Dual Coronary Artery Dissection With Contrasting Healing Patterns: Spontaneous Left Circumflex And Iatrogenic Right Coronary Artery

Abstract

Spontaneous coronary artery dissection (SCAD) is an uncommon but important cause of acute coronary syndrome (ACS), particularly in postpartum women without traditional cardiac risk factors. Our case involves a 29-year-old postpartum woman who presented with severe substernal chest pain eight days after an emergency cesarean section for pregnancy-associated hypertension. Electrocardiography showed ST elevation in the inferior and posterior leads, and coronary angiography revealed a spontaneous dissection in the left circumflex artery (LCx) with an intramural hematoma, alongside a dissection of the right coronary artery (RCA) extending from the ostium to the mid-vessel. This RCA dissection was most likely catheter-induced. Patients with SCAD often have frail arterial walls that are predisposed to dissection, even with minimal trauma, as seen in this case. The patient was treated medically with aspirin, clopidogrel, and bisoprolol. After 10 months, she presented with anginal chest pain and a positive stress ECG. Coronary angiography showed complete healing of the LCx and multiple stenotic lesions in the RCA. This disparity in healing patterns may be attributed to different mechanisms underlying the dissections: spontaneous dissections, which typically involve hormonal and vascular remodeling, versus iatrogenic dissections, which can be influenced by procedural trauma. This case highlights the contrasting healing patterns of spontaneous and iatrogenic dissections and emphasizes the importance of clinical suspicion, procedural caution, and long-term follow-up.