Multiple Spontaneous Coronary Artery Dissections Research Articles

Successful healing of aneurysmal false lumen using a second-generation drug-eluting stent in spontaneous coronary artery dissection: a case report

BackgroundAccording to 2023 ESC Guideline, conservative medical management is generally recommended for the treatment of spontaneous coronary artery dissection (SCAD) except for patients with signs of ongoing myocardial ischemia. However, in some cases, invasive treatment (coronary artery bypass graft surgery or percutaneous coronary intervention (PCI)) is performed because of the progression of aneurysm in SCAD. Although there is no established strategy for the management of coronary aneurysm in SCAD, we report a case of successful healing of aneurysmal false lumen (AFL) using a second-generation drug-eluting stent (DES) in SCAD.Case presentationA 44-year-old woman without any cardiovascular risk factors was transferred to our hospital due to inferior myocardial infarction. Coronary angiography (CAG) showed multiple SCADs in the coronary artery. We performed PCI to the distal right coronary artery (RCA) because the RCA showed severe stenosis (99%) with bradycardia. Six days after the first PCI, SCAD relapsed in the mid left anterior descending artery (LAD). Furthermore, AFL was observed by intravascular ultrasound imaging. To avoid enlargement of the AFL and progression of the dissection toward the proximal site of the LAD, we performed PCI to the mid LAD to seal the entry tear of the dissection using a second-generation DES. CAG revealed that the AFL in the mid LAD completely diminished at 1 year after PCI.ConclusionsThe implantation of a second-generation DES might be one of therapeutic options for sealing AFL in SCAD patients.

Abstract 12644: Multiple Spontaneous Coronary Artery Dissections in a Middle-Aged Man With Acute Chest Pain

Introduction: Previously considered rare, spontaneous coronary artery dissection (SCAD) has emerged as an important cause of chest pain, acute coronary syndrome, and sudden cardiac death. Due to hormonal factors, SCAD often affects seemingly healthy women. SCAD in men remains little understood and under-recognized. We report a case of a 61-year-old gentleman who presented with NSTE-ACS and was found to have SCAD. Patient Presentation: A 61-year-old male with history of untreated hyperlipidemia presented with acute substernal chest pressure radiating to bilateral arms and back. On presentation, vitals and physical examination was normal.His labs showed troponin I at 0.015 ng/mL which later up trended to 21.7 ng/ml. ECG demonstrated sinus bradycardia with no ischemic changes. Decision was made to take him for cardiac catheterization.It demonstrated right coronary artery (RCA) was ecstatic. Distally, there was a a right conus branch fistula draining into pulmonary artery. There was evidence of microvascular dysfunction. An echocardiogram showed mid and basal inferolateral akinesis, normal EF.He was started on dual anti platelets (DAPT) and GDMT. At the time of discharge, he started having recurrence of his chest pain with exertion. Cardiac CT showed multiple spontaneous coronary artery dissections with healing dissections and remodeling throughout the ecstatic RCA and its distal branches with additional contour irregularities and non-obstructive dissection flaps in the diagonal branch of the left anterior dissecting artery. He was enrolled into cardiac rehabilitation. Conclusion: SCAD occurs by the formation of an intramural hematoma or intimal disruption causing a coronary obstruction. Coronary angiography remains the primary tool in the diagnosis. Alternative imaging modalities, such as intravascular ultrasound and optical coherence tomography, CT coronary angiography can be used to confirm the diagnosis. It is managed medically with DAPT and adequate control of blood pressure. Cardiac rehabilitation appears to be beneficial in preventing recurrence. We would also like to emphasize that SCAD can occur in any age group and gender, it’s crucial to recognize it early and is a condition that can be managed conservatively.

Multiple Spontaneous Coronary Artery Dissections and Ruptures in Vascular Ehlers-Danlos Syndrome.

Multiple Spontaneous Coronary Artery Dissections and Ruptures in Vascular Ehlers-Danlos Syndrome.

Case Report: Severe Peripartum Cardiac Disease in Myotonic Dystrophy Type 1

BackgroundMyotonic dystrophy type 1 (DM1) is a hereditary muscular dystrophy affecting ∼2.1–14.3/100,000 adults. Cardiac manifestations of DM1 include conduction disorders and rarely cardiomyopathies. DM1 increases the risk of obstetric complications, however, little is known about the relationship between pregnancy and cardiomyopathy in DM1 due to disease rarity.CaseA 23-year-old with DM1 developed cardiomyopathy during pregnancy. Despite initial medical stabilization, she subsequently developed multiple spontaneous coronary artery dissections postpartum, worsening cardiomyopathy and multiorgan failure. She died 5 months postpartum.ConclusionThough cardiomyopathy and arterial dissection are both known complications of pregnancy, this case suggests individuals with myotonic dystrophy type 1 may be at heightened risk for cardiac disease during the peripartum period. Physicians caring for women with suspected or proven DM1 should offer counseling and be alerted to the risk of cardiac complications with pregnancy and in the peripartum period. Pregnant and peripartum women with DM1 are likely to benefit from more frequent assessments of cardiac function including echocardiograms and early institution of heart failure management protocols when symptoms of cardiomyopathy present.

Multiple spontaneous coronary artery dissections associated with intravenous daunorubicin treatment for acute myelocytic leukaemia: a case report.

BackgroundMultiple spontaneous coronary artery dissection (SCAD) is a rare condition which may lead to serious consequences such as sudden cardiac death, acute myocardial infarction (AMI), and acute heart failure.Case summaryIn this paper, we report the case of a 57-year-old woman with acute myelocytic leukaemia who was undergoing her second phase of chemotherapy. After the first induction cycle of intravenous infusion of daunorubicin, the patient experienced chest pain, shortness of breath, and low blood pressure. The electrocardiograms revealed significant ST-elevation in the D1, aVL, and V2–V6 leads, which indicated AMI. Coronary catheterization showed spontaneous coronary dissection in the mid-left descending coronary artery and first obtuse marginal artery of the circumflex. The patient died immediately.DiscussionThis is the first reported case of multiple SCAD associated with intravenous (IV) daunorubicin infusion. We also reviewed the literature and proposed the mechanism of this complication.

Spontaneous Coronary Artery Dissection in Young Women Presenting with Acute Coronary Syndrome

The pathophysiology of acute coronary syndrome (ACS) in women is complex and may involve non-atherosclerotic mechanisms. Spontaneous coronary artery dissection (SCAD) is a rare cause of ACS that predominantly affects younger women. However, limited information is available for its incidence, clinical course and outcomes compared to younger women with acute coronary syndrome (ACS) not associated with SCAD. Gender and Sex determinants of cardiovascular disease: From bench to beyond-Premature Acute Coronary Syndrome (GENESIS-PRAXY) study is multicenter prospective study of ACS patients aged 18 to 55 years. Detailed demographic, clinical, laboratory and outcome data were collected and coronary angiograms analyzed in a blinded manner. Among 383 women with ACS, 42 (11%) had SCAD confirmed by angiography. Multiple SCAD were present in 9 (21%) patients. Compared with no-SCAD patients, SCAD subjects were more likely to have absence of any cardiac risk factor (24% vs 7%, p=0.0001), lower LDL (2.5±0.9 vs 3.0±1.2 mmol/L, p=0.06) and higher HDL (2.3±4.7 vs 1.1±0.5 mmol/L p=0.0002) levels. Single vessel disease was more common (81% vs. 50%, p=0.0002) and SYNTAX score lower (8±6 vs. 12±8, p=0.002) in SCAD compared to no-SCAD patients. Coronary intervention was less commonly performed (43% vs 73%, p<0.0001) and TIMI 3 flow less commonly achieved (77% vs 93%, p=0.003) in SCAD compared with no-SCAD patients. The presence of autoimmune disease, connective tissue disorders were similar between the SCAD and no-SCAD group. Coronary hypertortuosity was identified in 95% of SCAD compared with 7% of no-SCAD patients, (p<0.0001). At 12 months follow up, SCAD patients were more likely to experience repeat hospitalization compared to no-SCAD patients (29% vs 16, p=0.04) with similar no difference in overall major adverse cardiac events (MACE). SCAD is an important and not infrequent cause of ACS in younger women. Despite a low risk factor and angiographic burden of atherosclerosis, a significant proportion of SCAD patients experience repeat hospitalization and MACE at one year. These findings underscore the need for greater understanding of SCAD mechanisms and better risk stratification for improving outcome in this high risk group.

Multiple Spontaneous Coronary Artery Dissections in a 46 Year-old Female

Multiple Spontaneous Coronary Artery Dissections in a 46 Year-old Female

Multiple spontaneous coronary artery dissections postpartum. Serial follow-up of intravascular ultrasound findings

Multiple spontaneous coronary artery dissections postpartum. Serial follow-up of intravascular ultrasound findings

Multiple spontaneous coronary artery dissection presenting in association with coronary ectasia

We report a case of a 76-year-old man who was admitted at our institution for unstable angina. Cardiac catheterization revealed multiple idiopathic spontaneous coronary artery dissection with coronary ectasia both right and left coronary artery (Figs. 1 and 2). The patient was well over six months of follow-up. www.elsevier.com/locate/ejcts European Journal of Cardio-thoracic Surgery 35 (2009) 907

The large and multiple spontaneous coronary artery dissections of a 54-year-old man

The large and multiple spontaneous coronary artery dissections of a 54-year-old man

Multiple spontaneous coronary artery dissections in association with anomalous origin of right coronary and intramural coronary artery dysplasia

We present a case of sudden death due to spontaneous acute coronary artery dissection. In addition, there was a healing spontaneous coronary dissection, intramural coronary artery dysplasia, and an anomalous origin of the right coronary artery from the pulmonary trunk. The coincidence of multiple spontaneous coronary dissections, coronary arterial dysplasia, and anomalous origin of the right coronary artery is unique.

Multiple spontaneous coronary artery dissections in a middle aged woman: support for an underlying eosinophilic arteritis predisposing to intimal disruption

A 43-year-old female received tissue plasminogen activator for an acute antero-apical myocardial infarction. Cardiac catheterization demonstrated three focal dissections involving the left anterior descending and circumflex arteries. She expired unexpectantly after undergoing emergency coronary artery bypass grafting for therapy of an extension of her infarct. To our knowledge, this is the fourth report of multiple spontaneous coronary artery dissections and the second in which tissue plasminogen activator was administered. The histologic findings and their implications are reviewed.