Intracoronary Stenting for Postpartum Coronary Artery Dissection

Porras, Miguel Carrascosa

doi:10.7326/0003-4819-128-10-199805150-00020

Cited by 16 publications

(12 citation statements)

References 4 publications

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“…Prior to the introduction of percutaneous coronary intervention techniques in 1997, the survival rates for spontaneous coronary artery dissection patients who survived until arrival in the emergency department was 20% [3,6]. However, since the introduction of PCI, survival rates have significantly improved [4].…”

Section: Discussionmentioning

confidence: 97%

“…Spontaneous coronary artery dissections have a female preponderance with approximately 68-80% of dissections occurring in women [3]. Furthermore, the disease is typically found in young and middle-aged individuals (under 50), making it an unusual disease entity [7].…”

Section: Discussionmentioning

confidence: 99%

“…While any of the coronary arteries can be affected, the most commonly affected vessel is the left anterior descending artery (LAD) [2]. Greater than 70% of individuals who develop spontaneous coronary artery dissection are women, and of those, one-third had a dissection event within 6 weeks of childbirth [3][4][5]. The higher incidence of these events in women, especially in the post-partum period, has been postulated to be due to alteration in the micro-vascular physiology associated with higher levels of progesterone and estrogen during the peurperium [4,6].…”

Section: Introductionmentioning

confidence: 99%

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Postpartum spontaneous coronary dissection presenting with ventricular fibrillation

Brammer

Gupta

Lakkis

2011

Journal of Cardiology Cases

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Background: Spontaneous coronary artery dissection is a rare cause of acute coronary syndromes; and one quarter of these patients present during the post-partum period. Furthermore, ventricular fibrillation is a rare presentation of this disease entity. Case: A 32-year-old woman presented 3 days post Cesarean-section delivery with chest pain, ischemic electrocardiogram changes, and ventricular fibrillation arrest. The patient was taken for cardiac catheterization and found to have a left anterior coronary artery dissection necessitating 6 stents to restore flow to the vessel. Conclusion: We report the first case of survival after ventricular fibrillation arrest of a woman presenting with spontaneous coronary dissection in the post-partum period. Our case underscores the importance of recognizing ventricular fibrillation as a first presenting sign of spontaneous coronary artery dissection in the post-partum period.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postpartum spontaneous coronary dissection presenting with ventricular fibrillation

Brammer

Gupta

Lakkis

2011

Journal of Cardiology Cases

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“…12 In the absence of severe left ventricular impairment, symptomatic patients with single vessel dissection not involving the left main coronary artery may benefit from primary coronary stenting to decrease the chance of sudden death, reinfarction, and arrhythmia. 15 16 With a complicated dissection involving thrombus and a nearly occluded lumen, however, this approach may be difficult with sometimes devastating consequences.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous coronary artery dissection involving the left main stem: assessment by intravascular ultrasound

Auer

Punzengruber²,

Berent³

et al. 2004

Heart

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This case report describes the devastating consequences of spontaneous coronary dissection in a 36 year old female patient who otherwise had a normal coronary arteriogram. Intravascular ultrasound showed coronary artery dissection and intramural haematoma at the left main stem coronary artery. Acute coronary syndrome developed and subsequently surgical revascularisation was performed successfully. Spontaneous coronary artery dissection is a rare and often fatal cause of ischaemic heart disease occurring predominantly in young or middle aged otherwise healthy patients. It is mostly recognised at postmortem examination in young victims of sudden death.1 The cause of and optimal management approach for this challenging condition are still being debated. [1][2][3][4][5][6][7][8][9][10] About 250 cases of spontaneous coronary artery dissection have been reported in the literature. Spontaneous coronary artery dissection is the result of an intramural haematoma in the media of the arterial wall that creates a false lumen. Expansion of this lumen through blood or clot accumulation leads to compression of the real lumen and to myocardial ischaemia.An intimal tear is only seldom observed. Most reports are of apparently healthy, young to middle aged patients (mean age 40 years) without overt risk for coronary artery disease and without severe coronary atheromatosis.2 More than 70% of the reported cases occurred in women.2 The aetiology remains uncertain. We present a case of a spontaneous coronary dissection in a 36 year old female patient involving the left main stem. The patient was admitted with acute coronary syndrome and ECG signs of anterior wall ischaemia. Despite optimised pharmacological treatment, recurrent ischaemia occurred. Subsequently, surgical revascularisation was performed successfully. CASE REPORTA previously fit 36 year old white woman was admitted with a one hour history of chest pain. Precordial discomfort started during housekeeping. The patient had a fairly unremarkable medical history. She had two healthy children. Pregnancy was excluded by b human chorionic gonadotropin testing. She used no oral contraceptives or illicit drugs. There was no history of hypertension but the patient was a current smoker (10 pack-years). On examination, her supine heart rate was 86 beats/min and blood pressure was 112/78 mm Hg. She had no clinical signs of Marfan's syndrome or heart failure. On admission to hospital, her ECG showed ST segment elevation in the precordial leads indicating acute anterior wall myocardial infarction. Cardiac enzymes were slightly increased (creatine kinase (CK)) 204 U/l, normal range , 145 U/l; CK-MB fraction 23 U/l; troponin T 0.09 ng/ml, normal range , 0.03 ng/ml). Echocardiography showed a region of akinesia confined to the anterior wall and the apex of the left ventricle. The left ventricular lateral wall showed hypokinesia. The chest radiograph was normal. The patient was treated with aspirin, enoxaparin, metoprolol, nitrates, and opiates for acute coronary syndrome. Thirty five minut...

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“…12 Stenting is the considered therapy in case of a well-localised dissected lesion in a single vessel not involving the left main stem. 13 On the other hand it will be difficult to stent a complicated dissection involving thrombus and a nearly occluded lumen.…”

Section: Discussionmentioning

confidence: 99%