Management of spontaneous coronary artery dissection complicated by cardiogenic shock using mechanical circulatory support with the Impella device

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• Cases 1 and 4 highlight the role of MCS independent of revascularization.

• Repeat cardiac angiography revealed patent stents and no propagation of the dissection, suggesting that the mechanism of cardiogenic shock was not ongoing ischemia.

• ventricular dysfunction and cardiogenic shock without ongoing ischemia

• The etiology of left ventricular dysfunction and shock in the absence of ischemia in SCAD patients is unknown.

• catecholamine surges, coronary artery wall stress, and a hyperdynamic myocardium

• avoid a risky revascularization procedure and instead support the myocardium while allowing SCAD vessels to heal on their own.