Spontaneous coronary artery dissection as a cause of acute myocardial infarction with ST elevation

Abstract

Introduction. Spontaneous coronary artery dissection (SCAD) is defined as a dissection that has not occurred with atherosclerosis, trauma, or has not developed iatrogenically. Case outline. A 53-year-old man was admitted to the hospital due to chest pain and ischemic electrocardiographical changes. Coronarography was performed and 85% of the stenosis of the first diagonal branch (D1) was registered. During percutaneous coronary intervention (PCI), one drug-eluting was directly implanted into the D1. About three hours after the intervention, the patient developed an acute myocardial infarction with ST elevation (STEMI) and recoronarography was performed. The previously implanted stent in D1 was patent without thrombi. The subocclusive stenosis of the left anterior descending artery (LAD) was registered and PCI was performed. After implantation of the stents into the LAD, propagation of dissection towards left circumflex artery (LCx) was creating significant stenosis. Following the registration of the stenosis, PCI was performed on this branch. In order to determine the cause of acute STEMI, intravascular imaging was performed, seven days after last PCI. Optical coherence tomography showed an excellent stent apposition and expansion. In the area under the stents, in the proximal segment of LAD and LCx, showed duplication in the blood vessel wall. This duplication represents an unresorbed intramural hematoma as a consequence of SCAD. Conclusion. When performing coronarography on younger patients, on women in the peripartum and on patients with connective tissue, SCAD disorders should be kept in mind. The use of intravascular imaging could reduce the number of unrecognized SCAD.

Keywords

• spontaneous coronary artery dissection
• acute myocardial infarction with st elevation
• optical coherence tomography