Genç Erkek Hastada Sirkumfleks Koroner Arterin Spontan Diseksiyonu ve Tedavisi

Year 2015, Volume: 18 Issue: 1, 60 - 62, 06.04.2015

İbrahim Uyar Engin Tulukoğlu Erhan Kaya Mehmet Meriç

Abstract

Spontan koroner arter diseksiyonu
(SKAD) nadir fakat bazen akut koroner sendromun hayatı tehdit eden nedenidir.
Hastalar angina pektoristen kardiyojenik şoka ve ani kardiyak ölüme kadar
çeşitli klinik durumlar ile ortaya çıkabilir. SKAD koroner anjiyografi, koroner
CT anjiyografi veya intravasküler ultrason ile teşhis edilebilir. Tedavi
stratejisi seçimi ortaya çıkan kliniğine, lokalizasyonuna, diseksiyonun
yaygınlığına ve risk altındaki iskemik miyokardium miktarına bağlıdır. Bu
yazıda, ek risk faktörü olmayıp egzersiz sonrası göğüs ağrısı ile başvuran ve
EKG ve kardiyak enzim anormalliği olmayan 33 yaşındaki erkek hastayı sunuyoruz.
Ek risk faktörü, EKG değişikliği ve kardiyak enzim anormalliği olmaması
nedeniyle konvansiyonel KAG yerine koroner CT anjiyografi ile sirkumfleks
koroner arterin spontan yaygın diseksiyonu tanısı kondu, perkütan koroner
stentleme uygulandı. Sorunsuz klinik seyir sonrası medikal tedavi ile taburcu
edildi. Postop birinci ayda restenoz gelişen hastaya yeniden başarılı stentleme
uygulandı. Ayrıca bu klinik tablo ile ilgili literatürü kapsamlı bir inceleme
ile sunuyoruz.

Keywords

Spontan koroner arter diseksiyonu, akut koroner sendrom, çok kesitli bilgisayarlı tomografi, koroner anjiyografi, perkütan koroner, revaskülarizasyon

Spontaneous Dissection of Circumflex Coronary Artery in a Young Male Patient

Abstract

Spontaneous coronary
artery dissection (SCAD) is a rare but sometimes life-threatening cause of
acute coronary syndrome. Patients may present with various clinical conditions
ranging from angina pectoris to cardiogenic shock to sudden cardiac death. SCAD
is diagnosed with coronary angiography, coronary computed tomography
angiography or intravascular ultrasound. The selection of treatment strategy
depends upon the clinical manifestation, location and the extent of dissection
and amount of ischemic myocardium at risk. Herein, we present the case of a
33-year-old man who presented with post exercise chest pain. Diffuse
spontaneous dissection of circumflex coronary artery was diagnosed with
coronary computed tomography angiography instead of conventional coronary
angiography due to the absence of additional risk factors, ECG changes, and
cardiac enzyme abnormalities. He was treated with percutaneous coronary
stenting and had a favorable clinical course and was discharged on medical
therapy. Re-stenosis developed at one month later and re-stenting was performed
successfully. We also provide a comprehensive review of published literature
related to this clinical entity.

Keywords

Coronary artery dissection spontaneous, acute coronary syndrome, multislice computed tomograpy, angiography coronary, percutaneous coronary, revascularization

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