Coronary artery fenestration as rescue management of intramural haematoma with luminal compression

Abstract

Conservative management is the first‐line treatment for spontaneous coronary artery dissection (SCAD) with stable haemodynamic status and thrombolysis in myocardial infarction three flow on angiography. However, in a few very specific patients, recurrent ischemia, or haemodynamic instability necessitates revascularization. Here, we describe a case of successful optical coherence tomography (OCT)‐guided percutaneous coronary intervention (PCI) with a cutting balloon. We performed fenestration at multiple decompression sites prior to stenting in an intramural haematoma with luminal compression. Rescue management of SCAD with luminal compression is a critical issue, because SCAD is an emergent clinical condition affecting young patients with a severe prognosis. To our knowledge, there are no large published series evaluating procedural success rates and long‐term follow‐up of this technique.

Successful Coronary Flow Restoration by Stent-Free Strategy Using the Pull-Back Method of Cutting Balloon in Spontaneous Coronary Artery Dissection

“…6 Intracoronary imaging is an evolving technology for diagnosing SCAD. In a recent case report by Bresson et al, 7 optical coherence tomography was used to show IMH and false lumen progression in a patient with SCAD treated with the cutting balloon strategy. optical coherence tomography provides more detailed information with significantly higher resolution than IVUS.…”

Successful revascularization with percutaneous coronary intervention using a combination of the subintimal transcatheter withdrawal technique and coronary artery fenestration for spontaneous coronary artery dissection

“…Some case reports have shown the efficacy of coronary artery fenestration with cutting balloon angioplasty to decompress the hematoma and avoiding longitudinal extension. 6 , 7 , 8 We also attempted this technique; however, our attempt was unsuccessful. We believe the following reasons were responsible for the failure of this attempt: 1) the cutting balloon could not advance sufficiently distally because the true lumen was severely compressed by the false lumen and 2) the dissection had reached the distal end of the LAD.…”

“… 4 , 5 Percutaneous coronary intervention (PCI) for SCAD treatment is associated with an increased risk of complications and suboptimal outcomes; however, several case reports have shown the efficacy of coronary artery fenestration with cutting balloon angioplasty. 6 , 7 , 8 Here, we present the case of a patient with SCAD whose ischemia was not corrected with coronary artery fenestration alone but was successfully revascularized by the additional use of the subintimal transcatheter withdrawal (STRAW) technique. 9 , 10…”

Successful revascularization with percutaneous coronary intervention using a combination of the subintimal transcatheter withdrawal technique and coronary artery fenestration for spontaneous coronary artery dissection

“…Some case reports have shown the efficacy of coronary artery fenestration with cutting balloon angioplasty to decompress the hematoma and avoiding longitudinal extension. [6][7][8] We also attempted this technique; however, our attempt was unsuccessful. We believe the following reasons were responsible for the failure of this attempt: 1) the cutting balloon could not advance sufficiently distally because the true lumen was severely compressed by the false lumen and 2) the dissection had reached the distal end of the LAD; therefore, coronary artery fenestration could not be made at the distal end of the false lumen, and the compression of the true lumen was not released by the remaining hematoma in the false lumen.…”

“…4,5 Percutaneous coronary intervention (PCI) for SCAD treatment is associated with an increased risk of complications and suboptimal outcomes; however, several case reports have shown the efficacy of coronary artery fenestration with cutting balloon angioplasty. [6][7][8] Here, we present the case of a patient with SCAD whose ischemia was not corrected with coronary artery fenestration alone but was successful revascularized by the additional use of the subintimal transcatheter withdrawal (STRAW) technique. 9,10…”