The role of angioplasty in spontaneous coronary dissection

Spontaneous coronary dissection (SCAD), although rare, is a significant cause of acute coronary syndrome (ACS) in young patients, particularly women without notable risk factors. Due to the limited number of cases reported in the literature and the scarcity of prospective studies, uncertainties remain regarding the most appropriate therapeutic approach. Observational studies of small sample sizes suggest a benefit in adopting a conservative strategy, reserving revascularization for cases with ongoing ischemia, hemodynamic instability, or high-risk anatomy.

The aim of this study was to analyze our local experience regarding the epidemiology and therapeutic approach to SCAD, with a particular focus on cases that underwent revascularization.

We conducted a single-center, retrospective study of patients that underwent urgent catheterization procedures between January 2022 and October 2024. Patients with SCAD were selected. Electronic medical records were reviewed and sociodemographic, clinical, catheterization data, medical treatment, and follow-up were assessed.

Out of 257 catheterizations performed for suspected ACS, six patients were included (2.3%), 5 of whom were women, with a mean age of 49.8 ± 7.1 years (range: 41-61). The mean maximal troponin level was 17356 ± 16562 ng/L (range: 2090-49646). There was a low prevalence of cardiovascular risk factors: dyslipidemia (n=3), hypertension (n=2), and overweight (n=1). There was an history of previous ACS in 2 cases. Electrocardiographically, 2 patients presented with ST-segment elevation. The most frequently involved vessel was the left anterior descending artery (n=2) (figure 1). A conservative strategy was adopted in 4 cases, although stenting was necessary in two (figure 2). In one case, evidence of ongoing ischemia (chest pain and new ST elevation) warranted the implantation of a single stent, while in another, four sequential stents were implanted to restore the coronary flow and prevent the progression of the dissection. The mean left ventricle ejection fraction after the event was 53.7% (range: 46.0-61.0). The outpatient therapy included dual antiplatelet therapy (n=6), beta-blockers (n=6), ACE inhibitors (n=3), calcium channel blockers (n=2), and statins (n=4). Screening for arterial disease in other territories revealed splenic and renal aneurysms in only one patient. One patient underwent a follow-up coronary angiography 6 months after the event, which confirmed complete resolution of the dissection with no observed recurrence.