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Left main and triple vessel dissection 2 months postpartum.

Negeen Shahandeh1, Michael I Miyamoto2, Jonathan Tobis1

  • 1Department of Medicine, University of California Los Angeles, Los Angeles, California.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|January 20, 2019
PubMed
Summary
This summary is machine-generated.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. This case highlights rare triple vessel and left main SCAD in a postpartum patient, with a literature review on percutaneous coronary intervention for SCAD.

Keywords:
complicationscoronary aneurysm/dissection/perforationimaging, intravascular ultrasoundleft main coronary diseasepercutaneous coronary interventionpregnancy, cardiovascular complications

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Area of Science:

  • Cardiology
  • Vascular Medicine
  • Interventional Cardiology

Background:

  • Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome (ACS).
  • Literature predominantly reports single-vessel SCAD, with multivessel and left main (LM) involvement being exceptionally rare.
  • SCAD can occur in the postpartum period, posing unique diagnostic and management challenges.

Observation:

  • A postpartum patient presented with symptoms consistent with acute coronary syndrome.
  • Diagnostic imaging revealed spontaneous coronary artery dissection affecting three coronary arteries, including the left main coronary artery.
  • The clinical presentation necessitated a review of management strategies.

Findings:

  • This case represents a rare instance of triple-vessel and left main SCAD.
  • Percutaneous coronary intervention (PCI) in the context of SCAD presents specific technical considerations and potential risks.
  • A comprehensive literature review was conducted to evaluate existing evidence on PCI for SCAD.

Implications:

  • The findings underscore the importance of considering SCAD in young women presenting with ACS, particularly postpartum.
  • Management of complex SCAD, including LM involvement, requires careful consideration of revascularization strategies.
  • Further research is needed to establish optimal percutaneous coronary intervention techniques and outcomes for SCAD patients.