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Spontaneous coronary artery dissection mimicking coronary spasm diagnosed by intravascular ultrasonography
Hyemoon Chung1, Sung-Joo Lee, Jong-Kwan Park
1Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Insights
Spontaneous coronary artery dissection (SCAD) is a rare cause of heart attack. This case highlights diagnosis with intravascular ultrasound (IVUS) and successful stenting treatment for SCAD.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome.
- Its etiology, pathophysiology, and optimal treatment strategies remain poorly understood.
- SCAD can present with diverse clinical scenarios, from angina to sudden cardiac death.
Purpose of the Study:
- To present a case of SCAD in a young woman with acute myocardial infarction.
- To illustrate the diagnostic utility of intravascular ultrasound (IVUS) in SCAD.
- To demonstrate a successful percutaneous coronary stenting treatment approach for SCAD.
Main Methods:
- Diagnosis of SCAD using coronary angiography and intravascular ultrasound (IVUS).
- Treatment with percutaneous coronary stenting.
- Medical therapy post-intervention.
Main Results:
- A 35-year-old woman diagnosed with spontaneous diffuse dissection of the left anterior descending artery via IVUS, without evidence of atheroma.
- Successful percutaneous coronary stenting of the affected artery.
- Favorable clinical outcome with discharge on medical therapy.
Conclusions:
- SCAD is a critical diagnosis in acute coronary syndrome, especially in younger patients.
- IVUS is a valuable tool for clarifying SCAD diagnosis when angiography is inconclusive.
- Percutaneous coronary stenting can be an effective treatment for SCAD with favorable outcomes.
Abstract:
Spontaneous coronary artery dissection (SCAD) is a rare and occasionally life-threatening cause of acute coronary syndrome. Patients may present with clinical scenarios ranging from angina pectoris to cardiogenic shock to sudden cardiac death, and it may be a potentially life-threatening condition if not recognized. However, its etiology, pathophysiology and optimal therapeutic strategies have not been well understood. SCAD is diagnosed on the basis of coronary angiography, but complementary techniques as such intravascular ultrasound (IVUS) and optical coherence tomography should be considered for diagnostic clarification where appropriate. Likewise, the selection of treatment strategy depends upon the clinical manifestation, location and the extent of dissection and amount of ischemic myocardium at risk. Herein, we present the case of a 35-year-old woman who presented with acute myocardial infarction. She was diagnosed by IVUS with spontaneous diffuse dissection of the left anterior descending artery without atheroma, treated with percutaneous coronary stenting, and had a favorable clinical course and was discharged on medical therapy.
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