Spontaneous Coronary Artery Dissection

Adlam, David; Tweet, Marysia S.; Gulati, Rajiv; Kotecha, Deevia; Rao, Praveen; Moss, Andrew; Hayes, Sharonne N.

doi:10.1016/j.jcin.2021.06.027

Cited by 48 publications

(51 citation statements)

References 51 publications

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“…The booming use of new adjunctive methods of intracoronary imaging has led to increased rates of SCAD diagnosis. CAG and ancillary intracoronary imaging can help to maximize diagnostic accuracy [15]. In addition, the angiographer must be extremely careful not to cause catheter-induced coronary artery dissection.…”

Section: Discussionmentioning

confidence: 99%

Discussion on the causes of thrombolysis failure in a patient with STEMI: a case report

Qiu

Li²,

Yan³

et al. 2022

BMC Cardiovasc Disord

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Background Spontaneous coronary artery dissection (SCAD) has emerged as an increasingly diagnosed cause of ST-segment elevation myocardial infarction (STEMI), which is easily missed or delayed. The effective use of coronary angiography (CAG) and advanced intracoronary imaging examinations in STEMI patients has led to increased detection of SCAD. Case presentation A 59-year-old woman with acute angina pectoris was diagnosed with STEMI detected by electrocardiography combined with measurement of myocardial enzymes. Due to the ongoing pandemic of coronavirus disease 2019 (COVID-19) in Wuhan, she was first given thrombolytic therapy after excluding contraindications according to the requirements of the current consensus statement; however, subsequently, both the symptoms of ongoing chest pain and the electrocardiographic results indicated the failure of thrombolytic therapy, so the intervention team administered rescue percutaneous coronary intervention treatment under third-grade protection. CAG confirmed total occlusion in the distal left anterior descending (LAD) artery, with thrombolysis in myocardial infarction (TIMI) 0 flow, whereas the left circumflex and right coronary arteries appeared normal, with TIMI 3 flow. Intravenous ultrasound (IVUS) was further performed to investigate the causes of occlusion, which verified the absence of atherosclerosis but detected SCAD with intramural haematoma. During the operation, the guidewire reached the distal end of the LAD artery smoothly, the balloon was dilated slightly, and the reflow of TIMI blood could be seen by repeated CAG. During the follow-up period of one and a half years, the patient complained of occasional, slight chest tightness. The repeated CAG showed that the spontaneous dissection in the LAD artery had healed well, with TIMI 3 flow. The repeated IVUS confirmed that the SCAD and intramural haematoma had been mostly resorbed and repaired. Conclusion This was a case of failed STEMI thrombolysis in our hospital during the outbreak of COVID-19. This case indicates that doctors need to consider the cause of the disease when treating STEMI patients, especially patients without traditional cardiovascular risk factors. Moreover, CAG and intracoronary imaging examinations should be actively performed to identify the aetiology and improve the treatment success rate.

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Section: Discussionmentioning

confidence: 99%

Discussion on the causes of thrombolysis failure in a patient with STEMI: a case report

Qiu

Li²,

Yan³

et al. 2022

BMC Cardiovasc Disord

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“…However, its lower spatial resolution makes it challenging to distinguish SCAD from lipid-rich atheroma (a key differential diagnosis). 46 Because of this, routine imaging is not recommended and should only be considered if angiography alone is not enough to make a diagnosis (e.g. type 3 or unclear lesions).…”

Section: Discussionmentioning

confidence: 99%

Spontaneous coronary artery dissection, a multifactorial disease: insights from a center experience

Oliveira¹,

Vasconcelos²,

Abreu³

et al. 2023

J Transcat Intervent

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Background: Although it is a poorly known disease, spontaneous coronary artery dissection is an important and frequently underdiagnosed cause of non-atherosclerotic acute coronary syndrome, particularly in women. The objective of this study was to characterize a consecutive sample of patients diagnosed with spontaneous coronary artery dissection with respect to predisposing and precipitating factors; clinical and angiographic presentation; management; occurrence of adverse cardiac events; recurrence; and de novo spontaneous coronary artery dissection. Methods: Longitudinal, observational, retrospective, single-centre study, including patients diagnosed with spontaneous coronary artery dissection (n=60) admitted between January 2010 and December 2020. Results: Median age was 55 years, and 83% were women. Most patients (60%) presented without any or just one cardiovascular risk factor. Non-ST-segment elevation acute myocardial infarction accounted for 67% of clinical presentations. The most frequently affected coronary artery was the left anterior descending (47%). Most lesions (77%) appeared on angiography as type 2 spontaneous coronary artery dissection. Conservative management was chosen as the initial approach in most patients (72%). The overall incidence of de novo spontaneous coronary artery dissection was not significantly different among patients initially managed with revascularization as compared to conservative treatment (p=0.953). However, spontaneous coronary artery dissection recurrence occurred in the originally involved vessel in 3 of 15 patients initially managed with revascularization, as compared to only one among 43 patients treated conservatively (p<0.05). Conclusion: Spontaneous coronary artery dissection occurs more often in young women. Non- ST-segment elevation acute myocardial infarction was the most frequent clinical presentation involving mainly the left anterior descending artery. Revascularization did not protect from recurrence.

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“…SCAD occurs frequently in women under 50 years of age and is characterized by true and false lumens caused by hematomas within the coronary mesothelium, most often in the LAD. [ 12 , 13 ] The disease is generally observed to heal spontaneously, so conservative treatment is preferred. The etiology may be related to fibromuscular dysplasia, pregnancy, autoimmune diseases, or mental stress.…”

Section: Discussionmentioning

confidence: 99%

Typical clinical presentation of acute myocardial infarction and confusing coronary angiography: A case report and literature review of coronary embolism

2023

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Rationale: The purpose of this article is to discuss the characteristics, diagnosis, treatment, and outcomes of cases of multiple coronary embolism (CE) highly suspected to be caused by a dislodged aneurysm of the ventricular membranous septum (AVMS) thrombus. Patient concerns: A 35-year-old man was rushed to the Chest Pain Center of Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine for sudden onset of chest pain. The patient had severe and persistent chest pain without relief, accompanied by sweating throughout the body. Diagnosis: An electrocardiogram showed ST-segment elevation in the inferior wall leads, and blood tests suggested elevated troponin I levels. The initial diagnosis was acute ST-segment elevation myocardial infarction. Emergency coronary angiography revealed complete occlusion of the first diagonal branch, thrombolysis in myocardial infarction grade 0 flow, and smooth remaining vessels. Complete occlusion of the left anterior descending artery unexpectedly occurred during interventional treatment. Postoperative cardiac ultrasonography revealed the presence of a thrombus within the AVMS and in the apical portion of the heart. The final diagnosis was a CE. Interventions: Intraoperatively, the diagonal branch occluded segment was dilated with a balloon and intracoronary administration of tirofiban and nitroglycerin. Postoperatively, antithrombotic therapy (aspirin, clopidogrel, and rivaroxaban) was administered. Outcomes: Ten days after admission, a repeat coronary angiography showed complete restoration of left anterior descending artery flow on its own, balloon dilation was again performed on the diagonal branch, and flow was restored to thrombolysis in myocardial infarction grade 1. Six months later, the intracardiac thrombus disappeared on repeat cardiac ultrasound. Lessons: AVMS is a potential source of embolism in patients with CE. CE has features that distinguish it from atherosclerosis, and a timely and correct diagnosis can help improve patient clinical outcomes.

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Spontaneous Coronary Artery Dissection

Cited by 48 publications

References 51 publications

Discussion on the causes of thrombolysis failure in a patient with STEMI: a case report

Discussion on the causes of thrombolysis failure in a patient with STEMI: a case report

Spontaneous coronary artery dissection, a multifactorial disease: insights from a center experience

Typical clinical presentation of acute myocardial infarction and confusing coronary angiography: A case report and literature review of coronary embolism

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