Two-Vessel Spontaneous Coronary Artery Dissection Requiring LAD Stents Placement

Case Report | Open Access

Volume 2023 - 2 | Article ID 221 | http://dx.doi.org/10.51521/WJCRCI.2023.220115

Two-Vessel Spontaneous Coronary Artery Dissection Requiring LAD Stents Placement

Academic Editor: John Bose

Received 2023-06-21
Revised 2023-07-04
Accepted 2023-07-09
Published 2023-07-15

Ziad Affas MD, Fatima Charara DO, Ashish Kalakuntla MD, Natesh Lingam

MD Henry Ford Macomb Hospital

Corresponding Author: Dr. Fatima Charara, DO, MD Henry Ford Macomb Hospital, Email: fcharar2@hfhs.org

Citation: Ziad Affas, MD, Fatima Charara, DO, Ashish Kalakuntla, MD, Natesh Lingam (2023) Two-Vessel Spontaneous Coronary Artery Dissection Requiring LAD Stents Placement. World J Case Rep Clin Imag. 2023 June-July; 2(2)1-6.

Copyrights: © 2023, This article is licensed under the Creative Commons Attribution-Non Commercial-4.0-International-License-(CCBY-NC) (https://worldjournalofcasereports.org/blogpage/copyright-policy). Usage and distribution for commercial purposes require written permission.

ABSTRACT

Introduction: Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome, most often seen in young to middle aged women without cardiac risk factors. It is often fatal due to it’s sudden onset and rapid progression. Clinical signs and symptoms of SCAD may range widely, from minor symptoms and stable angina to myocardial infarction, cardiogenic shock, and arrhythmias. Risk factors divided into four categories including, Genetics, Atherosclerotic and vasculitis, Peripartum, and Idiopathic.

Case Presentation: A 47-year-old woman presented to the emergency room via EMS due to chest pain. ECG showed significant ST elevation in anterolateral leads. Code STEMI was activated prior to patient’s arrival in the ED. The patient was taken directly to the cardiac catheterization lab on arrival. Review of coronary angiograms appeared to be consistent with spontaneous coronary artery dissection (SCAD) Angiography showed 99% occlusion in mid- LAD. Intracardiac nitroglycerin was given for possibility of coronary vasospasm with no improvement. Due to persistent ST elevations with ongoing chest pressure, it was decided to proceed with PCI. Few days later she was eventually discharged home.

Conclusion: Given the high mortality rate associated with SCAD, it is crucial to diagnose and treat this disorder as soon as possible. Observational studies have indicated that 70-97% of patients receiving conservative therapy showed angiographic repair of SCAD lesions when repeat angiography was done.

Results: As a result, a cautious approach to therapy is usually advised, which calls for a prolonged inpatient observation period of 3-5 days. Although conservative therapy is indicated most of the times, few times stent might be needed. We present the following case who presented with anterolateral ST elevation myocardial infarction secondary to SCAD that required a stent placement which ended with a favorable outcome.