Key result
Cutting balloon angioplasty successfully restored coronary flow in two women with spontaneous coronary artery dissection, with healed appearances on follow-up imaging at 15 and 36 months.
Why the study?
Cutting balloon angioplasty is acknowledged as a revascularization option for SCAD, but few observations of coronary artery conditions after the procedure have been reported.
Does cutting balloon angioplasty without stent implantation improve angiographic outcomes in patients with spontaneous coronary artery dissection?
Case Report (n=2)
No
Does cutting balloon angioplasty without stent implantation improve angiographic outcomes in patients with spontaneous coronary artery dissection?
Cutting balloon angioplasty without stent implantation may be a viable treatment option for spontaneous coronary artery dissection, allowing for vessel healing and eventual discontinuation of antiplatelet therapy.
May support antiplatelet discontinuation after SCAD healing; leaves open efficacy versus conservative or stented approaches.
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a unique cause of myocardial infarction, and optimal treatment should be selected according to the ischaemic condition. Patients with ongoing ischaemia or haemodynamic instability may require revascularization. Cutting balloon (CB) angioplasty has been acknowledged as an option for revascularization. However, few observations of the coronary artery conditions after CB angioplasty in SCAD patients have been reported. Here, we demonstrate two cases in which we evaluated the angiographic morphology of targeted coronary arteries in the chronic phase after CB angioplasty. CASE SUMMARY: Patient 1 was a 46-year-old woman who presented at our hospital with chest pain. Electrocardiography suggested acute coronary syndrome and coronary angiography was performed. The coronary angiography and intravascular ultrasound (IVUS) examinations revealed SCAD in the left anterior descending artery (LAD). Revascularization with CB angioplasty was successful. Follow-up coronary angiography 15 months after the angioplasty showed no visible stenosis in the LAD. Accordingly, the patient no longer needed to antiplatelet therapy. Patient 2 was a 50-year-old woman who was transported to our hospital for ventricular tachycardia. Coronary angiography and IVUS revealed SCAD in the right coronary artery. Coronary flow was restored by CB angioplasty. Follow-up contrast-enhanced computed tomography angiography 36 months after angioplasty showed a healed appearance. Thus, she was able to discontinue antiplatelet therapy. DISCUSSION: Cutting balloon angioplasty may be a possible method to treat SCAD.
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Fujita et al. (2021) conducted a case report in Spontaneous coronary artery dissection (SCAD) (n=2). Cutting balloon angioplasty was evaluated on Angiographic morphology and coronary flow restoration. Cutting balloon angioplasty successfully restored coronary flow in two women with spontaneous coronary artery dissection, with healed appearances on follow-up imaging at 15 and 36 months.
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