title: IVUS and OCT guided primary percutaneous coronary intervention for spontaneous coronary artery dissection with bioresorbable vascular scaffolds.
abstract: Spontaneous coronary artery dissection (SCAD) is an uncommon but important cause of acute coronary syndrome. The diagnosis of SCAD by an angiogram alone can be challenging and the increasing use of intracoronary imaging has proven an invaluable diagnostic adjunct in this regard. The appropriate initial management of SCAD has been a matter of significant debate. Owing to frequent spontaneous healing of coronary dissection and a higher risk of complications with percutaneous coronary intervention (PCI) in the setting of SCAD, a default approach of mechanical revascularization is not recommended. However in the presence of vessel occlusion and on-going myocardial infarction PCI is mandated. Bioresorbable vascular scaffolds (BVS) offer potential advantages over the conventional stents in the setting of SCAD. We describe a state-of-the-art approach to the acute treatment of SCAD causing STEMI, utilizing intravascular ultrasound (IVUS), optical coherence tomography (OCT) and BVS and discuss management strategies for the modern era.
authors.affiliation: James Cook University Hospital, Middlesbrough, UK.
authors.forename: Muhammad Muzaffar
authors.initials: MM
authors.lastname: Mahmood
authors.affiliation: James Cook University Hospital, Middlesbrough, UK. Electronic address: david.austin@stees.nhs.uk.
authors.forename: David
authors.initials: D
authors.lastname: Austin
mesh_terms: D020341:Absorbable Implants; D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D000328:Adult; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002317:Cardiovascular Agents / Q000008:administration & dosage; D020099:Coated Materials, Biocompatible; D003323:Coronary Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D041623:Tomography, Optical Coherence; D018084:Ultrasonography, Interventional
chemical_list: D002317:Cardiovascular Agents; D020099:Coated Materials, Biocompatible
keywords: Bioresorbable vascular scaffold; Intravascular ultrasound; Optical coherence tomography; Spontaneous coronary artery dissection