Abstract
We herein describe a 49-year-old woman without significant cardiovascular risk factors who was transferred to our hospital with sudden onset of chest pain. The patient was diagnosed with non-ST-elevation acute myocardial infarction, and coronary angiography revealed a dissection at the proximal site of the left anterior descending artery (LAD) extending from the left main trunk (LMT) suggestive of spontaneous coronary artery dissection (SCAD). Because coronary flow was impaired after contrast injection and the patient had chest pain with ST elevation, urgent percutaneous coronary intervention was performed. The first guide wire was initially introduced from the LMT to the distal LAD, but intravascular ultrasound (IVUS) imaging revealed that the guide wire had passed through the true lumen of the left coronary artery ostium, false lumen at the ostium of the left circumflex artery, and true lumen of the distal LAD. We then reinserted another guide wire using an IVUS-guided rewiring technique from the true lumen of the LMT to the distal LAD. Finally, a drug-eluting stent was deployed to cover the dissected segment, and final coronary angiography revealed acceptable results with a patent left circumflex artery. This case report highlights that physicians should consider SCAD among the differential diagnoses in patients presenting with acute coronary syndrome, particularly in young women. In the present case, IVUS played a pivotal role in not only detecting the arterial dissection but also correctly introducing the guide wire into the true lumen.
Highlights
Spontaneous coronary artery dissection (SCAD) is a relatively rare but important cause of acute coronary syndrome, especially in young women without significant cardiovascular risk factors and coronary atherosclerosis [1, 2]
In patients with high-risk features such as ongoing ischemia with ST elevation, dissection involving the left main trunk (LMT), and hemodynamic instability, urgent revascularization strategies including percutaneous coronary intervention (PCI) or coronary artery bypass surgery should be considered for the treatment of SCAD [5,6,7]
The first wire (SION Blue; Asahi Intecc Co., Ltd., Nagoya, Japan) was initially introduced into the distal left anterior descending artery (LAD), but intravascular ultrasound (IVUS) imaging revealed that the guide wire had passed through the true lumen of the left coronary artery ostium, false lumen at the ostium of the left circumflex artery (LCX), and true lumen of the distal LAD (Figure 2(a))
Summary
Spontaneous coronary artery dissection (SCAD) is a relatively rare but important cause of acute coronary syndrome, especially in young women without significant cardiovascular risk factors and coronary atherosclerosis [1, 2]. In patients with high-risk features such as ongoing ischemia with ST elevation, dissection involving the left main trunk (LMT), and hemodynamic instability, urgent revascularization strategies including percutaneous coronary intervention (PCI) or coronary artery bypass surgery should be considered for the treatment of SCAD [5,6,7]. We successfully reinserted another guide wire using an IVUS-guided rewiring technique from the true lumen of the LMT to the distal LAD. In this case, IVUS played a pivotal role in detecting the dissection and introducing the guide wire into the compressed true lumen
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
