Aortic dissection type B and SCAD

A 57 years-old female was admitted in regional hospital because of NSTEMI with OHCA due to the VF in October 2022.
Risk factors for cardiovascular diseases: hypertension, positive family history for CVD and smoker.

Three years ago Stanford B dissection was registered and conservatively treated.

After initial stabilisation patient was transferred to the tertiary center for coronary angiography and further diagnostic.
At the admission she was without any symptoms.
Status at the admission: alerted, oriented, hemodynamically and rhythmically stable, Killip I.

ECG on admission:

ECHO:

Coronary angiography:

Operators: Prof. Dr I. Ivanov, Doc. Dr M. Čanković, IKVBV Sremska Kamenica

Would you decide for PCI LAD?

Comments

Aleksandra Djokovic 09/02/2023 at 12:21 (Edit)

Great images of the case! Since patient was without chest pain, with a TIMI 2-3 flow in LAD, would opt for conservative treatment (no PCI, no DAPT or LMWH, control angio before dismission). Best regards for colleagues from IKVB Sremska Kamenica!
Gordana Krljanac 09/02/2023 at 17:20 (Edit)

It is a really great case. I am not an interventional cardiologist, however, it is very illustrative. And what did you do? Could you inform us about the FU of this patient, please?
Svetlana Apostolović 09/02/2023 at 22:29 (Edit)

Thank you for these experience.
I would also stay to a conservative approach.
How do you explain the association of aortic dissection and SCAD?
Svetlana 10/02/2023 at 19:27 (Edit)

What do you think about contrast retension before LM? Calcium?
Vladimir Mitov 13/02/2023 at 19:26 (Edit)

Very interesting case. Of curse conservative approach is correct choice for this patients. Fibromuscular dysplasia can be pathophysiological mechanism who can explain aortic dissection and SCAD. Shadow (contrast retention) before LM is similar like calcium, but must think about aortic dissection especially in patients with history for aortic dissections and SCAD!

Milenko Čanković 13/02/2023 at 19:48 (Edit)

Since the patient had NSTEMI complicated with VF and OHCA I wouldn’t be brave enough to proceed with conservative treatment without a further diagnostic.
I would do intracoronary imaging to assess the distribution and MLA of the true lumen. If the true lumen is severely compromised I would proceed with PCI. I agree with Dr Mitov that FMD can be the cause.

Reply

16February2023

Part two

In the second act was planned PCI LAD with intravascular imaging ( OCT).

During the hospitalization, the patient had symptoms of COVID-19 infection and was transferred to COVID hospital Novi Sad.

Two weeks later OCT guided PCI LAD was performed.

OCT pullback before PCI

PCI LAD

OCT pullback after stent implantation

Stent postdilatation

Final result:

8 Replies to “Aortic dissection type B and SCAD”

Aleksandra Djokovic says: 09/02/2023 at 12:21

Great images of the case! Since patient was without chest pain, with a TIMI 2-3 flow in LAD, would opt for conservative treatment (no PCI, no DAPT or LMWH, control angio before dismission). Best regards for colleagues from IKVB Sremska Kamenica!

Gordana Krljanac says: 09/02/2023 at 17:20

It is a really great case. I am not an interventional cardiologist, however, it is very illustrative. And what did you do? Could you inform us about the FU of this patient, please?

Svetlana Apostolović says: 09/02/2023 at 22:29

Thank you for these experience.
I would also stay to a conservative approach.
How do you explain the association of aortic dissection and SCAD?

Svetlana says: 10/02/2023 at 19:27

What do you think about contrast retension before LM? Calcium?

Vladimir Mitov says: 13/02/2023 at 19:26

Very interesting case. Of curse conservative approach is correct choice for this patients. Fibromuscular dysplasia can be pathophysiological mechanism who can explain aortic dissection and SCAD. Shadow (contrast retention) before LM is similar like calcium, but must think about aortic dissection especially in patients with history for aortic dissections and SCAD!

Milenko Čanković says: 13/02/2023 at 19:48

Since the patient had NSTEMI complicated with VF and OHCA I wouldn’t be brave enough to proceed with conservative treatment without a further diagnostic.
I would do intracoronary imaging to assess the distribution and MLA of the true lumen. If the true lumen is severely compromised I would proceed with PCI. I agree with Dr Mitov that FMD can be the cause.

I says: 18/02/2023 at 19:14

Dear colleagues,
1. You performed LAD PCI fantastically, guided with OCT!!!!!
2. Would you be so kind to show us a left ventricle ECHO two weeks after initial NSTEMI? (I expected LV function improvement and before PCI)
3. You are virtuous and procedure was done very good, but it was a dangerous to work ! In situations with huge false lumen we would to try to fenestration intima with cutting balloon ! Stent implementation in SCAD artery would be start from proximal to distal or with sandwich Technic.
4. All the time the flow was TIMI 3, and conservative treatment would be acceptable, with follow up!
5. Please to send us follow up OCT!!! We need to know a possibility of stent malappostion after haematoma resorption!
6. Congratulation, one more time!

Bojan says: 21/02/2023 at 17:49

very interesting case. considering the slow coronary flow and large false lumen, cutting balloon colud have been an option. Second option is of course oct guided PCI.In this particularly case ( ACS and VF) agree with invasive approach.

Serbian conference on interventional cardiology

Aortic dissection type B and SCAD

Comments

Part two

8 Replies to “Aortic dissection type B and SCAD”

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