Bioresorbable Scaffolds to Treat Spontaneous Coronary Artery Dissection

Macaya, Fernando; Peral, Vicente; Alameda, Mar; Pascual, Marcos; Gómez-Jaume, Alfredo; Asmarats, Lluís; Maristany, Jaume; Ojeda, Manuel; Bethencourt, Armando

doi:10.1161/circinterventions.115.003133

Cited by 19 publications

(9 citation statements)

References 4 publications

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“…7 Conceptually, BRSs are appealing for treating unstable patients with SCAD who need PCI, although, to date, few cases have been reported. [8][9][10][11][12][13][14] The role of BRSs in treating patients with coronary artery disease is not clear, given the current limitations of the technology and the increased risk of stent thrombosis seen in clinical trials. 15 Moreover, in the presence of SCAD, the sizing of vessels may be challenging because the true lumen is distorted; improper sizing of BRSs increases the risk of early stent thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Bioresorbable Scaffolds in Spontaneous Coronary Artery Dissection: Long-Term Follow-Up in 4 Patients

Freire¹,

Menchero²,

Garrido³

et al. 2017

Texas Heart Institute Journal

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Spontaneous coronary artery dissection is a rare condition, and diagnosis and treatment are challenging among patients who present with acute coronary syndrome. Typically, the condition affects young females who have no underlying atherosclerotic disease. To date, few cases of bioresorbable scaffold implantation for the treatment of spontaneous coronary artery dissection have been reported. Therefore, we describe the cases of 4 patients whom we treated with scaffolds. We evaluated the long-term results by using intravascular ultrasound and optical coherence tomographic scanning.

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Section: Discussionmentioning

confidence: 99%

Bioresorbable Scaffolds in Spontaneous Coronary Artery Dissection: Long-Term Follow-Up in 4 Patients

Freire¹,

Menchero²,

Garrido³

et al. 2017

Texas Heart Institute Journal

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“…A successful use of bioabsorbable vascular scaffolds (BVS) has been recently reported in several patients with non-pregnancy-related SCAD. [120][121][122] There is a potential advantage for the use of BVS for the treatment of PASCAD over stents, which may allow sealing and healing with scaffold resorption over time, avoiding lifetime commitment to metallic stents in young patients and possible return of vasoreactivity. 123 This aspect is especially important because PCI in women with SCAD is often associated with extension of coronary dissections requiring implantation of several stents.…”

Section: Percutaneous Interventionmentioning

confidence: 99%

Pregnancy and the Risk of Spontaneous Coronary Artery Dissection

Havakuk

Goland

Mehra

et al. 2017

Circ: Cardiovascular Interventions

137

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Background-Because of the rarity of this condition, information on pregnancy-associated spontaneous coronary artery dissection is limited. We reviewed a large number of contemporary pregnancy-associated spontaneous coronary artery dissection cases in an attempt to define the clinical characteristics and provide management recommendations. Methods and Results-A literature search for cases of pregnancy-associated spontaneous coronary artery dissection reported between 2000 and 2015 included 120 cases; 75% presented with ST-segment-elevation myocardial infarction, and 80% had anterior myocardial infarction. Left anterior descending coronary artery was involved in 72% of cases, left main segment in 36%, and 40% had multivessel spontaneous coronary artery dissection. Ejection fraction was reduced to <40% in 44% of cases. Percutaneous coronary intervention was successful in only 50% of cases. Coronary artery bypass surgery was performed in 44 cases because of complex anatomy, hemodynamic instability, or failed percutaneous coronary intervention. Maternal complications included cardiogenic shock (24%), mechanical support (28%), urgent percutaneous coronary intervention (28%), urgent coronary artery bypass surgery (27.5%), maternal mortality (4%), and fetal mortality (2.5%). During follow-up for 305±111 days, there was a high incidence of symptoms because of persistent or new spontaneous coronary artery dissections, and 5 women needed heart transplantation or ventricular assist device implantation. Conclusions-Pregnancy-associated spontaneous coronary artery dissection is commonly associated with left anterior descending, left main, and multivessel involvement, which leads to a high incidence of reduced ejection fraction, and lifethreatening maternal and fetal complications. Percutaneous coronary intervention is associated with low success rate and high likelihood of complications, and coronary artery bypass surgery is often required. Recurrent ischemic events because of persistent or new spontaneous coronary artery dissection are common during long-term follow-up. (Circ Cardiovasc Interv. 2017;10:e004941.

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“…12,13 A reabsorção espontânea do hematoma intramural ocorre ao longo do tempo, e a possibilidade de má aposição aguda ou tardia, com consequente risco de trombose do stent, tornaria atraente o uso de plataformas bioabsorvíveis, embora essa tecnologia tenha mostrado resultados pouco animadores ultimamente. 14 O tratamento cirúrgico aplica-se às circunstâncias nas quais a ICP não for possível.…”

Section: Discussionunclassified