Spontaneous Distal Right Coronary Artery Dissection in a Patient With Massive Pulmonary Embolism: Thrombolyze or Not?

Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial ischemia, myocardial infarction, and sudden cardiac death. We report a case with SCAD of distal right coronary secondary to pulmonary thromboembolism. Reported treatment options for SCAD include medical therapy, thrombolysis, balloon angioplasty, and coronary artery bypass surgery. The decision as to which one depends on the clinical and angiographic factors. The benefit of thrombolysis in these patients is controversial. The prognosis in patients surviving the initial event is generally believed to be favorable. In patients who remain stable, conservative management seems to be safe and is compatible with a good long-term outcome.