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Case Reports
. 2023 Jan 18;85(1):32-36.
doi: 10.1097/MS9.0000000000000095. eCollection 2023 Jan.

Spontaneous coronary artery dissection (SCAD): a case report

Driss Britel  1 , Soumaila Nikièma  1 , Désiré Massimbo  1 , Emmanuel Graham  1 , Aatif Benyass  1 , Zouhair Lakhal  1
Affiliations
Case Reports

Spontaneous coronary artery dissection (SCAD): a case report

Driss Britel et al. Ann Med Surg (Lond). .

Abstract

Spontaneous coronary artery dissection (SCAD) is often revealed by an acute coronary syndrome classified then as a MINOCA. The typical patient is a female patient with no or few cardiovascular risk factor. Our work aims to illustrate the effectiveness of medical treatment in patients with SCAD.

Case report: We report a case of a 56-year-old female patient who was admitted after 3 days of infarct-like thoracic pain related to an anterior extended ST-elevation myocardial infarction. The coronarography showed a SCAD of the left anterior descending coronary artery. The patient was discharged under medical treatment. Six weeks later, coronarography showed a perfused coronary artery.

Discussion: Most cases of SCAD present as acute coronary syndrome. Coronary angiography remains the 'first-line' examination. The use of endocoronary imaging such as IVUS and optical coherence tomography is necessary in case of diagnostic doubt (especially in SCAD type 2 and 3). The optimal management of SCAD remains unclear. A conservative approach should be the preferred strategy.

Conclusion: SCAD should be considered in any young woman presenting with suspicious chest pain with positive troponin. The diagnosis is initially angiographic and may require endocoronary imaging for greater accuracy. Conservative treatment remains the best option.

Keywords: acute coronary syndrome; coronary artery; spontaneous dissection.

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Conflict of interest statement

The authors declare that they have no financial conflict of interest with regard to the content of this report.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
12 derivations ECG showing a ST-elevation myocardial infarction in the anterior extended leads with Q waves of necrosis.
Figure 2
Figure 2
(A) Angiographic image showing a lesion of the left descending coronary artery suggestive of a spontaneous coronary artery dissection type 2A; there is no atheromatous lesion. (B) The circumflex coronary artery is free of lesion. (C) The right coronary artery is free of lesion. Lesion of the left descending coronary artery suggestive of a spontaneous coronary artery dissection type 2A.
Figure 3
Figure 3
Angiographic image showing a reperfusion of the left descending coronary artery after medical care confirming the hypothesis of a spontaneous coronary artery dissection.
Figure 4
Figure 4
Cross-sectional views of the coronary artery. (A) Normal coronary artery. (B) Coronary artery with intramural hematoma. (C) Coronary artery with intimal tear. Spontaneous coronary artery dissection is characterized by the spontaneous formation of an intramural hematoma, which can lead to compression of the true lumen and myocardial infarction. An intimal tear may be present.
Figure 5
Figure 5
Angiographic, anatomical, and intravascular appearance of SCAD. Asterisks indicate artifact of the guide; arrows indicate false and true lumens. OCT, optical coherence tomography; SCAD, spontaneous coronary artery dissection.
Figure 6
Figure 6
Diagnosis and treatment of patients with non–ST-segment elevation acute coronary syndrome related to SCAD. aSelection of revascularization strategy for highrisk anatomy according to local expertise, bBeta-blocker recommended while benefit of DAPT is questionable. cLeft main or proximal left anterior descendent or circumflex or right coronary artery, multivessel SCAD. CABG, coronary artery bypass grafting; CAD, coronary artery disease; CCTA, cardiac computed tomographic angiography; ICA, invasive coronary angiography; IVUS, intravascular ultrasound; OCT, optical coherence tomography; OMT, optimal medical therapy; PCI, percutaneous coronary intervention; SCAD, spontaneous coronary artery dissection.
See this image and copyright information in PMC

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