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Case Reports
. 2014 Dec;23(4):275-80.
doi: 10.1055/s-0033-1349163.

Spontaneous Coronary Artery Dissection and Hemodynamic Instability: Can Emergent PCI Be Life Saving? Report of Two Cases and Literature Review

Abdel Rahman A Al Emam  1 , Ahmed Almomani  1 , Syed A Gilani  2
Affiliations
Case Reports

Spontaneous Coronary Artery Dissection and Hemodynamic Instability: Can Emergent PCI Be Life Saving? Report of Two Cases and Literature Review

Abdel Rahman A Al Emam et al. Int J Angiol. 2014 Dec.

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. It occurs predominantly among younger females and typically in the absence of atherosclerotic coronary artery disease. It is associated with peripartum period, connective tissue disorders, vasculitides, and extreme exertion. Presentations vary greatly, and this condition can be fatal. Given its rarity, there are no guidelines for management of SCAD. We present the cases of two female patients, with no coronary artery disease risk factors or recent pregnancy, who were presented with non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI), respectively, secondary to SCAD. Both had excellent outcome after emergent percutaneous intervention. Our first patient was presented with NSTEMI with ongoing chest pain and dynamic electrocardiogram (ECG). Emergent left heart catheterization was significant for first obtuse marginal (OM1) dissection, confirmed by optical coherence tomography. Percutaneous coronary intervention (PCI) with two bare metal stents was performed with resolution of symptoms and ECG changes. The second patient is known to have syndrome, presented with STEMI and emergent coronary angiography showed left anterior descending dissection with intramural hematoma confirmed by intravascular ultrasound and treated with a drug-eluting stent with resolution of symptoms and ST changes. Her hospital course was complicated by post-myocardial infarction pericarditis that was improved with colchicine. Both the patients were observed in the coronary care unit for 24 hours. Both remained asymptomatic at 6-month follow-up. SCAD is a rare cause of acute coronary syndrome. In patients with early presentation, limited disease, and ongoing symptoms, emergent cardiac catheterization with percutaneous intervention has excellent outcome. More studies are needed to establish evidence-based management guidelines.

Keywords: PCI; acute coronary syndrome; dissection; myocardial infarction.

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Figures

Fig. 1
Fig. 1
Dissection (arrows) of the first obtuse marginal branch of the left circumflex artery that extended distally.
Fig. 2
Fig. 2
No flow in first obtuse marginal upon advancing the wire.
Fig. 3
Fig. 3
Optical coherence tomography showed a large false lumen (FL) compressing the true lumen (TL) of the dissected artery.
Fig. 4
Fig. 4
Normal flow in first obtuse marginal (OM1) after PCI. Seen also is insignificant distal OM1 dissection.
Fig. 5
Fig. 5
Severe LAD stenosis secondary to intramural hematoma (horizontal arrow). Also seen is the large LAD that wraps around the apex and supplies the inferior wall (vertical arrow).
Fig. 6
Fig. 6
Intravascular ultrasound showed intramural hematoma (IH) of distal LAD.
Fig. 7
Fig. 7
Restoration of flow in LAD post-PCI.
See this image and copyright information in PMC

References

    1. Pretty H C. Dissecting aneurysm of coronary artery in a woman aged 42. BMJ. 1931;1:667.
    1. Verma P K, Sandhu M S, Mittal B R. et al.Large spontaneous coronary artery dissections-a study of three cases, literature review, and possible therapeutic strategies. Angiology. 2004;55(3):309–318. - PubMed
    1. Azzarelli S, Fiscella D, Amico F, Giacoppo M, Argentino V, Fiscella A. Multivessel spontaneous coronary artery dissection in a postpartum woman treated with multiple drug-eluting stents. J Cardiovasc Med (Hagerstown) 2009;10(4):340–343. - PubMed
    1. Sherrid M V, Mieres J, Mogtader A, Menezes N, Steinberg G. Onset during exercise of spontaneous coronary artery dissection and sudden death. Occurrence in a trained athlete: case report and review of prior cases. Chest. 1995;108(1):284–287. - PubMed
    1. Tweet M S, Hayes S N, Pitta S R. et al.Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation. 2012;126(5):579–588. - PubMed

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