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Successful treatment of a spontaneous right coronary artery dissection with a 4-mm diameter cutting balloon: a case report.
Eur Heart J Case Rep. 2019 Dec; 3(4):1-6.EH

Abstract

Background

Guidelines recommend conservative management for a spontaneous coronary artery dissection (SCAD) in the absence of ongoing ischaemia, haemodynamic instability, or left main dissection. Conventional percutaneous coronary intervention methods for SCAD are associated with an unfavourable prognosis due to difficulties wiring the lesion, dissection propagation, and potential 'milking' of the intramural haematoma along the vessel or into other vessels. These factors promote implantation of multiple stents which are often undersized, increasing the risk of in-stent restenosis significantly. There have been several case reports demonstrating the novel use of small diameter cutting balloons in the left anterior descending artery system. Here, we describe the successful use of a larger 4 mm cutting balloon to treat a spontaneous right coronary artery (RCA) dissection.

Case summary

A 53-year-old woman with troponin negative chest pain and was diagnosed with unstable angina due to ischaemic electrocardiographic features. Coronary angiography revealed a tight discrete lesion in the RCA. Intravascular imaging confirmed SCAD and a 4 mm cutting balloon was used to dissect the tunica intima to allow complete resorption of the intramural haematoma and resolution of symptoms.

Discussion

This case demonstrates the safe use of a larger 4 mm cutting balloon to treat an RCA SCAD, resulting in complete resolution of the haematoma.

Authors+Show Affiliations

Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, B15 2TH Edgbaston, Birmingham, UK.Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, B15 2TH Edgbaston, Birmingham, UK. Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy.Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, B15 2TH Edgbaston, Birmingham, UK.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31912001

Citation

Sharma, Harish, et al. "Successful Treatment of a Spontaneous Right Coronary Artery Dissection With a 4-mm Diameter Cutting Balloon: a Case Report." European Heart Journal. Case Reports, vol. 3, no. 4, 2019, pp. 1-6.
Sharma H, Vetrugno V, Khan SQ. Successful treatment of a spontaneous right coronary artery dissection with a 4-mm diameter cutting balloon: a case report. Eur Heart J Case Rep. 2019;3(4):1-6.
Sharma, H., Vetrugno, V., & Khan, S. Q. (2019). Successful treatment of a spontaneous right coronary artery dissection with a 4-mm diameter cutting balloon: a case report. European Heart Journal. Case Reports, 3(4), 1-6. https://doi.org/10.1093/ehjcr/ytz212
Sharma H, Vetrugno V, Khan SQ. Successful Treatment of a Spontaneous Right Coronary Artery Dissection With a 4-mm Diameter Cutting Balloon: a Case Report. Eur Heart J Case Rep. 2019;3(4):1-6. PubMed PMID: 31912001.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Successful treatment of a spontaneous right coronary artery dissection with a 4-mm diameter cutting balloon: a case report. AU - Sharma,Harish, AU - Vetrugno,Vincenzo, AU - Khan,Sohail Q, Y1 - 2019/11/27/ PY - 2019/07/18/received PY - 2019/09/17/revised PY - 2019/11/07/accepted PY - 2020/1/9/entrez PY - 2020/1/9/pubmed PY - 2020/1/9/medline KW - Case report KW - Cutting balloon KW - Percutaneous coronary intervention KW - Spontaneous coronary artery dissection SP - 1 EP - 6 JF - European heart journal. Case reports JO - Eur Heart J Case Rep VL - 3 IS - 4 N2 - Background: Guidelines recommend conservative management for a spontaneous coronary artery dissection (SCAD) in the absence of ongoing ischaemia, haemodynamic instability, or left main dissection. Conventional percutaneous coronary intervention methods for SCAD are associated with an unfavourable prognosis due to difficulties wiring the lesion, dissection propagation, and potential 'milking' of the intramural haematoma along the vessel or into other vessels. These factors promote implantation of multiple stents which are often undersized, increasing the risk of in-stent restenosis significantly. There have been several case reports demonstrating the novel use of small diameter cutting balloons in the left anterior descending artery system. Here, we describe the successful use of a larger 4 mm cutting balloon to treat a spontaneous right coronary artery (RCA) dissection. Case summary: A 53-year-old woman with troponin negative chest pain and was diagnosed with unstable angina due to ischaemic electrocardiographic features. Coronary angiography revealed a tight discrete lesion in the RCA. Intravascular imaging confirmed SCAD and a 4 mm cutting balloon was used to dissect the tunica intima to allow complete resorption of the intramural haematoma and resolution of symptoms. Discussion: This case demonstrates the safe use of a larger 4 mm cutting balloon to treat an RCA SCAD, resulting in complete resolution of the haematoma. SN - 2514-2119 UR - https://www.unboundmedicine.com/medline/citation/31912001/Successful_treatment_of_a_spontaneous_right_coronary_artery_dissection_with_a_4-mm_diameter_cutting_balloon:_a_case_report L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31912001/ DB - PRIME DP - Unbound Medicine ER -
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