Bioresorbable Scaffolds to Treat Spontaneous Coronary Artery Dissection.

S pontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndromes (ACS), typically affecting female and younger individuals with no underlying atherosclerotic disease. 1 Diagnosis of SCAD has traditionally relied on coronary angiography; however, new imaging modalities, and especially optical coherence tomography (OCT), improve diagnostic accuracy and help management. 2 The optimal treatment strategy remains controversial and may vary from a completely conservative approach to percutane-ous or even surgical revascularization, always guided by the clinical scenario and symptoms. 1 When percutaneous coronary intervention is chosen, metal stents are usually implanted on vessels with no significant atherosclerotic lesions. 3 Use of bioresorbable vascular scaffolds (BVS) may have an interesting therapeutic role for these patients because they disappear completely after 2 or 3 years and may allow for a complete functional recovery, 4 which is particularly appealing in SCAD, where spontaneous healing is part of the natural history of this entity. In this sense, we describe 3 documented experiences corresponding to 3 different patients with ACS caused by SCAD from 3 different coronary arteries. Case 1: 58-year-old male, active smoker, with systemic hypertension and family history of coronary disease. He was admitted for presenting an inferior ST-segment–elevation myocardial infarction. Diagnostic coronary angiography (Figure 1, row 1, first column) showed an occluded right coronary artery with an image of a large dissection. The rest of the coronary tree appeared normal. Five Absorb stents were implanted with a successful result (Figure 1, second column; arrows indicate stented segment). Ten days later, the patient experienced rest angina, and coronary angiography was repeated, showing narrowing of the vessel distal to the stents. OCT revealed an intramural hematoma after the last stent (Figure 2). Another Absorb stent was implanted overlapping the previous one, with good results (Figure 2). Control angiography at 6 months with OCT showed good patency of the treated vessel and good endothelialization of the struts (Figure 1, row1, third and fourth column). Case 2 (Figure 1, row 2): 43-year-old woman, active smoker. Admitted for a Non–ST-segment–elevation acute coronary syndrome. Coronary angiogram showed a circum-flex coronary artery dissection image with poor anterograde flow. The rest of the arteries appeared normal. OCT-guided implantation of 3 Absorb stents was performed recovering patency and normal angiographic appearance of the vessel. Control study with OCT 6 months later showed satisfactory angiographic results and process of endothelialization of the stents' struts. Case 3 (Figure 1, row 3): …