Postpartum Spontaneous Coronary Artery Dissection: A Case of Pseudoaneurysm Evolution Detected on MDCT

Abstract

Postpartum Spontaneous Coronary Artery Dissection: A Case of Pseudoaneurysm Evolution Detected on MDCT Spontaneous coronary dissection predominantly affecting young women is rare but is often dramatic. A third of the cases occur at the end of pregnancy or during the postpartum period [1]. Its treatment remains empiric [2], usually depending on the symptoms, hemodynamic state, and angiography results. A 31-year-old woman, gravida 2, para 2, without medical history of cardiovascular disease or cardiovascular risk factors presented with an acute myocardial infarction 3 days postpartum. The angiography images obtained in the emergency department showed a left main artery dissection extending to the proximal left anterior descending (LAD) coronary artery with good distal flow and occlusion of the first diagonal artery. Once the patient received medical treatment, the initial clinical and ECG evolution were favorable. The next day, MDCT showed the same dissection with recanalization of the diagonal artery (Fig. 1A). The diagnosis was confirmed on angiography. At 6 weeks, MDCT showed a pseudoaneurysm of the left main artery in addition to the LAD artery dissection (Figs. 1B and 1C). Because of this fast evolution, we chose to treat the lesion with stenting guided by the MDCT images and measurements. After angiographic confirmation, the proximal LAD and left main arteries were treated using two short paclitaxel-eluting stents (3.5 × 8 and 4 × 8 mm; Taxus Express, Boston Scientific) to allow intimal flap correction and closure of the pseudoaneurysm. The stent placement showed satisfactory exclusion of the pseudoaneurysm, which was confirmed at 6 months using angiography and MDCT (Fig. 1D). At 1 year after stent placement, the patient remains asymptomatic. To our knowledge, this is the first observation of pseudoaneurysm complicating a spontaneous coronary dissection in which MDCT allowed an early diagnosis and was used to guide the therapeutic strategy. A B