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Spontaneous Coronary Artery Dissection — EECC MCQ

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HardCoronary Artery DiseaseSpontaneous Coronary Artery DissectionEECC

A 45-year-old man with no past medical history presents with an inferior STEMI. During primary PCI, the operator identifies a spontaneous coronary artery dissection (SCAD) of the distal RCA as the cause. There is TIMI 3 flow distally. What is the most appropriate management?

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Reveal the answer and explanation

Correct answer: E — Conservative management with medical therapy and close surveillance

Explanation lettering: D = shown as A · C = shown as B · E = shown as C · A = shown as D · B = shown as E

In SCAD with TIMI 3 flow and no ongoing ischaemia, conservative management is recommended as the dissection typically heals spontaneously. Stenting of SCAD (A) carries a high risk of propagating the dissection. CABG (C) is reserved for ongoing ischaemia despite conservative measures or left main dissection. GPIIb/IIIa inhibitors (D) may worsen intramural haematoma. Intravascular lithotripsy (E) is for calcified lesions and has no role in SCAD.

Reference: ESC (2023): Guidelines for the Management of Acute Coronary Syndromes