Resolution of spontaneous coronary artery dissection within 3 weeks detected by computed tomography angiography and intr
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CASE REPORT
Resolution of spontaneous coronary artery dissection within 3 weeks detected by computed tomography angiography and intravascular ultrasound Hiroshi Tsutsui1 • Chiharu Chino1 • Miho Komatsu1 • Takahiro Sakai1 Kazunori Aizawa1 • Mafumi Owa1
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Received: 15 March 2015 / Accepted: 9 December 2015 Japanese Association of Cardiovascular Intervention and Therapeutics 2015
Abstract A 62-year-old woman was admitted with chest pain lasting about 3 h. Spontaneous coronary artery dissection (SCAD) was detected in the left anterior descending artery (LAD) by intravascular ultrasound (IVUS). Sixteen days after onset, follow-up computed tomography angiography was performed and revealed shrinkage of the false lumen of the SCAD. On hospital day 22, IVUS image confirmed that the SCAD in the LAD was completely healed. This case shows the possibility of rapid healing of SCAD. Keywords Spontaneous coronary artery dissection Computed tomography angiography Rapid healing
Introduction Spontaneous coronary artery dissection (SCAD) is a rare cause of ischemic heart disease. Without the appearance of a radiolucent intimal flap on conventional coronary angiography, detection of SCAD and its longitudinal distribution has been difficult. The natural course of SCAD remains unclear, because evaluation has mainly been performed using conventional coronary angiography. Recently, computed tomography angiography (CTA) has allowed clear imaging of the coronary arteries, including those affected by atherosclerosis and SCAD. We present
& Hiroshi Tsutsui [email protected] 1
The Department of Cardiovascular Medicine, Japanese Red Cross Society Suwa Hospital, 5-11-50 Kogandori, Suwa City, Nagano 392-8510, Japan
herein a case in which SCAD resolved within approximately 3 weeks.
Case report A 62-year-old woman was admitted to the emergency department of our hospital with pressure-like chest pain lasting about 3 h. She did not have any relevant medical history or risk factors for ischemic heart disease. On admission, blood pressure was 180/110 mmHg and electrocardiography (ECG) showed a [2-mm ST elevation in leads V2-4. Troponin T level was positive for myocardial necrosis, and conventional coronary angiography was immediately performed. This revealed 90 % stenosis of the middle to distal segments of the left anterior descending artery (LAD) with Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow. The left circumflex artery (LCx) showed a smooth lumen and no obstructive lesions. Nitrate was administrated into the left coronary artery, but failed to improve the diffuse stenosis (Fig. 1). Due to the atypical angiographic images for acute coronary syndrome, an intravascular ultrasound (IVUS) probe was inserted into the distal portion of the LAD. The IVUS image revealed SCAD extending from the left main trunk (LMT) to the distal LAD (Fig. 1). The healthy portion of the distal LAD was relatively short. The lumen diameter of the proximal LAD, which had normal findings on angiography, was smaller than the vessel diameter observ
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