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Coronary Thrombosis and Type A Aortic Dissection

Matteo Marchetti1, Paolo Scacciatella1, Elio Di Rosa2

  • 1Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Corso Bramante 88, Turin, Italy.

Journal of Cardiac Surgery
|May 19, 2015
PubMed

Insights

This case report details a rare instance of acute type A aortic dissection co-occurring with ST-elevation myocardial infarction. Successful treatment involved aortic repair, bivalirudin, and angioplasty for coronary artery thrombosis.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Acute type A aortic dissection is a life-threatening condition requiring urgent surgical intervention.
  • Myocardial infarction (MI) can occur secondary to aortic dissection, often due to coronary ostial compression or embolization.
  • The coexistence of these two critical events presents complex diagnostic and therapeutic challenges.

Observation:

  • A 74-year-old female presented with acute type A aortic dissection requiring ascending aorta replacement.
  • Postoperatively, she developed ST-segment elevation myocardial infarction (STEMI) in the anterolateral leads.
  • Coronary angiography identified thrombotic occlusion of the left anterior descending artery.

Findings:

  • The STEMI was successfully treated with bivalirudin administration, thrombus aspiration, and balloon angioplasty.
  • This intervention addressed the coronary artery thrombosis, a rare complication in this clinical context.
  • The patient's presentation highlights the infrequent but significant association between aortic dissection and acute coronary syndrome.

Implications:

  • This case underscores the importance of considering coronary artery complications in patients with aortic dissection, even postoperatively.
  • Timely diagnosis and multimodal treatment are crucial for managing the combined pathology.
  • Understanding the pathophysiology of coronary plaque thrombosis in the setting of aortic dissection can inform future management strategies.

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