Recurrent spontaneous coronary artery dissection with transient left ventricular systolic dysfunction

Ventricular tachycardia in a man with spontaneous coronary artery dissection

“…In cases associated with pregnancy or in the postpartum period, the postulated mechanism is a degeneration of the intimal and medial connective tissue that leads to a weakening of the arterial media and also, it has been speculated the rupture and haemorrhage of the vasa vasorum could be the primary force in triggering dissections. A periadventitial infiltrate composed of eosinophilic lymphocytes and histiocytes has been described in histologic analysis of some patients following coronary dissection [5][6][7][8]. Most of the patients do not have risk factors, but there is an association with smoking and hypertension [5].…”

“…A new technique has recently reported the multi-detector row computed tomographic (MDCT) coronary angiography. It is applied to identify intramural hematoma, showing luminal reduction and have under surveillance the progress of the dissection, to avoid repeated invasive imaging [6].…”

“…Stable patients with limited dissections frequently are candidates for medical treatment [5][6][7][8]. Thrombolysis was not recommended because it may cause propagation of the dissection and expansion of the intramural haematoma [5,8].…”

“…Coronary artery bypass grafting (CABG) should be reserved for those patients with left main dissection, multivessel disease or failure of interventional procedures and percutaneous coronary angioplasty (PCA) is the therapy of choice in the case of single-vessel disease [5][6][7][8]. CABG as an alternative mode of therapy is often technically challenging in these cases due to the difficulty in ensuring bypass into the true lumen.…”

“…Our patient is not a suitable case for stent implantation. Indeed, PCA in SCAD may also be dangerous with the risk of a coronary perforation or an expansion of the coronary dissection [6].…”