Case report: a very large dissection in the left anterior descending coronary artery of a 56-year-old man

Spontaneous coronary artery dissection (SCAD) is a rare condition that usually occurs in relatively young patients who are predominantly female. Seldom it could be a cause of acute myocardial ischemia leading to a sudden cardiac death. SCAD consists of intramural hematoma formation or, rarely, intim...

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Bibliographic Details
Published in:Cardiovascular revascularization medicine 2006-10, Vol.7 (4), p.240-242
Main Authors: Capuano, Cinzia, Sesana, Marco, Predolini, Simonetta, Leonzi, Ornella, Cuccia, Claudio
Format: Article
Language:English
Subjects:
Aneurysm, Dissecting - diagnosis
Aneurysm, Dissecting - drug therapy
Coronary Aneurysm - diagnosis
Coronary Aneurysm - drug therapy
Coronary Aneurysm - etiology
Coronary Angiography
Diagnosis, Differential
Humans
Male
Middle Aged
Myocardial Infarction - complications
Myocardial Infarction - drug therapy
Platelet Aggregation Inhibitors - therapeutic use
Primary coronary dissection
Spontaneous coronary dissection
Thrombolytic Therapy
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Summary:Spontaneous coronary artery dissection (SCAD) is a rare condition that usually occurs in relatively young patients who are predominantly female. Seldom it could be a cause of acute myocardial ischemia leading to a sudden cardiac death. SCAD consists of intramural hematoma formation or, rarely, intimal tears that initiate and propagate the dissection in the vessel wall. In rare cases, the SCAD occurs in male patients. We report the case of a 56-year-old man with acute myocardial infarction who was successfully treated via systemic thrombolysis in a peripheral hospital. Associated conditions were thrombosis of right femoral artery in the past and high platelet count (800,000/mm 3). After 1 month, elective coronary angiography revealed a very diffuse spiral dissection of the left anterior descending artery; hence, our choice of medical treatment consisted of double oral antiplatelet therapy (clopidogrel 75 mg plus aspirin 325 mg once daily). After a 2-year follow-up, there was absence of both angina and myocardial ischemia and there was a decrease in platelet count. Many strategies could be considered in patients with SCAD, such as PCI, bypass surgery, or conservative medical management. In general, the long-term prognosis of patients with SCAD is considered favorable if they survive the acute phase.
ISSN:1553-8389
1878-0938
DOI:10.1016/j.carrev.2006.07.003