Spontaneous coronary artery dissection and concomitant atherosclerotic disease
DOI:
https://doi.org/10.63600/xs94zb46Keywords:
Spontaneous coronary artery disease, Atherosclerotic coronary artery disease, Acute coronary syndromeAbstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute ST-elevation myocardial infarction (STEMI), mainly affecting young female patients. What is more infrequent is its being concomitant with atherosclerotic disease in non-dissected segments. We proceed to report the case of a 55-year-old female patient having been admitted due to inferior wall STEMI. The angiography revealed a type 2B SCAD image in the distal third of the right coronary artery, verified via intravascular ultrasound (IVUS). Conservative treatment was thus determined. Thirty days later, control angiography was performed showing angiographic improvement of the SCAD. Via IVUS, focal stenosis was assessed in the middle third of the anterior descending artery, confirming significant atherosclerotic plaque. Subsequently, revascularization was carried out with drug-eluting stent. Risks remain unknown in terms of ischemic events and SCAD recurrence in the follow-up in the presence of both entities.
References
1. Vanzetto G, Berger-Coz E, Barone-Rochette G et al. Prevalence,therapeutic management and medium-term prognosis of spontaneous coronary artery dissection: results from a database of 11,605 patients; Eur J Cardiothorac Surg 2009; 35(2): 250-254.
2. Nishiguchi T, Tanaka A, Ozaki Y et al. Prevalence of spontaneous coronary artery dissection in patients with acute coronary síndrome; Eur Heart J Acute Cardiovasc Care 2016; 5(3): 263-70.
3. Saw J. Spontaneous coronary artery dissection. Interv Cardiol 2015; 10:142–143.
4. Wisecarver J, Jones J, Goaley T, et al. "Spontaneous" coronary artery dissection: the challenge of detection, the enigma of cause. Am J Forensic Med Pathol 1989; 10(1): 60-62.
5. Saw J, Starovoytov A, Humphries K, et al. Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes, Eur Heart J. 2019; 40: 1188–1197.
6. Choi J, Yang C, Saw J et al. Atherosclerotic Spontaneous Coronary Artery Dissection. JAAC 2023; case reports vol 10.
7. Adlam D, García-Guimaraes M, Maas A. Spontaneous coronary artery dissection: no longer a rare disease; Eur Heart J 2019; 40:1198-201.
8. Adlam D, Alfonso F, Maas A, et al. Committee. European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection. Eur Heart J. 2018; 39(36):3353‑68.
9. Saw J. Coronary angiogram classification of spontaneous coronary artery dissection. Catheter Cardiovasc Interv 2014:1; 84 (7):1115–22.
10. Combaret N, P Motreff. French National registry of spontaneous coronary artery dissections : ''DISCO registry'. Ann Cardiol Angeiol 2023; 72(6):101684.
11. Hayes S, Tweet M, Adlam D et al. Spontaneous coronary artery dissection: JACC state-of-the-art review. J Am Coll Cardiol. 2020; 76 (8):961–84.
12. Rogowski S, Maeder M, Weilenmann D et al. Spontaneous coronary artery dissection: angiographic follow-up and long-term clinical outcome in a predominantly medically treated population. Catheter Cardiovasc Interv Off J Soc Card. Angiogr Interv. 2017; 89(1):59–68.
13. Lettieri C, Zavalloni D, Rossini R et al. Management and long-term prognosis of spontaneous coronary artery dissection. Am J Cardiol 2015; 116:66–73.
14.Tweet M, Eleid M, Best P et al.. Spontaneous coronary artery dissection: revascularization versus conservative therapy. Circ Cardiovasc Interv 2014; 7:777–786.
15. Dang Q, Psaltis P, Burgess S et al. The Australian-New Zealand spontaneous coronary artery dissection cohort study: predictors of major adverse cardiovascular events and recurrence European Heart Journal 2025; 00, 1–12.
