Abstract 12977: Combined Coronary Stenting and Cutting Balloon Angioplasty in the Management of a Postpartum Spontaneous Coronary Artery Dissection

Abstract

Introduction: Spontaneous coronary artery dissection (SCAD), whilst documented in the peripartum period, has limited data in regard to management with cardiac intervention. SCAD is typically managed conservatively; however, in cases of hemodynamic instability and persistent ischemia, cardiac intervention with percutaneous coronary intervention (PCI) or coronary artery bypass grafting can be considered. Case: We present the case of a 34-year-old G2P2 female, without significant past medical history, who initially presented with severe substernal chest pain, five days following a spontaneous vaginal delivery. Initial electrocardiogram revealed sinus bradycardia without ischemic changes. Troponin I was elevated to 0.22 and 0.24. Heparin infusion, Aspirin loading, and Metoprolol were initiated. Coronary catheterization was performed and revealed dissection of a large left circumflex artery dissecting distally into the first obtuse marginal (OM1). A drug eluting stent (DES) was placed to the OM1. However, this worsened the dissection hematoma, propagating distally to the second obtuse marginal (OM2), also treated with a DES. Cutting balloon angioplasty was performed on the proximal circumflex to fenestrate the dissection flap and prevent proximal propagation of the dissection. A third DES was placed to the proximal circumflex artery. The patient continued dual anti-platelet therapy (DAPT) for one year, without complication. Conclusions: SCAD, in a young postpartum female, is a rare and potentially catastrophic condition. We present a case of SCAD, managed with PCI. This case demonstrates both the risk of dissection propagation with coronary stenting, as well as potential risk mitigation with cutting balloon angioplasty. Figure 1. Coronary Catheterization with PCI. A , SCAD of Lateral Circumflex to OM1. B , Post-DES to OM1 with dissection propagation to OM2 . C , Post-DES to OM2. D , Post-Balloon angioplasty and DES to proximal lateral circumflex