Spontaneous coronary artery dissection presenting with stroke.

Abstract

Spontaneous coronary artery dissection is a rare and potentially life-threatening condition that can cause rapid deterioration and fatal myocardial infarction. A 60-year-old Caucasian male was admitted with a complaint of left-sided numbness followed by weakness in the left arm and leg. Magnetic resonance imaging of the brain showed acute infarct in the posterior limb of the right internal capsule. Troponin I was 0.04 ng/ml. Two-dimensional echocardiography showed anterolateral hypokinesis to akinesis with an ejection fraction of 35–40 %, suggesting anterolateral myocardial infarction. Cardiac catheterization showed that the left anterior descending artery (LAD) was a good-sized 3 mm vessel with clear evidence of localized spontaneous coronary dissection at the second diagonal branch involving the ostium of the second diagonal branch. A stent was placed in the localized area of spontaneous dissection in the mid-LAD area with no post-catheterization complications, restoring normal flow. This case represents a unique manifestation of spontaneous coronary artery dissection leading to myocardial infarction, resulting in clot formation in the akinetic left ventricle with possible embolization, leading to acute stroke. It also shows that a single stent at the origin of the coronary artery dissection is a good method of treating spontaneous coronary artery dissection.