Casi Clinici


IVUS-guided BioVascular Scaffolds
implantation to treat a Sudden
Coronary Spontaneous Dissection in a young woman



Medical History

48 years old healthy and sporty woman
Without any comorbidities / chronic drug treatment

Cardiovascular History

  • Jan the 3rd 2014: during a trekking excursion over mountains, experienced a prolonged angina
->ER: NSTEMI troponin I up to 2.9 ng/dl; EF 50% with anterior hypokinesia.

Diagnostic Angiogram


Cranial view - Left Anterior cranial view

IVUS interrogation LAD

IVUS Interrogation

DA VEDERE

First BioVascular Scaffold implantation


Bioabsorbable Vascular Scaffold (BVS) 2,5/18 mm implantation
Angiografic result after implantation
Semi-compliant balloon dilatation (2,5/40 mm at 10 atm)
Antegrade flow restoration with residual segment of dissection in the distal LAD
BioVascular Scaffold (2,5 x 28 mm) implantation Post-dilatation NC 2.5/10mm @24atm

Final Angiographic and IVUS result

DA VEDERE

Learning messages

  • Optimal treatment of Sudden Coronary Spontaneous Dissection remains still debated.
  • In this case, the use of Intravascular Imaging was the key to confirm the diagnosis, to assure the correct wiring of the lesion as well to control residual dissections and the extension of subintimal hematoma after stents deployment.
  • The use of BioVascular Scaffolds could be an attractive option in such patients that usually are young and otherwise healthy as well at high risk of extensive treatment in case of propagation of hematoma