Full scaffold jacket for spontaneous coronary artery dissection of left anterior descending artery with magnesium reabsorbable scaffolds: 1 year follow-up

Spontaneous coronary artery dissection (SCAD) is a non-traumatic and non-iatrogenic separation of the coronary artery wall that is now recognised as an important cause of myocardial infarction, especially in younger women. SCAD can be elusive on coronary angiography and clinician familiarity with non-pathognomonic angiographic SCAD variants and the use of intracoronary imaging will improve diagnosis. Conservative management and long-term cardiovascular follow-up are typically recommended.

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Not Your Common Athletic Heart Problem: Using Coronary CTA to Visualize Spontaneous Coronary Artery Dissection

Case Reports in Cardiology ◽

10.1155/2020/8882561 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Padma Shenoy ◽

Taher Tayeb ◽

Pedro Covas ◽

Nardos Temesgen ◽

Cynthia Tracy

Keyword(s):

Coronary Artery ◽

Young Patients ◽

Reference Value ◽

Left Ventricular ◽

Artery Dissection ◽

Heart Catheterization ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Coronary Catheterization ◽

Left Anterior Descending Artery

A 19-year-old healthy male collegiate athlete presented with typical anginal symptoms after running a 5K race. He had complained of similar symptoms off and on for the past month. On presentation, troponin was 0.12 ng/ml (reference value < 0.01 ng/ml), which peaked at 17.7 ng/ml and CK-MB was 28.71 IU/L (reference value < 25 IU/L). ECG showed diffuse biphasic T-waves. Coronary computed tomography angiogram (cCTA) demonstrated a 1.5 cm dissection in the left anterior descending artery and a 1.9 × 1.8 cm attenuation defect in the left ventricular apex consistent with thrombus. Subsequent coronary catheterization confirmed dissection of the left anterior descending artery. Spontaneous coronary artery dissection (SCAD) is a rare phenomenon. Diagnosis can be made through noninvasive measures but is usually done through left heart catheterization. In young patients who present with an NSTEMI, clinical suspicion for SCAD among other conditions should be raised. Additionally, recognizing that complications such as intracardiac thrombi can occur in SCAD is critical in ensuring appropriate therapy.

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Spontaneous coronary artery dissection: Rare but challenging

Vojnosanitetski pregled ◽

10.2298/vsp120819055p ◽

2014 ◽

Vol 71 (3) ◽

pp. 311-316

Author(s):

Biljana Putnikovic ◽

Ivan Ilic ◽

Milos Panic ◽

Aleksandar Aleksic ◽

Radosav Vidakovic ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Blood Flow ◽

Coronary Artery ◽

Coronary Angiography ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Coronary Syndrome

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.

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Spontaneous Coronary Artery Dissection in the Gulf: G-SCAD Registry

Angiology ◽

10.1177/0003319720946974 ◽

2020 ◽

Vol 72 (1) ◽

pp. 32-43

Author(s):

Amin Daoulah ◽

Salem M. Al-Faifi ◽

Sameer Alhamid ◽

Ali A. Youssef ◽

Mohammed Alshehri ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Coronary Intervention ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Gulf Countries ◽

Percutaneous Coronary ◽

St Elevation

Data on spontaneous coronary artery dissection (SCAD) is based on European and North American registries. We assessed the prevalence, epidemiology, and outcomes of patients presenting with SCAD in Arab Gulf countries. Patients (n = 83) were diagnosed with SCAD based on angiographic and intravascular imaging whenever available. Thirty centers in 4 Arab Gulf countries (Kingdom of Saudi Arabia, United Arab Emirates, Kuwait, and Bahrain) were involved from January 2011 to December 2017. In-hospital (myocardial infarction [MI], percutaneous coronary intervention, ventricular tachycardia/fibrillation, cardiogenic shock, death, implantable cardioverter-defibrillator placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were recorded. Median age was 44 (37-55) years, 42 (51%) were females and 28.5% were pregnancy-associated (21.4% were multiparous). Of the patients, 47% presented with non-ST-elevation acute coronary syndrome, 49% with acute ST-elevation myocardial infarction, 12% had left main involvement, 43% left anterior descending, 21.7% right coronary, 9.6% left circumflex, and 9.6% multivessel; 52% of the SCAD were type 1, 42% type 2, 3.6% type 3, and 2.4% multitype; 40% managed medically, 53% underwent percutaneous coronary intervention, 7% underwent coronary artery bypass grafting. Females were more likely than males to experience overall (in-hospital and follow-up) adverse cardiovascular events ( P = .029).

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