Stenting of Spontaneous Coronary Artery Dissection From a Pathological Point of View.

Abstract

A 32-year-old female recently postpartum was admitted with chest pain and shortness of breath. She was diagnosed with acute inferior myocardial infarction and taken to catheterization laboratory in cardiogenic shock. The proximal right coronary artery was occluded, and an everolimus-eluting stent (Abbott Vascular, Santa Clara, CA) was implanted successfully. Left coronary angiography showed 50% stenosis of proximal left anterior descending (LAD) and total occlusion of left circumflex. The patient remained in cardiogenic shock despite insertion of an intra-aortic balloon pump and temporary pacemaker and died after cardiac arrest. At autopsy (Figure [A]), coronary arteries showed no gross atherosclerosis, but diffuse coronary artery dissections, involving left main, LAD, left circumflex, and right coronary artery. The stent was implanted in the true lumen (TL, Figure [A3 through A5]), though it was not well expanded and the underlying dissection was still observed. The dissection in the right coronary artery extended both proximally and distally, but severe narrowing was only observed in the distal right …