A case report of spontaneous coronary artery dissection and the role of intravascular imaging for accurate diagnosis and successful management

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Abstract

RATIONALE: Acute myocardial infarction (AMI) secondary to spontaneous coronary artery dissection (SCAD) is a rare condition. SCAD can be underdiagnosed on a coronary angiography (CAG). Therefore, the application of intravascular imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) is crucial for ensuring an accurate diagnosis and treatment. PATIENTS CONCERNS: A 72-year-old woman had an evolving AMI with ST elevation in the inferior leads (II, III, and aVF). DIAGNOSES: An emergent CAG showed that a double lumen had developed in the middle portion of the left circumflex artery. An IVUS examination revealed a coronary artery dissection and intramural hematoma. INTERVENTIONS: First, the patient was treated with conservative management. We later placed a stent in response to the progression of the intramural hematoma observed during the IVUS follow-up. OUTCOMES: The patient remained symptom free after discharge. CAG with OCT at the 1-year follow-up after stent implantation showed in-stent restenosis with dissection flap with residual false lumen at the proximal site of stent. We treated this lesion with another stent. LESSONS: From this case, we learned that in patients with AMI, SCAD should be considered as a possible diagnosis and that intravascular imaging tool can successfully guide clinical decision making and the treatment strategies.

Original languageEnglish
Pages (from-to)e14112
JournalMedicine
Volume98
Issue number2
DOIs
Publication statusPublished - Jan 1 2019

Keywords

  • Aged
  • Coronary Angiography
  • Coronary Vessel Anomalies/complications
  • Female
  • Humans
  • Myocardial Infarction/etiology
  • Tomography, Optical Coherence
  • Ultrasonography, Interventional
  • Vascular Diseases/complications

ASJC Scopus subject areas

  • Medicine(all)

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