Introduction. Spontaneous coronary artery dissection (SCAD) is a rare cause
of the acute coronary syndrome. It occurs mostly in patients without
atherosclerotic coronary artery disease, carrying fairly high early mortality
rate. The treatment of choice (interventional, surgical, or medical) for this
serious condition is not well-defined. Case report. A 41-year old woman was
admitted to our hospital after the initial, unsuccessful thrombolytic
treatment for anterior myocardial infarction administered in a local hospital
without cardiac catheterization laboratory. Immediate coronary angiography
showed spontaneous coronary dissection of the left main and left anterior
descending coronary artery. Follow-up coronary angiography performed 5 days
after, showed extension of the dissection into the circumflex artery. Because
of preserved coronary blood flow (thrombolysis in myocardial infarction -
TIMI II-III), and the absence of angina and heart failure symptoms, the
patient was treated medicaly with dual antiplatelet therapy, a low molecular
weight heparin, a beta-blocker, an angiotensinconverting enzyme (ACE)
inhibitor and a statin. The patient was discharged after 12 days. On
follow-up visits after 6 months and 2 years, the patient was asymptomatic,
and coronary angiography showed the persistence of dissection with preserved
coronary blood flow. Conclusion. Immediate coronary angiography is necessary
to assess the coronary anatomy and extent of SCAD. In patients free of angina
or heart failure symptoms, with preserved coronary artery blood flow, medical
therapy is a viable option. Further evidence is needed to clarify optimal
treatment strategy for this rare cause of acute coronary syndrome.
The utility of low dose serial computed tomography coronary angiography (CTCA) in the management of spontaneous coronary artery dissection (SCAD)
