Coronary Artery Dissection: When Conservative Medical Therapy Has Not Achieved Angiographic Healing
Coronary artery dissection is initially managed conservatively with medical therapy, with angiographic healing of the dissection as the primary treatment goal. When that goal is not reached — or when the patient deteriorates clinically — a more definitive intervention is required.
Conservative management with medical therapy (including aspirin, β-blockers, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers where indicated) is considered to have failed when angiographic healing of the coronary artery dissection is not achieved, or when clinical worsening occurs despite this approach.
The protocol for this situation centres on a specific invasive reassessment and revascularization strategy aimed at achieving relief of myocardial ischemia. The precise indication criteria, procedural approach, and decision pathway are detailed in the full protocol.
References
DOI: 10.1161/cir.0000000000000564
- If clinical worsening occurs despite conservative management (worsening of symptoms together with evidence of ischemia by electrocardiography or significant arrhythmia), repeat angiography should be performed and emergency revascularization undertaken to relieve ischemia if feasible.