Spontaneous Coronary Artery Dissection Manifested during Ergonovine Test and Treated with Intravascular Ultrasound Guided Stenting: A Case Report

Ahn, Sung Gyun; Tahk, Seung Jea; Choi, Jung Hyun; Yoo, Sang-Yong; Zheng, Zhen Guo; Choi, Byoung‐Joo; Choi, Tae Young; Choi, So Yeon; Yoon, Myeong‐Ho; Hwang, Gyo Seung; Shin, Joon Han

doi:10.4070/kcj.2005.35.3.264

Cited by 3 publications

(4 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An association between intense coronary vasospasm and intramural hematoma formation has been reported, 4 but in our case the possibility of an iatrogenic effect is highly unlikely because the patient presented with ischemic symptoms and signs before intracoronary ergonovine, and these symptoms and signs did not reappear after drug administration.…”

mentioning

confidence: 78%

Intravascular Ultrasound–Documented Healing of Spontaneous Coronary Artery Dissection

Porto

Aurigemma

Pennestrì

et al. 2010

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

A 46-year-old woman without a history of cardiovascular disease and no coronary risk factor was urgently admitted to our hospital with rest crushing chest pain, which had started 3 hours before. The ECG demonstrated minimal anterior STsegment elevation in leads V 1 to V 4 (Figure 1). In the first sample cardiac troponin T was 0.08 ng/mL. Coronary angiography was urgently performed and demonstrated a 50% smooth stenosis in the proximal left anterior descending (LAD) coronary (Figure 2) with a faint dye staining just proximal to the first diagonal branch. Because initial differential diagnosis included variant angina, intracoronary ergonovine (32 g) was given. Diffuse LAD coronary vasoconstriction, more severe on the LAD coronary ostium, was seen. Because there was still no clear indication of a culprit lesion, intravascular ultrasound (IVUS) examination was performed, which surprisingly showed an intramural hematoma starting from the mid-LAD up to its ostium, with mild lumen compromise, and the presence of nonobstructive atheroma (Figure 2). Echo-free material, consistent with contrast medium or saline, was seen mixing with echogenic blood within the hematoma (Figure 3), indirectly indicating that the hematoma was the result of a spontaneous coronary dissection (SCAD), with an occult entry flap. Stenting was considered, but because of the stable hemodynamic condition, medical management with aspirin, clopidrogel, nitrates, and ␤-blockers was chosen. After 12 hours, repeat ECG demonstrated deep, negative T waves in the anterior leads. (Figure 1). The cardiac troponin T peak was 0.2 ng/dL at 24 hours. Angiography and IVUS were repeated at 48 hours and showed persisting intramural hematoma, although with reduced lumen compression (Figure 4). Because of the absence of what we considered to be "high-risk" IVUS features, the patient was discharged home on medical therapy. At 3 months, IVUS control showed an almost complete disappearance of intramural hematoma, and echocardiography was normal ( Figure 5). Oneyear clinical follow-up was uneventful.SCAD is an uncommon cause of acute coronary syndrome and sudden death. 1 Its etiology and pathogenesis have not been fully elucidated, and prognosis and treatment are not clearly defined. Connective tissue disease, immune system alterations, pregnancy, oral contraceptive use, intense physical activity, and illicit drug consumption are known to be involved in SCAD etiology, 1 and yet in a relevant percentage of SCAD, as in our case, none of these conditions is overtly present.The initial presentation is frequently an acute coronary syndrome, and SCAD should be taken into consideration in patients without known cardiovascular risk factors presenting with acute coronary syndrome. 1 Because there is lack of consensus concerning SCAD treatment, management decisions are generally made on a case-by-case basis, integrating the clinical scenario with angiographic assessment of dissection location and the extent and degree of flow compromise. 1 Treatment options include medical therapy, ...

show abstract

mentioning

confidence: 78%

Intravascular Ultrasound–Documented Healing of Spontaneous Coronary Artery Dissection

Porto

Aurigemma

Pennestrì

et al. 2010

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

show abstract

“…If the hematoma is extensive, long lesion stent deployment may be neccessary 19). The use of angioplasty alone, without stenting, is associated with a potential risk of dissection propagation 20). IVUS may be useful in determining and controlling the bailout therapy, which includes stenting of the entry point at the initial dilatation site.…”

Section: Discussionmentioning

confidence: 99%

“… 19) The use of angioplasty alone, without stenting, is associated with a potential risk of dissection propagation. 20) IVUS may be useful in determining and controlling the bailout therapy, which includes stenting of the entry point at the initial dilatation site. Surgery must be considered in patients who have hematomas extending into the left main coronary artery.…”

Section: Discussionmentioning

confidence: 99%

Intravascular Ultrasound-Guided Troubleshooting in a Large Hematoma Treated With Fenestration Using a Cutting Balloon

et al. 2009

View full text Add to dashboard Cite

Intramural hematoma formation is not a well-studied complication of percutaneous coronary intervention. We describe a patient with stable angina who developed an intramural hematoma during elective percutaneous coronary intervention (PCI) in the right coronary artery (RCA). Total occlusion with dense dye staining developed a long way from the distal RCA, near the posterior descending artery bifurcation site. The true lumen was compressed by the enlarged, tense, false lumen. The patient was successfully treating with intravascular ultrasound-guided fenestration using a cutting balloon, and a stent was implanted in the distal RCA.

show abstract

“…Twelve cases are reported in the Korean literature with related events including exercise, insomnia, ergonovine test, hypertension, diabetes mellitus and peripartum women (Table 1). 8–15 These Korean cases were clinical cases detected by echocardiography or angiography, except one case which was a woman at an early postpartum 13…”

Section: Discussionmentioning

confidence: 99%

Spontaneous coronary artery dissection as a cause of sudden, unexpected death

Han

Nam

Kim

et al. 2008

Basic and Applied Pathology

View full text Add to dashboard Cite

Two cases of sudden unexpected death due to spontaneous coronary artery dissection are reported, retrieved from a series of forensic autopsies of 3300 cases since 1997. The first case was a 52-year-old man who had no previous health problem but cardiomegaly and atherosclerosis in coronary arteries. The dissection was found between the intima and the media at the proximal and mid-portion of the left anterior descending coronary artery, 6.6cm in segment. The second case was a 39year-old woman who had a history of hypertension and an intrauterine device. The dissection was also found between the intima and the media of the mid-portion of the left anterior descending coronary artery, 8.7cm in segment. There was no myocardial infarct probably due to the hyperacute nature of this coronary obstruction. No significant predispositions were noted although hypertension and the intrauterine device may have causal association. Both reported cases present previously healthy adults who experienced sudden, unexpected death.

show abstract

Spontaneous Coronary Artery Dissection Manifested during Ergonovine Test and Treated with Intravascular Ultrasound Guided Stenting: A Case Report

Cited by 3 publications

References 22 publications

Intravascular Ultrasound–Documented Healing of Spontaneous Coronary Artery Dissection

Intravascular Ultrasound–Documented Healing of Spontaneous Coronary Artery Dissection

Intravascular Ultrasound-Guided Troubleshooting in a Large Hematoma Treated With Fenestration Using a Cutting Balloon

Spontaneous coronary artery dissection as a cause of sudden, unexpected death

Contact Info

Product

Resources

About