Spontaneous Intimal Dissection in a Patient with Post-Infarct Angina: Identification with Intravascular Ultrasound and Treatment with Coronary Stenting

Abstract

SUMMARYA 45-year-old Turkish male patient was admitted to our hospital for an acute myocardial infarction. He had suffered two previous acute myocardial infarctions 5 and 6 years earlier. Coronary angiography performed after the previous two acute myocardial infarctions had shown normal coronary arteries and coronary vasospasm had been suspected. The patient was treated with thrombolytic therapy (rt-PA) during the last coronary event.Five days after the current admission, the patient had postinfarct angina and underwent coronary angiography, showing only a nonobstructive lesion with irregular ulcerated edges in the left anterior descending artery after the first diagonal branch. Subsequent intravascular ultrasound confirmed the presence of an atherosclerotic lesion with plaque dissection. Stenting of this lesion was performed with successful relief of on-going chest pain.Intravascular ultrasound can provide important diagnostic information in patients presenting with acute coronary syndromes in the absence of severe angiographic stenosis. Identification of plaque dissection at mildly stenotic lesions provides pathophysiologic insights that may have therapeutic implications. However, the optimal treatment for such lesions is not known. (Jpn Heart J 2003; 44: 557-564)

Normal angiogram in acute coronary syndromes: The underestimated role of alternative substrates of myocardial ischemia

“…Alternative substrates of acute myocardial ischemia may include coronary paradoxical embolism, coronary embolism from other sources, coronary spasm, coronary artery anomalies, coronary dissection, hyper-coagulating states and imbalance of blood flow demand and supply. Complying with the ACS international guidelines, evaluation of the age and gender, electrocardiographic profile, stress tests, and by an imaging point of view, intravascular ultrasound [29,33,34] with pharmacological drug tests have to be taken in account by invasive and clinical cardiologists when they have to deal with CAS patients with normal coronary arteries. Further large scale studies are warranted to investigate proper preangiographic stratification and optimal management of this subset of patients with ACS.…”

Sub-acute anterior myocardial infarction due to the discontinuation of warfarin in a patient with aortic valve prosthesis: what is the best treatment

“…Intravascular ultrasonography and optical coherence computed tomography are very useful to diagnosis so which treatment is the best; thrombolysis, angioplasty or stenting. Previous cases of coronary emboli in association with prosthetic mechanical valves have been reported previously but the treatment is controversial [8][9][10][11][12][13][14][15][16]. We present a patient who had a mechanical aortic valve and was admitted to the hospital for a sub-acute anterior ST elevation myocardial infarction due to the discontinuation of warfarin.…”

Postpartum Multivessel Spontaneous Coronary Artery Dissection Confirmed by Coronary Ct Angiography

“…Patients presenting to a hospital facility typically have their definite diagnosis made by traditional coronary angiography. One published case reported the use of intravascular ultrasound to show the luminal dissection characteristic of SCAD (7). We believe that new CT angiography technology can be applied to the diagnosis and monitoring of SCAD.…”