Stent Embolization in Spontaneous Coronary Artery Dissection and Its Deployment at the Right Radial Artery.

Curēus
Akash BattaBasant Kumar

Abstract

Spontaneous coronary artery dissection (SCAD) is an unusual but important cause of acute coronary syndrome and is often underdiagnosed. The first clue to the diagnosis is the angiographic appearance of the lesion, and, in certain cases, intravascular imaging is needed to confirm it. Conservative management is the preferred treatment strategy for the majority of cases. However, revascularization is needed in the presence of high-risk features, including hemodynamic instability, ongoing ischemia, and left main dissection. We report a case of a 43-year-old man who presented with acute inferior wall myocardial infarction. Angiogram revealed SCAD of the right coronary artery (RCA). In view of ongoing chest pain, we proceeded with direct stenting. However, during the stent delivery, the stent got embolized and laid unexpanded in the proximal RCA. The stent was successfully retrieved and was deployed at the right radial artery. Subsequently, after the troubleshoot, we again secured wire access across the RCA, and this time after pre-dilatation, successful stenting across the SCAD segment was achieved. Percutaneous coronary intervention (PCI) in SCAD is technically challenging with lower success and higher complication rates compared t...Continue Reading

References

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