Aspiration technique in occlusive spontaneous coronary artery dissection

A 53-year-old woman with no cardiovascular risk factors was admitted for anterior ST-segment elevation myocardial infarction. Coronary angiography revealed an abrupt mid-left anterior descending (LAD) coronary artery occlusion (Figure 1A) and the absence of atheroma in other coronary arteries (Moving image 1, Moving image 2). Spontaneous coronary artery dissection (SCAD) was suspected, and percutaneous coronary intervention was performed because of ongoing ischaemia in a large myocardial area (Moving image 3). Intravascular ultrasound (IVUS) revealed an extensive intramural haematoma, with compression of the true lumen (TL) by the false lumen (FL) throughout the distal segment (Moving image 4), confirming a type 4 SCAD (occluded vessel) and showing a long subintimal passage of the guidewire with a very distal TL re-entry (Figure 1A1-Figure 1A3). The haematoma was manually aspirated, using a 6 Fr Eliminate catheter (Terumo) in order to reduce the compression of the TL. After the first aspiration, coronary flow was immediately restored to Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow (Figure 1B, Moving image 5, Moving image 6) with normalisation of the electrocardiogram. Three aspiration passages across the lesion were performed. Optical...