CORONARY - Acute Coronary Syndromes (STEMI, NSTE-ACS)
Primary PCI in Spontaneous Coronary Artery Dissection with Cardiogenic Shock: What to Do When You are Forced to Intervene!
Ankur Batra1, RR Mantri2
Nidaan Hospital, India1, Sir Ganga Ram Hospital, India2,
48-year-old maleKnown case of Essential Hypertension Known case of Coronary Artery Disease: Status Post CABG 2012 with LIMA to LADPresented with left precordium pain on exertion since 2 days and increased since last 3 hours with one episode of syncope and excessive sweating.Examination: P-80/min, BP- 90/50mm of hg right arm supine, Physical examination: unremarkableECG: QR in III, aVF with intermittent CHB
He was planned for Primary PCI with Temporary Pacemaker and inotropic support with dopamine and noradrenaline.
CAG: right FemoralLIMA to LAD: Patent Left main: NormalLAD: Proximal LAD; Total OcclusionLCX: Non Dominant, NormalRCA: Dominant with Spontaneous Coronary Artery Dissection from Proximal to Distal RCA, Culminating just prior to the bifurcation to PDA and PLV 202011181121310673.avi
Spontaneous Coronary Artery Dissection presents a dilemma for an interventional cardiologist. The evidence clearly suggests that if the clinical condition allows, optimal medical management and lifestyle modification has shown better cardiovascular outcomes.PCI in SCAD carries a higher than ordinary perioperative complication risk due to abrupt vessel closure, inadvertent subintimal stenting and high risk of perforation.This case demonstrates that in selected patients where intervention is indicated, PCI can be safely performed with careful manipulation of wire.Intravascular imaging with IVUS plays an important decision making role in the procedure.