Three-vessel spontaneous coronary artery dissection in a patient with hyperhomocysteinemia

Abstract

Increased homocysteine has been related to the occurrence of dissections in the coronary circulation, aorta, and cervical arteries. Spontaneous coronary artery dissection (SCAD) is a relatively rare phenomenon, and data on the long-term follow-up of patients with SCAD are extremely limited. Herein, we describe a case of a young male patient with 3-vessel SCAD (presence of radiolucent linear defects indicating the presence of dissections in all three major coronary arteries) who was found to have hyperhomocysteinemia and a concurrent methylenetetrahydrofolate reductase prothrombotic mutation. Despite the presence of multi-vessel SCAD, the patient had clinically stable coronary artery disease for a long period. <Learning objective: Three-vessel spontaneous coronary artery dissection (SCAD) is an extremely rare phenomenon. Familiarity with the angiographic characteristics of multi-vessel SCAD as shown here is important for diagnosis. Hyperhomocysteinemia and a concurrent methylenetetrahydrofolate reductase prothrombotic mutation is one of the genetic diseases causally related with premature coronary artery disease and SCAD. Patients with angiographic evidence of SCAD may remain clinically stable for a long time.>.

Keywords: Hyperhomocysteimemia; Methylenetetrahydrofolate reductase; Spontaneous coronary artery dissection.

Fig. 1

Left and right coronary angiogram. (A) Left coronary angiogram demonstrating coronary dissection in the left main (white arrow), left anterior descending (red arrow), and left circumflex (yellow arrows) arteries. (B) Right coronary angiogram showing the dissection in the right coronary artery (red arrow) and collaterals from right coronary artery to a totally occluded left anterior descending artery (white arrows).