Korean Circ J.  2013 Jul;43(7):491-496. 10.4070/kcj.2013.43.7.491.

Spontaneous Coronary Artery Dissection Mimicking Coronary Spasm Diagnosed by Intravascular Ultrasonography

Affiliations
  • 1Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. cardiobk@yuhs.ac
  • 2Cardiology Division, Department of Internal Medicine, Chungju Medical Center, Chungju, Korea.
  • 3Cardiology Division, Department of Internal Medicine, NHIC Ilsan Hospital, Goyang, Korea.
  • 4Cardiology Division, Department of Internal Medicine, Gachon University, Incheon, Korea.
  • 5Cardiology Division, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare and occasionally life-threatening cause of acute coronary syndrome. Patients may present with clinical scenarios ranging from angina pectoris to cardiogenic shock to sudden cardiac death, and it may be a potentially life-threatening condition if not recognized. However, its etiology, pathophysiology and optimal therapeutic strategies have not been well understood. SCAD is diagnosed on the basis of coronary angiography, but complementary techniques as such intravascular ultrasound (IVUS) and optical coherence tomography should be considered for diagnostic clarification where appropriate. Likewise, the selection of treatment strategy depends upon the clinical manifestation, location and the extent of dissection and amount of ischemic myocardium at risk. Herein, we present the case of a 35-year-old woman who presented with acute myocardial infarction. She was diagnosed by IVUS with spontaneous diffuse dissection of the left anterior descending artery without atheroma, treated with percutaneous coronary stenting, and had a favorable clinical course and was discharged on medical therapy.

Keyword

Coronary artery dissection, spanteneous; Ultrasonography, interventional; Coronary vasospasm

MeSH Terms

Acute Coronary Syndrome
Angina Pectoris
Arteries
Coronary Angiography
Coronary Vasospasm
Coronary Vessels
Death, Sudden, Cardiac
Female
Humans
Myocardial Infarction
Myocardium
Plaque, Atherosclerotic
Shock, Cardiogenic
Spasm
Stents
Tomography, Optical Coherence
Ultrasonography, Interventional

Figure

  • Fig. 1 Electrocardiogram showing non specific T wave inversion in lead lll, aVF.

  • Fig. 2 Coronary angiogram imaging, showing RAO cranial view of the patient LAD. A: long, smooth narrowed lesion extending from the bifurcation point to mid LAD; the length of the narrowed lesion is marked by arrows. B: after intracoronary nitroglycerine infusion, the luminal narrowing of the mid LAD improved slightly, but not completely. RAO: right anterior oblique, LAD: left anterior descending artery.

  • Fig. 3 A: IVUS imaging before (A) and after (B) coronary stenting, and longitudinal imaging before coronary stenting (C). 1: proximal part of dissection. The intima and media are separated from the adventitia and compressed by an echolucent, probably RBC-poor, voluminous huge hematoma. There are two apparent echogenic tram tract like lines, representative of internal and external elastic lamina (A1). This lesion is covered by 3.0×28 mm XiencePrime stent (B1). 2: the most stenotic site on the angiogram. The true lumen is nearly obliterated by echogenic, probably RBC-rich, hematoma on IVUS (A2). This lesion is covered by 2.5×23 mm XiencePrime stent (B2). 3: distal normal segment of the m-LAD showing no atherosclerosis or dissection (A3). Distal stent lands at this normal segment (B3). 4: normal segment of the m-LAD showing just distal part of stent before (A4) and after (B4) coronary stenting. IVUS: intravascular ultrasound, LAD: left anterior descending artery, FL: false lumen, TL: true lumen.


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