Spontaneous Coronary Artery Dissection

Abstract

Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndromes but is represented disproportionately in young female patients. No specific guidelines exist concerning the appropriate treatment (medical therapy, intracoronary stents, coronary bypass surgery) or the optimal type of stents in otherwise atheroma-free vessels. The role of intracoronary imaging with intravascular ultrasound (IVUS) and optical coherence tomography (OCT) has yet to be fully established. A 39-year-old woman with no traditional risk factors for coronary artery disease presented with an anterior ST-segment elevation myocardial infarct after undergoing rigorous aerobic exercises. The patient was gravida 3 para 3, not known to be pregnant, and not postmenopausal. Her last pregnancy was 5 years earlier, and subsequent β human chorionic gonadotropin was negative. Coronary angiography suggested a long spiral dissection in the left anterior descending artery. Her other coronary arteries were smooth walled with no evidence of atherosclerosis. With ongoing symptoms and persisting ST elevation of the surface …