An Unusual Case of Chronic Total Occlusion Secondary to Late-Diagnosed Recurrent Spontaneous Coronary Dissection

Area of Science:

• Cardiology
• Vascular Medicine

Background:

• Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome (ACS).
• SCAD is even rarer in male patients compared to females.
• A high index of suspicion is necessary for timely diagnosis in patients presenting with ACS, especially younger individuals without traditional cardiovascular risk factors.

Observation:

• A 44-year-old male with a history of revascularization procedures presented with worsening exertional angina.
• Initial assessment revealed a "dynamic total occlusion" of the left circumflex coronary artery.
• This finding was ultimately diagnosed as an unrecognized spontaneous coronary artery dissection.

Findings:

• The case underscores that SCAD can present atypically, even in patients with prior cardiac interventions.
• Missed or delayed diagnosis of SCAD can result in significant adverse cardiovascular events.
• Intravascular imaging modalities are vital for confirming the diagnosis of SCAD.

Implications:

• This case highlights the importance of considering SCAD in the differential diagnosis of ACS, irrespective of patient demographics or history.
• Prompt and accurate diagnosis of SCAD is essential for appropriate management and to prevent complications.
• The utility of intravascular imaging in diagnosing SCAD, particularly in complex cases, is emphasized.