Contemporary PCI in SCAD and the Role of Intravascular Imaging

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Spontaneous coronary artery dissection (SCAD). Intervention: Intravascular imaging (IVUS) guided percutaneous coronary intervention.

Q: What does this research mean for the field?

Intravascular ultrasound (IVUS) facilitates successful percutaneous coronary intervention in spontaneous coronary artery dissection by enabling real-time true lumen wiring, delineating intramural hematoma extent, and guiding stent sizing. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

M. Hordern; Sarah L. Fairley; Scott A. Harding

doi:10.1016/j.jaccas.2026.109759

August 1, 2026JACC Case ReportsOpen Access

Contemporary PCI in SCAD and the Role of Intravascular Imaging

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Key result

Intravascular imaging plays an integral role in the diagnosis, procedural planning, and facilitation of true lumen wiring during percutaneous coronary intervention for spontaneous coronary artery dissection.

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Key Points

To review procedural challenges and define the role of intravascular ultrasound and interventional strategies during percutaneous coronary intervention for spontaneous coronary artery dissection.
Evaluated high-risk criteria warranting percutaneous coronary intervention, including ongoing ischemia, hemodynamic instability, ventricular arrhythmias, or left main involvement.
Assessed algorithmic intravascular ultrasound imaging strategies for true lumen wire confirmation and hematoma extent evaluation.
Reviewed mechanical interventions such as direct stenting without predilatation and cutting balloon angioplasty for intramural hematoma decompression.
Real-time intravascular ultrasound imaging facilitates true lumen wiring and stent sizing while preventing propagation of the intramural hematoma.
Direct stenting with stents extending beyond the hematoma limits dissection propagation, while cutting balloon angioplasty offers hematoma decompression to restore true lumen flow.
Conservative therapy remains preferred for most spontaneous coronary artery dissection cases due to higher rates of procedural failure and complications associated with percutaneous intervention.

Structured PICO

P

Population

Patients with spontaneous coronary artery dissection (SCAD) undergoing percutaneous coronary intervention (PCI)

I

Intervention

Intravascular imaging (specifically IVUS) to guide percutaneous coronary intervention

O

Outcome

Procedural success including true lumen wiring, hematoma decompression, and appropriate stent sizing

Implication

Intravascular ultrasound is critical during PCI for SCAD to ensure true lumen wiring and optimize stent sizing or hematoma decompression strategies.

Abstract

[Figure: see text]

Discussion

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Cite This Study

Hordern et al. (2026) conducted an editorial in Spontaneous coronary artery dissection (SCAD). Intravascular imaging (IVUS) guided percutaneous coronary intervention was evaluated. Intravascular imaging plays an integral role in the diagnosis, procedural planning, and facilitation of true lumen wiring during percutaneous coronary intervention for spontaneous coronary artery dissection.

synapsesocial.com/papers/6ad0fcb515427f6a84040253 https://doi.org/10.1016/j.jaccas.2026.109759

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Contemporary PCI in SCAD and the Role of Intravascular Imaging

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Contemporary PCI in SCAD and the Role of Intravascular Imaging

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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