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Maričić B, Perišić Z, Kostić T, Božinović N, Petrović M, Čanković M, Mehmedbegović Z, Juričić S, Vasilev V, Dakić S, Perišić J, Milošević J, Bojanović M, Nikolić M, Maričić T, Apostolović S. An analysis of published cases of cutting balloon use in spontaneous coronary artery dissection. Front Cardiovasc Med 2023; 10:1270530. [PMID: 38028445 PMCID: PMC10666782 DOI: 10.3389/fcvm.2023.1270530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction SCAD involves a sudden tear or separation within the layers of the coronary artery wall, resulting in blood flow obstruction and subsequent myocardial ischemia. Materials and methods A comprehensive literature search was conducted to identify relevant published cases of cutting balloon use in patients diagnosed with spontaneous coronary artery dissection. Electronic databases including PubMed, MEDLINE, Embase, Cochrane Library and Google Scholar were systematically searched from inception until the present using terms "cutting balloon," "SCAD," "acute coronary syndrome," "intramural hematoma," and "angioplasty." Results A total of 32 published cases of cutting balloon use in spontaneous coronary artery dissection were analyzed in this study. The majority of the patients included in the analysis were female without prior history of cardiovascular disease. The median age of the SCAD population was approximately 46 years. The most frequently affected artery in SCAD cases was the Left Anterior Descending artery. Intravascular ultrasound was utilized more frequently than other modalities of adjunctive imaging techniques. The most frequent complication was the distal propagation of hematoma. Despite the successful dilation achieved with the cutting balloon, in some cases stenting was required to provide additional support. Conclusion The results of this analysis demonstrate that cutting balloon use in SCAD cases yields favorable outcomes.
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Affiliation(s)
- Bojan Maričić
- Department of Cardiology, University Clinical Center Nis, Niš, Serbia
| | - Zoran Perišić
- Department of Cardiology, University Clinical Center Nis, Niš, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of Nis, Niš, Serbia
| | - Tomislav Kostić
- Department of Cardiology, University Clinical Center Nis, Niš, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of Nis, Niš, Serbia
| | - Nenad Božinović
- Department of Cardiology, University Clinical Center Nis, Niš, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of Nis, Niš, Serbia
| | - Milovan Petrović
- Department of Cardiology, Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Milenko Čanković
- Department of Cardiology, Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Zlatko Mehmedbegović
- Department of Cardiology, University Clinical Center Belgrade, Belgrade, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of Belgrade, Belgrade, Serbia
| | - Stefan Juričić
- Department of Cardiology, University Clinical Center Belgrade, Belgrade, Serbia
| | - Vladimir Vasilev
- Department of Cardiology, VFV Clinic Skopje, Skopje, North Macedonia
| | - Sonja Dakić
- Department of Cardiology, University Clinical Center Nis, Niš, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of Nis, Niš, Serbia
| | - Jelena Perišić
- Department of Cardiology, University Clinical Center Nis, Niš, Serbia
| | - Jelena Milošević
- Department of Cardiology, University Clinical Center Nis, Niš, Serbia
| | - Mihajlo Bojanović
- Department of Cardiology, University Clinical Center Nis, Niš, Serbia
| | - Miroslav Nikolić
- Department of Cardiology, University Clinical Center Nis, Niš, Serbia
| | - Tijana Maričić
- Department of Anesthesiology, Resuscitation and Intensive Therapy, University Clinical Center Nis, Niš, Serbia
| | - Svetlana Apostolović
- Department of Cardiology, University Clinical Center Nis, Niš, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of Nis, Niš, Serbia
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Apostolovic S, Maricic B, Bozinovic N, Kostic T, Perisic Z, Djokovic A, Bojanovic M, Petrovic M, Stankovic G. The Use of Cutting Balloons in Published Cases of Acute Coronary Syndrome Caused by Spontaneous Coronary Artery Dissection. Rev Cardiovasc Med 2023; 24:235. [PMID: 39076696 PMCID: PMC11266841 DOI: 10.31083/j.rcm2408235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/31/2023] [Accepted: 04/24/2023] [Indexed: 07/31/2024] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a non-traumatic, non-atherosclerotic layering of the coronary artery wall due to the presence of a subintimal hematoma or an intimal tear with the creation of a false lumen that compresses the true lumen and restricts or obstructs the flow. Patients with SCAD and preserved coronary flow are treated conservatively according to the general recommendations. However, percutaneous coronary intervention should be considered in patients with artery occlusion and/or refractory ischemia. Stenting is associated with increased risks comprising stenting in the false lumen, in-stent thrombosis, and/or stent malappositon as well as antegrade or retrograde propagation of the intramural hematoma. Intracoronary imaging is of great value both for the diagnosis and treatment of SCAD. There is rising scrutiny on the use of cutting balloons in acute coronary syndrome caused by SCAD. The idea of using cutting balloons is to fenestrate the intima and drain the intramural hematoma. Our review presents an analysis of 17 published cases of cutting balloon (CB) use in SCAD. What is encouraging is that of the 12 published cases, in 11 Thrombolysis in Myocardial Infarction (TIMI) 3 flow was established with this technique, and TIMI 2 flow in one, without subsequent stent implantation. Four patients received a stent after the CB use, while one patient underwent CB angioplasty after hematoma propagation caused by stent implantation. In all cases, patients were asymptomatic at follow-up, with TIMI 3 flow.
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Affiliation(s)
- Svetlana Apostolovic
- Department of Cardiology, Division of Interventional Cardiology,
University Clinical Center Nis, 18000 Nis, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of Nis,
18000 Nis, Serbia
| | - Bojan Maricic
- Department of Cardiology, Division of Interventional Cardiology,
University Clinical Center Nis, 18000 Nis, Serbia
| | - Nenad Bozinovic
- Department of Cardiology, Division of Interventional Cardiology,
University Clinical Center Nis, 18000 Nis, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of Nis,
18000 Nis, Serbia
| | - Tomislav Kostic
- Department of Cardiology, Division of Interventional Cardiology,
University Clinical Center Nis, 18000 Nis, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of Nis,
18000 Nis, Serbia
| | - Zoran Perisic
- Department of Cardiology, Division of Interventional Cardiology,
University Clinical Center Nis, 18000 Nis, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of Nis,
18000 Nis, Serbia
| | - Aleksandra Djokovic
- Department of Cardiology, Division of Interventional Cardiology,
University Hospital Center Bezanijska kosa, 11080 Belgrade, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of
Belgrade, 11000 Belgrade, Serbia
| | - Mihajlo Bojanovic
- Department of Cardiology, Division of Interventional Cardiology,
University Clinical Center Nis, 18000 Nis, Serbia
| | - Milovan Petrovic
- Department of Cardiology, Division of Interventional Cardiology,
Cardiovascular Institute Vojvodina, 21204 Sremska Kamenica, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of Novi
Sad, 21000 Novi Sad, Serbia
| | - Goran Stankovic
- Faculty of Medicine, Department of Internal Medicine, University of
Belgrade, 11000 Belgrade, Serbia
- Department of Cardiology, Division of Interventional Cardiology,
University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Zainobidinov SS, Khelimsky DA, Baranov AA, Badoyan AG, Krestyaninov OV. Modern aspects of diagnosis and treatment of patients with spontaneous coronary artery dissection. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is one of the rarest causes of acute coronary syndrome. SCAD is most common in women <60 years of age (≥90% of cases) compared with men (10-12%). The rapid development of technologies used in interventional cardiology has made it possible to improve diagnostics and understand the pathogenesis. The management strategy in patients with SCAD is debatable and differs significantly from approaches to coronary atherosclerosis treatment. The review presents the results of recent studies. The angiographic classification of SCAD, the diagnostic algorithm and the choice of optimal treatment depending on clinical manifestations are also described.
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Aikawa T, Funayama N, Sunaga D, Furugen M, Hotta D. Treatment of an iatrogenic left main coronary artery dissection and intramural hematoma by fenestration instead of stent implantation. Hellenic J Cardiol 2022; 65:61-63. [PMID: 35278694 PMCID: PMC8904324 DOI: 10.1016/j.hjc.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/01/2022] [Accepted: 02/20/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Tadao Aikawa
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, Minami-27, Nishi-13, Chuo-ku, Sapporo, 064-8622, Japan; Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
| | - Naohiro Funayama
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, Minami-27, Nishi-13, Chuo-ku, Sapporo, 064-8622, Japan
| | - Daisuke Sunaga
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, Minami-27, Nishi-13, Chuo-ku, Sapporo, 064-8622, Japan
| | - Makoto Furugen
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, Minami-27, Nishi-13, Chuo-ku, Sapporo, 064-8622, Japan
| | - Daisuke Hotta
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, Minami-27, Nishi-13, Chuo-ku, Sapporo, 064-8622, Japan
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Fujita H, Yokoi M, Ito T, Nakayama T, Shintani Y, Sugiura T, Seo Y, Ohte N. Unusual interventional treatment of spontaneous coronary artery dissection without stent implantation: a case series. Eur Heart J Case Rep 2021; 5:ytab306. [PMID: 34377927 PMCID: PMC8350351 DOI: 10.1093/ehjcr/ytab306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/30/2020] [Accepted: 07/13/2021] [Indexed: 11/16/2022]
Abstract
Background Spontaneous coronary artery dissection (SCAD) is a unique cause of myocardial infarction, and optimal treatment should be selected according to the ischaemic condition. Patients with ongoing ischaemia or haemodynamic instability may require revascularization. Cutting balloon (CB) angioplasty has been acknowledged as an option for revascularization. However, few observations of the coronary artery conditions after CB angioplasty in SCAD patients have been reported. Here, we demonstrate two cases in which we evaluated the angiographic morphology of targeted coronary arteries in the chronic phase after CB angioplasty. Case summary Patient 1 was a 46-year-old woman who presented at our hospital with chest pain. Electrocardiography suggested acute coronary syndrome and coronary angiography was performed. The coronary angiography and intravascular ultrasound (IVUS) examinations revealed SCAD in the left anterior descending artery (LAD). Revascularization with CB angioplasty was successful. Follow-up coronary angiography 15 months after the angioplasty showed no visible stenosis in the LAD. Accordingly, the patient no longer needed to antiplatelet therapy. Patient 2 was a 50-year-old woman who was transported to our hospital for ventricular tachycardia. Coronary angiography and IVUS revealed SCAD in the right coronary artery. Coronary flow was restored by CB angioplasty. Follow-up contrast-enhanced computed tomography angiography 36 months after angioplasty showed a healed appearance. Thus, she was able to discontinue antiplatelet therapy. Discussion Cutting balloon angioplasty may be a possible method to treat SCAD.
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Affiliation(s)
- Hiroshi Fujita
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Masashi Yokoi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Takafumi Nakayama
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Yasuhiro Shintani
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Tomonori Sugiura
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
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Zghouzi M, Moussa Pacha H, Sattar Y, Alraies MC. Successful Treatment of Spontaneous Coronary Artery Dissection With Cutting Balloon Angioplasty. Cureus 2021; 13:e13706. [PMID: 33824840 PMCID: PMC8016528 DOI: 10.7759/cureus.13706] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare but serious condition that requires immediate attention. It has a similar presentation to acute coronary syndrome in terms of chest pain, electrocardiogram changes, and an increase in troponins, and is considered to be a significant cause of myocardial infarction. Coronary angiography is needed to confirm the diagnosis, and subsequent repair should be pursued when needed. We describe a case of SCAD in a 72-year-old female treated using the cutting balloon angioplasty technique to create communication between the true and false lumens.
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Affiliation(s)
| | - Homam Moussa Pacha
- Cardiovascular Disease, University of Texas Health Science Center at Houston McGovern Medical School, Houston, USA
| | - Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
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