From medical treatment to CABG, considering also percutaneous angioplasty, management of spontaneous dissection of coronary arteries, especially during or after pregnancy, is not standardized. In clinical practice, how to do with such condition?
Currently, there are no guidelines that have been established regarding the optimal management strategy for patients with SCAD in the peripartum period. This may be the result of the rarity of the disease, reported sporadically with little long-term follow-up data available. However, the treatment strategy for peripartum SCAD should take into consideration the hemodynamic status of the patient, the extent of the myocardium at risk and certainly, in pregnant patients the well-being of the fetus. Medical therapy is currently reserved for patients who have demonstrated limited dissection on angiography, percutaneous coronary intervention (PCI) being the treatment of choice in patients with ongoing signs of ischemia and single-vessel disease, or in those in whom a large, viable myocardial territory is at risk, such as proximal LAD disease. CABG surgery has been successfully used in SCAD involving the LMCA, multivessel dissections or in cases of medical or PCI failure.
thanks a lot for all these pertinent answers.
stenting the wrong lumen is a really risk when we opt of percutaneous angioplasty. If necessary, the procedure can be done under guidance of intravascular ultrasounds. it must make PCI more safe!!
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