Artery Dissection Research Articles

Prevalence of coronary microvascular disease in myocardial infarction with non-obstructive coronary artery disease

Abstract Background Six percent of patients presenting with acute myocardial infarction (MI) have MI with non-obstructed coronary artery disease (MINOCA). Coronary microvascular disease (CMD) is common in angina with non-obstructive coronary artery disease (ANOCA), but its prevalence and severity in MINOCA is undefined. Purpose Patients with CMD may have elevated risk of myocardial infarction despite no significant stenosis. We tested the hypothesis that patients with MINOCA have more significant burden of CMD than patients with ANOCA. Methods A retrospective case-control study was performed on patients who underwent invasive testing for signs of coronary ischemia and found to have non-obstructive disease (stenoses< 50%). Cases of MI were classified as MINOCA (n=87) and compared to patients with ANOCA (n=552). Patients with spontaneous coronary artery dissection, myocarditis, Takotsubo cardiomyopathy or prior atherothrombotic MI were excluded. Coronary catheterization was performed followed by invasive provocation testing with adenosine and acetylcholine using a Doppler flow wire. CMD was subdivided into endothelium-independent, defined as coronary flow reserve (CFR) < 2.5 with intra-coronary adenosine, and endothelium dependent, defined as < 50% increase in coronary blood flow with acetylcholine. Epicardial vasoconstriction > 90% with typical anginal symptoms was classified as epicardial vasospasm. Results There was no difference in age, sex or traditional coronary risk factors between the MINOCA and ANOCA groups (Table 1). Fifty (57%) of patients with MINOCA had type 2 MI secondary to supply-demand mismatch. Both MINOCA and suspected ANOCA patients had a high prevalence of CMD (71% vs 67%) and endothelium-independent CMD is more prevalent in MINOCA (64.5% vs 50.4%). Although odds of endothelium-dependent CMD were similar, the CFR within this group and CMD overall was worse in MINOCA patients (Figure 1). There was no difference in epicardial spasm. Conclusion Coronary microvascular disease and vasomotor dysfunction are common in patients with MINOCA, with a higher prevalence of endothelium-independent CMD and more severe CMD overall compared to patients with ANOCA. Treatment of CMD in patients with MINOCA may help reduce recurrence and warrants further investigation.

The role of cardiac magnetic resonance in patients with an angiographically diagnosed SCAD

Abstract Background/Introduction Spontaneous coronary artery dissection (SCAD) characterized by its non-atherosclerotic nature, poses challenges in diagnosis and management. While recent efforts shed light on SCAD's clinical aspects, the specific utility of CMR demands deeper investigation for enhanced diagnosis and patient care. Purpose This study aims to analyze the characteristics of patients with an angiographically diagnosed SCAD, evaluate qualitative and quantitative parameters of baseline CMR and investigate predictors of myocardial injury and the association between CMR parameters and clinical outcome (major adverse cardiac events, MACE). Methods The study is a prospective single-center analysis of 59 patients, presented acutely in our hospital, from March 2018 to November 2023, with an angiographically detected SCAD. CMR was performed after a median of 4 days (IQR 1.5-7) from the acute onset of symptoms. SCAD Types were angiographically categorized according to the Yip-Saw classification. Most patients (71%) were screened for fibromuscular dysplasia (FMD) with a brain MR and at least one contrast-enhanced abdominal vessels investigation (CT or MR). CMR imaging was performed on a clinical 1.5 T Scanner. T1-weighted, T2-weighted turbo-spin-echo (TSE) Black-Blood (BB) and Short-Tau-Inversion-Recovery (STIR) sequences in short-axis orientation were acquired. The scan protocol included standard cine and T1/T2-weighted TSE BB and Mapping sequences. Late gadolinium enhanced (LGE) images were acquired ≏10 min after the contrast injection and were visually assessed for the presence and extension of LGE areas. LGE quantification was assessed semiautomatically. Results 40 (68%) were females. 54(92%) complained of chest pain, in 55 (93%) high-sensitive Troponin T was eleveted (>14 ng/l) and 24 (41%) presented with the clinical picture of STEMI on admission. From an angiographic point of view, the majority (69.5%) were classified as SCAD Type 2 (a+b). Among patients who underwent a proper screening, 7 patients (16%) were diagnosed with FMD. Baseline CMR showed signs of active injury in 81% and LGE in 93% of the population; however, it was often moderate in size (median of LGE segments 3, IQR 2-5). Most patients had a preserved LVEF (55±10%). STEMI presentation is an independent predictor of LGE extension (p=0.02, OddsRatio(95% CI)=7(2-24)). ScadType1 (p=0.01, OR=10( 2-39)) and N°LGE transmural segments >3 (p=0.03, OR=5.4(1.2-25)) were found to be significant predictor of MACE. 6 of the 11 MACEs were SCAD recurrence/progression, and 4 out of these 11 had already shown signs of previous myocardial injury in the baseline CMR. Conclusion(s) This study emphasized the significance of CMR, which may provide further insights into extend of myocardial damage and may aid in patients’ risk stratification.

Cognitive and physical fatigue: the experience and consequences of brain fog after spontaneous coronary artery dissection, a qualitative study

Abstract Background Mild cognitive impairment (often subjectively referred to as "brain fog") and cognitive fatigue are common sequelae after acute coronary syndrome. However, little is known about the nature and impact of these experiences in spontaneous coronary artery dissection (SCAD) survivors. Purpose To understand if and how brain fog and cognitive fatigue are experienced following SCAD. Methods Participants were recruited from a larger SCAD genetics study database and were considered eligible if they had experienced SCAD within 12 months. Seven semi-structured online focus groups, with the primary aim of exploring psychosocial impacts of SCAD, were conducted between December 2021 and January 2022. Each focus group lasted for 1 hour 30 minutes and were led by investigators extensively experienced in qualitative research and cardiac rehabilitation. Interviews were digitally recorded, transcribed verbatim, and thematically analysed using Braun and Clark’s reflexive approach. Results Participants (n=30) had a mean age of 52.2±9.5 years and mostly female (n=27, 90%), partnered (n=27, 90%) and employed (n=27, 90%). Four main themes were identified: experiences of brain fog, perceived causes of brain fog, impacts of brain fog and coping with brain fog. Experiences of brain fog included memory lapses, difficulty concentrating and impaired judgement. Perceived causes of brain fog included medication, sleep deprivation and tiredness, and menopause and hormonal changes. The impacts of brain fog included rumination, changes in self-perception, disruption to hobbies and pastimes, and limitations at work. Coping mechanisms used for these challenges included reminders, setting expectations, being one's own advocate, making lifestyle adjustments, and support from peers. Conclusion Brain fog is commonly experienced by SCAD survivors and present challenges to normal life after SCAD. The impacts on daily life are varied, including those relating to self-perception and capacity to work. SCAD survivors reported difficulty understanding causes and found their own path to coping. Clinicians should be aware of these experiences as they are ideally placed to assist patients with these challenges.

Preliminary data on short-term outcomes within the cardio-obstetrics registry

Abstract Background Pregnancy leads to physiological changes within the cardiovascular system such as increased plasma volume and cardiac output or hypercoagulability. These changes can be challenging for women with pre-existing cardiovascular disease with higher risks of complications. The guidelines of the European Society of Cardiology recommend treating high-risk patients in specialized centres by an interdisciplinary pregnancy heart team. In a team-based approach, the Pregnancy Heart Team was founded at our university hospital, in order to establish specific structures of communication and responsibility. Methods A prospective registry of all patients treated by the Pregnancy Heart Team between November 2022 and March 2024 was established. Patients consisted of women with pre-existing cardiovascular disease undergoing pregnancy as well as women who developed pregnancy-associated cardiovascular disease. Patients were evaluated throughout pregnancy by lab work and echocardiography during each trimester as well as in the postpartum period. Results In total 39 women (mean age 34±5 years) were prospectively included in the registry. 17 patients (43.5%) were classified as mWHO ≥ III. 17 patients (43.5 %) with pre-existing (pregnancy-associated) cardiovascular disease were managed throughout pregnancy and delivery. 9 patients (18.4 %) developed pregnancy-associated cardiovascular diseases such as peripartum cardiomyopathy or spontaneous coronary artery dissection. Preliminary data shows that mean left-ventricular ejection fraction remained stable during pregnancy with a non-significant trend towards lower values postpartum. Cardiac biomarkers such as high-sensitivity troponin T and NT-pro-BNP showed a non-significant trend towards increased values in the third trimester and postpartum. Adverse maternal outcomes occurred in 14 patients (35.9 %), including preterm premature rupture of membranes (12.2%), gestational hypertension (7.6%), gestational diabetes (5.1%), preeclampsia/eclampsia (7.6%) and delivery-associated complications (10.2%). Fetal complications included macrosomia (10.2%) or intrauterine growth retardation (5.1%). Discussion These preliminary data of a real-world patient collectivedemonstrate that a significant number of patients experienced adverse pregnancy outcomes which was associated with a trend towards increased cardiac biomarkers throughout pregnancy and postpartum. As recent studies have shown, interpretation of standard parameters such as cardiac biomarkers is not fully understood during pregnancy, especially in women with pre-existing cardiovascular disease. Our data may aid to understand prognostic implications of cardiac biomarkers during pregnancy.

Demographic, clinical characteristics, managements strategies and in-hospital outcomes of patients enrolled in prospective nationwide SCAD registry

Abstract Spontaneous coronary artery dissection (SCAD) is an uncommon yet increasingly recognized cause of acute coronary syndrome (ACS), particularly in young to middle-aged women. This multicentric, prospective nation-wide registry aimed to elucidate the demographic characteristics, clinical presentation, management strategies, and outcomes of patients with SCAD. A total of 95 patients with SCAD were enrolled in 10 centers, with females constituting 81% of the cohort, and with an average age of 49.7±11.9 years. Among the traditional risk factors, prior hypertension was observed in 49%, followed by hyperlipidemia in 43%, diabetes mellitus in 9% and prior or current smoking in 47% of patients. The presentation of SCAD as ST-elevation myocardial infarction (STEMI) was predominant, occurring in 61% of cases, with the left anterior descending artery (LAD) being the most involved vessel (68%). Regarding the classification of SCAD, type 2 SCAD was the most frequent (53%), followed by type 1 (24%) and type 4 (16%). Notably, involvement of the distal segment of the culprit artery was observed in 68% of cases, while baseline TIMI 3 flow was noted in 52% of patients. Percutaneous coronary intervention (PCI) was performed in 52% of cases, with pre-interventional TIMI 0-2 flow (62% Vs. 28%; p<0.05) and proximal artery involvement (41% Vs. 13%; p<0.05) being more prevalent compared to conservatively managed patients. Final stent implantation was performed in 67% of PCI cases, with TIMI 3 flow restoration in 76% of patients undergoing PCI. The average left ventricular ejection fraction prior to discharge was 51±9.9%. In-hospital mortality was reported in three female patients, undergoing attempted PCI with left main and LAD involvement. The use of antiplatelet therapy was widespread, with aspirin administered to 98% and P2Y12 inhibitors to 75% of patients at discharge. Data from this prospective nationwide multicentric SCAD registry show that SCAD occurs predominantly in relatively young female patients, with moderately prevalent traditional cardiovascular risk factors, usually presents as STEMI, with good overall survival rates despite half of the patients managed conservatively. PCI was often attempted in SCAD lesion with compromised arterial flow and located proximally, with lower rates of stent implantation and procedure success compared to traditionally observed rates in primary PCI. This underscores the importance of heightened awareness and tailored management approaches for this unique subset of ACS patients in order to refine risk stratification, optimize treatment strategies, and improve outcomes in this population.

Spontaneous Coronary Artery Dissection (SCAD) with cardiac arrest at presentation: a subanalysis from the DISCO registry

Abstract Introduction Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (AMI), which primarily affects young women without traditional cardiovascular risk factors, often presenting as sudden cardiac death. This study aims to investigate the prevalence, characteristics, predictors, and outcomes of cardiac arrest in SCAD patients. Methods The DISCO IT/SPA registry, an international retrospective multicenter study, enrolled 375 SCAD patients from 26 centers in Italy and Spain. Patients were categorized based on the presence or absence of cardiac arrest at admission. Data on demographics, clinical presentation, treatment, angiographic findings, and outcomes were collected. Angiograms were independently reviewed, and outcomes included major adverse cardiovascular events (MACE) and in-hospital bleeding. Results Among 375 SCAD patients, 20 (5.3%) presented with cardiac arrest. Both groups were similar in age, gender distribution, and conventional risk factors, except for a lower prevalence of dyslipidemia in the cardiac arrest group. ST-segment elevation myocardial infarction (STEMI) presentation and angiographic type 2b were independent predictors of cardiac arrest. Revascularization was more frequent in the cardiac arrest group. In-hospital outcomes, except for longer hospitalization, did not differ. On follow-up (average 21 months), MACE rates were similar between groups. Conclusions Cardiac arrest is a notable complication in SCAD, mostly presenting with ventricular fibrillation. The prognosis of SCAD patients presenting with cardiac arrest did not differ from those without, reporting a similar rate of events both in-hospital and during long-term follow-up. STEMI presentation and angiographic type 2b were identified as independent predictors of cardiac arrest in SCAD.

Fear of recurrence and its association with mental health outcomes after spontaneous coronary artery dissection (SCAD)

Abstract Background Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction, predominantly affecting younger women with few traditional cardiac risk factors. The condition is characterised by relatively high rates of recurrence. Recent qualitative studies demonstrate that SCAD survivors often experience fears about the future, particularly relating to SCAD recurrence and death. Research in psycho-oncology demonstrates that experiencing fear of cancer recurrence predicts worse outcomes for mental health and quality of life, an association that is also likely in cardiac patients. To date, no quantitative research has investigated fear of recurrence and its association with mental health in SCAD survivors. Purpose The aim of this study was to investigate the prevalence of fears relating to SCAD recurrence and the association of fear of recurrence with mental health outcomes. Methods 293 SCAD survivors completed an online questionnaire assessing the psychosocial impacts of SCAD. Participants rated whether they experienced these impacts ‘not at all’, ‘a small amount, ‘a moderate amount’ or ‘a large amount’ within the first six months of their SCAD. Items related to fears about the future, recurrence, and death were extracted for analysis. Participants also completed measures of anxiety (Generalised Anxiety Disorder-7), depression (Patient Health Questionnaire-9), distress (Cardiac Distress Inventory - Short Form), and mental health related quality of life (Short Form 12, mental health component). Results In the six months following their SCAD, 97.6% of survivors experienced some level of worry about having another SCAD, 95.6% were concerned about triggering another SCAD, 95.6% experienced fear of the future, and 82.6% experienced fear of dying. Reports of experiencing ‘a large amount’ of fear in these areas were 54.6%, 45.1%, 42.7%, and 30.4% respectively. The amount of worry reported about having another SCAD was significantly associated with increased levels of anxiety, depression, and cardiac distress, and reduced mental health quality of life. Conclusions Almost all SCAD survivors reported fears, worries, and concerns related to recurrence. Worry about SCAD recurrence was significantly associated with important mental health outcomes. Cardiac health professionals should monitor fears of recurrence in their patients, as a large amount of worry may be indicative of poor mental health, and referral to psychology services may be appropriate.Rates of fears of SCAD recurrence

Comparative analysis of negative pressure wound therapy (PICO) and standard dressing application after arterial vascular reconstructions.

Surgical site infections following arterial reconstructions with femoral exposures are common and potentially preventable. Negative pressure wound therapy has emerged as a potential solution to minimize groin wound complications. Our study evaluates efficacy of a negative pressure therapy (PICO dressing) in reducing groin wound complications after vascular reconstructions. A retrospective single center comparative analysis of vascular reconstructions involving common femoral artery dissection was performed between July 2021 and June 2023. Patients were divided into two groups: patients treated with PICO device and patients who received standard dressing (non-PICO). Patient demographics, comorbidities, vascular evaluation, and procedure indications were compared. Previous interventions, incision orientation and procedure types were noted. The wound complication categories were graded according to the Szilagyi classification: grade 1 (superficial infection/minor dehiscence), grade 2 (deep infection/major dehiscence), and grade 3 (artery or prosthetic involvement). Statistical significance level was determined at p < .05 for all analyses. A total of 217 groin dissections in 184 patients were analyzed with 132 and 85 groin dissections in the PICO and non-PICO groups, respectively. The baseline characteristics were similar between the groups in terms of age, sex, BMI, and procedure indications. Prior endovascular procedures and re-operative groin surgeries were more prevalent in the PICO group. The use of antibiotics post-operatively for groin wound complication was greater in the non-PICO group. The incidence of wound complications was higher in the non-PICO group (29.4% vs 10.6%, p < .001). Multivariate logistic regression analysis determined that PICO dressing as well as hybrid and endovascular index procedures were associated with lower risks of groin complications. PICO dressing decreased the incidence of groin wound complications in patients undergoing open vascular reconstructions. This study highlights the value of adjunctive negative pressure therapy in reduction of wound complications after arterial reconstructions in the inguinal region.

Antithrombotic drugs for carotid artery dissection: Updated systematic review.

Extracranial internal carotid artery dissection (eICAD) is a leading cause of stroke in younger patients. In this Cochrane Review update we compared benefits and harms of eICAD-patients treated with either antiplatelets or anticoagulants. Eligible studies were identified through Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, and EMBASE and personal search until December 2023. We included randomized-controlled trials (RCTs) and non-randomized studies comparing anticoagulants with antiplatelets in eICAD-patients. Co-primary outcomes were (i) death (all causes) and (ii) death or disability. Secondary outcomes were ischemic stroke, symptomatic intracranial hemorrhage, and major extracranial hemorrhage. Odds ratios (OR) with 95% CIs were calculated for (i) all studies and (ii) separately for RCTs and non-randomized studies. We meta-analyzed a total of 42 studies (2624 patients) including 2 RCTs (213 patients) for the primary outcome of death and 31 studies (1953 patients) including 1 RCT (115 patients) for the primary outcome of death or disability. Antiplatelet-treated patients had higher odds for death (ORall-studies 2.70, 95% CI 1.27-5.72; ORRTCs 6.80, 95% CI 0.14-345; ORnon-randomized studies 2.60, 95% CI 1.20-5.60) and death or disability (ORall-studies 2.1, 95% CI 1.58-2.66; ORRTCs 2.2, 95% CI 0.29-16.05; ORnon-randomized studies 2.1, 95% CI 1.58-2.66) than anticoagulated patients. Antiplatelet-treated patients had also higher odds for ischemic stroke, though this reached statistical significance only in the subgroup of RCTs (ORRTC 4.60, 95% CI 1.36-15.51). In turn, antiplatelet-treated patients had less symptomatic intracranial hemorrhage (ORall-studies 0.25, 95% CI 0.07-0.86) and a tendency toward less major extracranial hemorrhage (ORall-studies 0.17, 95% CI 0.03-1.03). The evidence considering antiplatelets as standard of care in eICAD is weak. Individualized treatment decisions balancing risks versus harms seem recommendable.

Management of Asymptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection and Morphology Features and Variations on Abdominal Contrast-Enhanced Computed Tomography: A Single-Center Experience

Management of Asymptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection and Morphology Features and Variations on Abdominal Contrast-Enhanced Computed Tomography: A Single-Center Experience

MINOCA: A Pathophysiological Approach of Diagnosis and Treatment—A Narrative Review

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a clinical entity characterized by the absence of significant coronary artery obstruction in epicardial arteries (&lt;50%) on coronary angiography in the setting of acute myocardial infarction (AMI). This article aims to provide a narrative review of the pathophysiological mechanisms, diagnostic challenges, and prognosis associated with MINOCA based on pathophysiology regarding the atherosclerotic and non-atherosclerotic causes. Etiological factors, including thromboembolism, coronary artery spasm, spontaneous coronary artery dissection, coronary microvascular disease, and supply–demand mismatch, are addressed. Imaging modalities such as echocardiography, advances in coronary angiography like intravascular ultrasound (IVUS) and optical coherence tomography (OCT), cardiac magnetic resonance (CMR), and coronary computed tomography angiography (CCTA) are also analyzed. MINOCA patients have a better short-term prognosis compared to those with obstructive coronary artery disease but face significant long-term risks, underscoring the need for precise diagnosis and management strategies. Elevated inflammatory markers and specific genetic predispositions are also associated with adverse outcomes in MINOCA. This review focused on MINOCA from a pathophysiological perspective on the diverse underlying mechanisms, the challenges in achieving accurate diagnosis, the importance of a tailored therapeutic approach and the necessity for further investigation of clinical outcomes.

Unraveling the challenges in spontaneous coronary artery dissection: a case series of VA ECMO support and heart transplantation.

Unraveling the challenges in spontaneous coronary artery dissection: a case series of VA ECMO support and heart transplantation.

Left, Then Right ICA Dissection: A Case Report

ABSTRACT IntroductionWe present a unique case report of a patient who presented to the emergency departmentwith stroke-like symptoms found to have a spontaneous left sided internal carotid arterydissection. Case ReportThe patient was treated successfully with thrombectomy, and subsequently developedcontralateral symptoms caused by a right sided internal carotid artery dissection. This wasmanaged with a second contralateral thrombectomy. The patient’s course was complicated bypersistent and mild hypotension, postulated to be secondary to bilateral carotid baroreceptortrauma from the dissections. ConclusionThis case highlights the importance of close neurological monitoring for patients,preferably in a neurologic critical care setting, during and after invasive treatments such assystemic thrombolytic administration or mechanical thrombectomy, as identifying the patient’ssubsequent development of contralateral symptoms in a timely fashion was key to his positive outcome. An additional factor which had a positive impact on this outcome was the use of the RAPID Artificial Intelligence software which assists in determining whether thrombectomy maybe indicated prior to receiving a formal radiologist read on CT angiography/perfusion studies. AI technologies such as this have a great potential to augment and expedite patient care.

Association between atherosclerotic disease and cervical artery dissection in a population-based cohort of older people.

Many cases of cervical artery dissection are considered "spontaneous." Recent data suggest that while cervical artery dissection may proportionally explain more strokes in young patients, hospitalization for dissection increases with age, suggesting a potential role of acquired vascular disease. In this study, we hypothesized that traditional vascular risk factors and comorbidities are associated with cervical artery dissection. We performed a retrospective cohort study using administrative claims data from a 5% sample of Medicare beneficiaries. Exposures of interest included traditional vascular risk factors and comorbidities: coronary artery disease, hyperlipidemia, hypertension, diabetes mellitus, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, valvular heart disease, atrial fibrillation, tobacco use, and alcohol abuse. The primary outcome was a new diagnosis of cervical artery dissection. Marginal structural Cox models were used to characterize the association between the exposures and outcomes, adjusted for time-dependent confounding. Among 2,256,710 eligible Medicare beneficiaries, 730 (0.03%) developed cervical artery dissection. The following exposures were found to be significantly associated with the development of cervical artery dissection: hypertension (HR 1.84 [95% CI: 1.40-2.41]), alcohol use (HR 1.83 [1.52-2.21]), atrial fibrillation (HR 1.80 [1.53-2.11]), tobacco use (HR 1.80 [1.52-2.13]), coronary artery disease (HR 1.56 [1.33-1.82]), and valvular heart disease (HR 1.23 [1.05-1.45]). In a large cohort of older people, several traditional vascular risk factors and comorbidities were associated with subsequent cervical artery dissection. Further studies exploring the role of such factors in the development of cervical artery dissection are warranted.

When Cardiac Magnetic Resonance Changed the Diagnosis of a Young Patient With Spontaneous Coronary Artery Dissection

When Cardiac Magnetic Resonance Changed the Diagnosis of a Young Patient With Spontaneous Coronary Artery Dissection

Ischemic stroke due to dissection of the posterior cerebral artery in a patient with polycystic kidney disease

Polycystic kidney disease (PKD) is a genetic condition clinically manifested by the formation of multiple cysts in the kidneys, liver and pancreas, as well as cardiovascular pathology. One of the rare complications of PKD is the development of dissections of the aorta, coronary and cerebral arteries.This article presents a clinical case of ischemic stroke due to dissection of the posterior cerebral artery in a young patient with PKD who had a history of recurrent bleeding in the deep parts of both cerebral hemispheres.

Recurrent Spontaneous Coronary Artery Dissections in a Male Patient With Fibromuscular Dysplasia

Recurrent Spontaneous Coronary Artery Dissections in a Male Patient With Fibromuscular Dysplasia

Anterior circulation acute ischemic stroke due to vertebral artery ostial stenosis in a patient with congenital internal carotid artery agenesis: a case report

BackgroundCongenital agenesis of internal carotid artery (ICA) is a rare cerebrovascular variation entity. Most cases of congenital ICA agenesis are asymptomatic and discovered incidentally. Congenital ICA agenesis presenting as ischemic stroke is even rare.Case presentationAn 80-year-old male patient was admitted to our hospital due to sudden dysarthria and left limb weakness for 3.5 h. Based on emergency physical examination and head computed tomography (CT) scan results, acute ischemic stroke (AIS) of right cerebral hemisphere was suspected. Following intravenous thrombolysis with recombinant tissue plasminogen activator, right congenital agenesis of ICA was confirmed by CT and digital subtraction angiography. Additionally, there was a severe right vertebral artery ostial (VAO) stenosis. After ruling out common causes of AIS such as haematological diseases, arterial dissection, organic heart disease, immunological abnormality and underlying possible malignancies, we hypothesize that the severe stenosis of the right VAO may have contributed to the development of AIS in this case.ConclusionsWe present a case of right congenital ICA agenesis in which severe stenosis of the right VAO may have played a role in the development of AIS. This case underscores a rare scenario where a lesion in the posterior circulation leads to an infarction in the anterior circulation in the setting of congenital ICA agenesis.

Uncommon triple vessel spontaneous coronary artery dissection in the setting of polyarteritis nodosa: a case report

Introduction and importanceSpontaneous coronary artery dissection is a rare cause of acute coronary syndromes not related to atherosclerosis. It involves the sudden tearing of the coronary artery wall, separating the inner intimal lining from the outer vessel wall, typically affecting a single coronary vessel. In 20% of cases, the cause of spontaneous coronary artery dissection is unknown. The other cases often occur in pregnant or postpartum women or in individuals with conditions such as connective tissue disorders or vasculitis.Case presentationHere, we describe a case of a 69-year-old African female presenting with non-ST-segment elevation myocardial infarction. Coronary angiography revealed an unusual triple-vessel spontaneous coronary artery dissection affecting peripheral segments, with further investigations suggesting polyarteritis nodosa.ConclusionWhile triple-vessel spontaneous coronary artery dissection and polyarteritis nodosa (PAN) are individually rare, their coexistence is exceptionally uncommon and presents diagnostic and therapeutic challenges. Clinicians should be alert to vasculitic causes in patients with spontaneous coronary artery dissection, especially with atypical clinical features.

Spontaneous Coronary Artery Dissection in a Patient With a Single Coronary Artery

Spontaneous Coronary Artery Dissection in a Patient With a Single Coronary Artery