Stent mal-apposition with resorption of intramural hematoma with spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome (ACS), involving separation of the intimal-medial arterial wall. Conservative management is typically recommended but revascularization may be necessary for ongoing ischemia or adverse anatomical characteristics. Percutaneous coronary intervention (PCI) may be challenging with SCAD and have suboptimal outcomes. Furthermore, resorption of the intramural hematoma (IMH) with healing can result in stent mal-apposition. We report three cases of SCAD treated with drug-eluting stents (DES) with optical coherence tomography (OCT) follow-up at different stages showing stent mal-apposition and their management/outcomes