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A case report of spontaneous coronary artery dissection complicated by stent fracture
1Department of Cardiology, First Hospital of Lanzhou University, Lanzhou, Gansu, China.
Insights
This case report details the first instance of stent fracture (SF) in a patient with spontaneous coronary artery dissection (SCAD) following percutaneous coronary intervention (PCI). This highlights potential complications in managing SCAD patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Spontaneous coronary artery dissection (SCAD) is an underdiagnosed condition with poorly understood pathophysiology.
- Stent fracture (SF) is a known complication of percutaneous coronary intervention (PCI), influenced by factors like vessel remodeling and radial force.
Observation:
- A 48-year-old male presented with a two-year history of chest pain.
- Coronary angiography identified a dissection in the obtuse marginal branch, diagnosed as SCAD.
- The patient underwent PCI guided by intravascular ultrasound (IVUS).
Findings:
- Stent fracture (SF) was detected nine months after the PCI procedure.
- This represents the first reported case of SF in a patient with SCAD post-PCI.
Implications:
- This case underscores the importance of considering SF as a potential complication in SCAD patients undergoing PCI.
- Further research is needed to understand the specific risks and management strategies for SF in the context of SCAD.
Rationale:
Spontaneous coronary artery dissection (SCAD) is a rare, complex disease, and nowadays poorly understood. The overall incidence of SCAD ranges from 0.28% to 1.1% in angiographic studies. Therefore, the true incidence of SCAD is most likely underestimated due to asymptomatic or sudden cardiac death before diagnosis. Stent fracture (SF) is a multifactorial issue. Longer vessel remodeled by 2 stents can be more prone to have SF due to higher radial force.
Patient Concerns:
In this paper we report a 48-year-old man with chest pain for 2 years.
Diagnoses:
Elective coronary angiography revealed a linear dissection in obtuse marginal branch (OM).
Interventions:
He underwent percutaneous coronary intervention (PCI) with the guidance of intravascular ultrasound (IVUS).
Outcomes:
Then SF was revealed 9 months later.
Lessons:
This is the first case report of SF after coronary intervention therapy in SCAD patients.
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