Rapid Healing Of A Spontaneous Coronary Artery Dissection Detected By Computed Tomography Angiography
Sakai, K., Kobayashi, Y., Shirai, S., & Ando, K. (2018). Rapid Healing of a Spontaneous Coronary Artery Dissection Detected by Computed Tomography Angiography. International heart journal, 59(2), 403–406. https://doi.org/10.1536/ihj.17-137
View Original Source →Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and little is known about characteristics, treatment, and follow-up of patients with SCAD. Computed tomography angiography (CTA) plays an important role in the diagnosis and management of SCAD. Herein, we describe a case of a patient with SCAD who underwent successful conservative management, and in whom CTA was able to detect rapid healing of the dissection, 4.5 hours post-dissection.
Case Details
Disease Location
Heart (heart vasculature)
Personal Characteristics
42-year-old man, history of current smoking
Clinical Characteristics
Experienced acute onset of chest pain while working. Ecg showed st-segment elevation in lead i, avl, v2, v3, v4, and v5. Angiography showed significant stenosis in the proximal segment of the left anterior descending artery (lada) with thrombolysis in myocardial infarction (timi) 3 flow, occlusion of the first diagonal branch with timi 1 flow and diffuse (>20 mm) smooth narrowing between the proximal lada and the left main coronary artery (lmca). Intra-aortic balloon pumping (iabp) was used. Immediately after iabp, the patient was free of chest pain, and the ecg changes resolved; the percentage resolution of st-segment elevation between ecgs obtained before and 30 minutes after iabp was 45%. Cta was performed 2 hours after iabp and revealed a false lumen with intramural hematoma between the proximal lada and the lmca and between the proximal lada and the first diagonal branch. Demonstrating that the st-segment elevation myocardial infarction, in this case, was caused by spontaneous coronary artery dissection. Cta on the 8th day post-dissection revealed the false lumen with intramural hema- toma between the proximal lada and the lmca and between the proximal lada and the first diagonal branch the patient was discharged with aspirin, angiotensin-converting enzyme inhibitor, nitrate, and statin therapy on the 14th day post-infarction.
Remission Characteristics
Coronary angiography the following day, showed resolution of the dissection with no significant stenosis in the proximal lada, no occlusion of the first diagonal branch, and no diffuse smooth narrowing between the proximal lada and the lmca. At the 3.5- and 10-month follow-ups, the patient was free of any symptoms of ischemia on medical therapy and cta revealed disappearance of the false lumen, which in- dictated complete vessel healing of scad
Treatment & Mechanisms
Clinical Treatment
Intra-aortic balloon pump ace inhibitor, nitrate, statin angiography