Chonnam Med J.  2010 Aug;46(2):112-116. 10.4068/cmj.2010.46.2.112.

Successful Management of Spontaneous Dissection with Spasm in both Coronary Arteries

Affiliations
  • 1Yeosu Chonnam Hospital, Yeosu, Korea.
  • 2The Heart Center of Chonnam National University Hospital, Gwangju, Korea. myungho@chollian.net

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. SCAD frequently occurs in young women during the peripartal period. There are few reports of SCAD associated with vasospasm. We report a case of a 36-year-old man who presented at our institution with SCAD with spasm. He presented with continuous chest pain for 1 hour. Initial EKG showed pathologic Q wave and ST elevation in lead II, III, and aVF. Emergent coronary angiography (CAG) revealed diffuse spastic narrowing of the left anterior descending coronary artery (LAD) and right coronary artery. On follow-up CAG, spontaneous type B dissection of the proximal LAD extending to the left main and middle LAD were detected. We decided to treat with medical therapy because he had no chest pain. Three days later, patient complained of severe chest pain. Emergency CAG revealed dissection in the left main to middle LAD and proximal left circumflex artery (LCx) with poor distal flow and spasm in the distal LAD. We performed percutaneous coronary intervention for SCAD in the LAD. The follow-up CAG performed 6 months later showed patent LAD stents. This case illustrates the successful management of SCAD that developed in both the culprit and non-culprit arteries of acute myocardial infarction associated with vasospasm.

Keyword

Coronary artery disease; Dissection; Spasm

MeSH Terms

Acute Coronary Syndrome
Adult
Arteries
Chest Pain
Coronary Angiography
Coronary Artery Disease
Coronary Vessels
Electrocardiography
Emergencies
Female
Follow-Up Studies
Humans
Muscle Spasticity
Myocardial Infarction
Percutaneous Coronary Intervention
Spasm
Stents

Figure

  • Fig. 1 The ECG showed Q wave with ST-segment elevation in II, III, and aVF.

  • Fig. 2 The CAG revealed diffuse spastic narrowing of the LAD (A) and RCA (B) (CAG, coronary angiography; LAD, left anterior descending coronary artery; RCA, right coronary artery).

  • Fig. 3 The CAG revealed diffuse stenosis in the left main to distal LAD with spontaneous type B dissection of the proximal LAD extending to the left main and middle LAD (CAG, coronary angiography; LAD, left anterior descending coronary artery).

  • Fig. 4 IVUS revealed dissection in the proximal LAD (A). Cardiac CT showed dissection in the LM to middle LAD (B), and dissection in the proximal RCA (C) (IVUS, intravascular ultrasonography; LM, left main coronary artery; RCA, proximal right coronary artery).

  • Fig. 5 CAG revealed dissection in the LM to middle LAD and proximal LCx with poor distal flow and spasm in the distal LAD (A). The final CAG after PCI for these lesions showed antegrade TIMI III flow with small dissection in the edge of the distal LAD stent (B) (CAG, coronary angiography; LM, left main coronary artery; LAD, left anterior descending coronary artery; LCx, proximal left circumflex artery; PCI, percutaneous coronary intervention).


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