Key result
Provisional crush stenting successfully treats extensive pregnancy-associated left main SCAD.
Why the study?
Stent implantation in SCAD lesions can facilitate extension of intramural hematoma into side branches causing stenosis or occlusion, requiring evaluation before intervention.
Case Report (n=1)
In SCAD with intramural hematoma extending to a side branch ostium, two-stent techniques like crush stenting that do not require guidewire recrossing should be considered to avoid side branch occlusion.
A 46-year-old pregnant woman, presented with worsening episodes of intermittent chest pain. The patient was diagnosed with a non-ST-elevation myocardial infarction. On arrival, she had a stable hemodynamic status without chest pain. She was initially treated with conservative medical therapy. One day later, she complained of severe chest pain, and an electrocardiogram showed ST elevation in leads I, aVL, and V2-5. Emergency coronary angiography showed total occlusion of the left anterior descending artery (LAD) and intermediate stenosis of the left main coronary artery (LMCA). The intravascular ultrasound (IVUS) revealed an intramural hematoma (IMH) from the LMCA to the LAD, extending to the left circumflex artery (LCX) ostium. This finding was consistent with spontaneous coronary artery dissection (SCAD). After stent implantation from the LMCA to the LAD, severe stenosis was noted at the proximal site of the LCX. IVUS showed that the IMH extended to the LCX. The provisional crush stent technique was performed, and the final angiography revealed satisfactory results with thrombolysis in myocardial infarction flow grade 3 in the LAD and LCX. This case report highlighted that stent implantation in the SCAD lesions facilitated the extension of the IMH longitudinally and laterally into the side branch, resulting in stenosis or occlusion. Therefore, the side branch should be evaluated using IVUS before stent implantation. In cases where the IMH extends to the ostium of the side branch, two-stent techniques that do not require guidewire recrossing, such as crush stents, should be considered to avoid side branch occlusion.
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Muraishi et al. (2022) conducted a case report in Spontaneous coronary artery dissection (SCAD) (n=1). Percutaneous coronary intervention (provisional crush stent technique) was evaluated. In a 46-year-old pregnant woman with SCAD, provisional crush stenting successfully treated extensive intramural hematoma extending from the left main coronary artery to the side branch.
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