Spontaneous coronary artery dissection presenting as massive brain stroke: Happy landing with percutaneous coronary intervention

Abstract

Spontaneous coronary artery dissection (SCAD) presenting as stroke is indeed an extremely rare scenario. We hereby describe our experience of a case of SCAD in a 29-year-old man who presented with a massive brain stroke. Based on the neurological findings, the diagnosis of left hemiparesis, left upper motor neuron facial palsy, and acute right middle cerebral artery infarct was made. Coronary angiography displayed a large type B dissection along with heavy burden of thrombus and intimal hematoma in proximal to the mid-left anterior descending artery (LAD). SCAD of the LAD was managed with percutaneous coronary intervention using a provisional stenting approach with two overlapping drug-eluting stents. With this case, the author would like to outline vital clinical insights for clinicians managing such a challenging and perplexing patient cohort.

Keywords

• left anterior descending artery
• percutaneous coronary intervention
• spontaneous coronary artery dissection
• stroke