Chronic Spontaneous Coronary Artery Dissection in a Young Woman Managed With Coronary Artery Bypass Grafting: A Case...

Spontaneous coronary artery dissection (SCAD) is an uncommon, non-atherosclerotic cause of acute coronary syndrome, typically occurring in young to middle-aged women. Although most cases resolve spontaneously with conservative therapy, a small proportion develop chronic dissections that require revascularization. We report the case of a 39-year-old Ethiopian woman with a 7-year history of coronary artery disease who had been managed medically but presented with worsening exertional chest pain. Invasive coronary angiography during the current presentation demonstrated a long-segment dissection of the left anterior descending (LAD) artery along with a 60% mid-right coronary artery (RCA) stenosis of uncertain etiology. Coronary angiography performed 1 year and 5 months earlier had shown a proximal LAD dissection and a 50% mid-RCA stenosis. Despite prolonged medical therapy, her symptoms persisted. She subsequently underwent successful coronary artery bypass grafting (CABG), with an uneventful perioperative course. This case highlights the rare occurrence of chronic SCAD with persistent ischemia despite conservative therapy. It underscores the potential role of follow-up coronary angiography in selected symptomatic patients to guide individualized management. CABG may be considered in refractory cases when medical therapy fails and PCI is not feasible or unlikely to achieve durable revascularization.