. (2026) conducted a case report in Spontaneous Coronary Artery Dissection (SCAD) complicated by cardiogenic shock (n=1). Conservative management with percutaneous left ventricular assist device (Impella), single antiplatelet therapy, and heparin was evaluated on Clinical recovery and resolution of coronary dissection. Conservative medical management paired with temporary mechanical circulatory support using an Impella device resulted in full clinical recovery and complete angiographic resolution of multivessel SCAD.
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