Succesful treatment of spontaneous dissection of the coronary artery by primary percutaneous coronary intervention

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction. The disease is usually seen in young-middle aged women and leads to sudden death in the majority of cases. In survived patients, diagnosis of SCAD has been made with coronary anjiography. Involvement of left main coronary artery (LMCA) is very unusual. We describe on a case of SCAD involving the LMCA in a young woman presenting with an acute myocardial infarction and cardiogenic shock status. There were no risk factors for coronary artery disease and no evidence of atherosclerosis on angiography. Coronary angiography revealed dissection of the LMCA that extended into the anterior descending and circumflex coronary arteries. The dissection was successfully treated with primary coronary artery stenting. The patient was discharged without complication. There was no problem in the first evaluation at the end of the first of the month.

Keywords

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Spontan koroner arter diseksiyonuna bağlı akut miyokard infarktüsünün primer perkütan girişimle başarılı tedavisi

Öz

Spontan koroner arter diseksiyonu, akut miyokard infarktüsünün nadir rastlanan bir nedenidir. Hastalık genellikle genç-orta yaştaki kadınlarda görülür. Spontan koroner arter diseksiyonu olguların büyük kısmında ani kardiyak ölüme neden olur. Yaşayan hastalarda hastalığın tanısı koroner anjiyografi ile konur. Hastalık en sık sol ön inen koroner arteri tutar, sol ana koroner arterin tutulumu ise son derece nadirdir. Biz sol ana koroner arterin spontan diseksiyonuna bağlı akut miyokard infarktüsü ve kardiyojenik şok tablosunda başvuran genç bir kadın hastayı bildirdik. Hastanın koroner arter hastalığı için risk faktörü yoktu. Koroner anjiyografisi sol ön inen koroner artere ve sirkumfleks artere uzanan sol ana koroner arter diseksiyonunu gösterdi. Anjiyografide ateroskleroza ait bulgu saptanmadı. Koroner diseksiyon, primer perkütan koroner girişim ile stentlenerek tedavi edildi. Hasta herhangi bir komplikasyon olmaksızın taburcu edildi ve birinci ayın sonundaki kontrolde sorunsuzdu.

Anahtar Kelimeler

• Akut miyokard infarktüsü, spontan koroner arter diseksiyonu, stent

References

1. Dhawan R, Singh G, Fesniak H. Spontaneous coronary artery dissection: the clinical spectrum. Angiology 2002;53(1):89- 93.
2. Jorgensen MB, Aharonian V, Mansukhani P, Mahrer PR. Spontaneous coronary dissection: a cluster of cases with this rare finding. Am Heart J 1994;127(5):1382-7.
3. Thayer JO, Healy RW, Maggs PR. Spontaneous coronary ar- tery dissection. Ann Thorac Surg 1987;44(1):97-102.
4. Hering D, Piper C, Hohmann C, Schultheiss HP, Horstkotte D. (Prospective study of the incidence, pathogenesis and therapy of spontaneous, by coronary angiography diagnosed coronary artery dissection). Z Kardiol 1998;87(12):961- 70.
5. Thompson EA, Ferraris S, Gres T, Ferraris V. Gender differ- ences and predictors of mortality in spontaneous coronary artery dissection: A review of reported cases. J Invasive Cardiol 2005; 17(1): 59-61.
6. Conraads VM, Vorlat A, Colpaert CG, et al. Spontaneous dissection of three major coronary arteries subsequent to cystic medial necrosis. Chest 1999; 116(5):1473-5.
7. DeMaio J, Samuel J, Kinsella SH, Silverman ME. Clinical course and long-term prognosis of spontaneous coronary artery dissection. Am J Cardiol 1989;64(8):471-4.
8. Aqel RA, Zoghbi GJ, Iskandrian A. Spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms: a re- view. Echocardiography 2004;21(2):175-82.

9. Lane JE, Cartledge RG, Johnson JH. Successful surgical treatment of spontaneous coronary artery dissection. Curr Surg 2001;58(3):316-8.
10. Çolak N, Nazlı Y, Alpay F. Spontan koroner arter diseksi- yonları: Dört olgu ve literatürün gözden geçirilmesi. Dicle Tıp Dergisi 2009;36(4):294-300.
11. Butler R, Webster MWI, Davies D, et al. Spontaneous dissec- tion of native coronary arteries. Heart 2005;91(2):223-4.
12. Le MQ, Ling FS. Spontaneous dissection of the left main coronary artery treated with percutaneous coronary stent- ing. J Invasive Cardiol 2007;19(8):218-21.
13. Zampieri P, Aggio S, Roncon L, et al. Follow up after spon- taneous coronary artery dissection: a report of five cases. Heart 1996;75(2):206-9.