# Spontaneous Coronary Artery Dissection in a Patient With Cardiogenic Shock: To Revascularize or Not to Revascularize?

## TL;DR

A 40-year-old woman with SCAD and severe heart failure was successfully treated with supportive care, not surgery.

## Contribution

Demonstrates successful non-revascularization management of SCAD complicated by cardiogenic shock.

## Key findings

- Patient with SCAI stage D cardiogenic shock due to SCAD was managed with a left ventricular assist device.
- Repeat angiogram showed healed SCAD and recovery of heart function without revascularization.
- Supportive care may be preferable to surgery in SCAD patients due to high perioperative risks.

## Abstract

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome in young patients. Supportive care is recommended for most uncomplicated cases. However, it is unclear if revascularization plays a role in treating SCAD, particularly in the setting of cardiogenic shock. We present a case of a 40-year-old female with no past medical history admitted for SCAD that was complicated by the Society for Cardiovascular Angiography & Interventions (SCAI) stage D cardiogenic shock. She was successfully managed with a percutaneous left ventricular assist device without revascularization. Repeat angiogram showed healed left anterior descending (LAD) SCAD with recovery of left ventricular (LV) systolic function. This case highlights the importance of supportive care in the treatment of SCAD, as revascularization by percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) can pose a significant perioperative risk in this patient population.