Why not to stent in SCAD with TIMI 3 flow?
Presenter
Wah Wah Htun, M.D., FSCAI, Gundersen Health System, La Crosse, WI
Wah Wah Htun, M.D., FSCAI, Gundersen Health System, La Crosse, WI
Title:
Why Not stent in SCAD with TIMI 3 flow?
Introduction:
37 yr old Amish lady without cardiac risk factor, came in after few days long chest pain. she was 2.5 months post partum from her last child ( 9th child).
Clinical Case:
EKG showed T wave inversion in anterior leads. High sensitivity troponin was in 300 range. Echo showed hypokinesis of inferoseptal and apical segment. Coronary angiography showed type 2 SCAD in mid LAD with TIMI 3 flow but TIMI 2 flow in last diagonal br. IVUS of proximal LAD showed retrograde dissection of intramural hematoma back to proximal LAD. Since her chest pain is minimal with SCAD in LAD having TIMI 3 flow, decided to manage with medical therapy including asa 81 mg daily for 6 mths along with low dose metoprolol.
Discussion:
Recognition is the key in the diagnosis of SCAD. This IVUS showed the good learning experience why stenting of SCAD area will make proximal and distal vessel intramural hematoma worse as it is not easily recognized by angiography.