Abstract 20381: Recurrent Spontaneous Coronary Artery Dissection Treated Medically
Introduction: Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome (ACS). Diffuse multi-vessel coronary artery dissection is extremely rare.
Case Presentation: 57 year old Caucasian female with history of non ST segment elevation MI due to spontaneous coronary artery dissection, presented with substernal chest pain. Electrocardiogram (EKG) revealed nonspecific ST-T wave changes. Peak troponin was 7.63 ng/ml. Contrast Echocardiogram revealed mild infero-lateral wall motion abnormality with preserved ejection fraction. A coronary angiogram showed 90% stenosis of distal left circumflex with retained dye highly suspicious for dissection. Her left anterior descending coronary artery, which showed dissections in the past, and was treated with dual antiplatelet therapy for 3 months, looked completely normal.
She was started on aspirin and clopidogrel as before without angioplasty. Her troponin levels steadily declined during follow up and she was asymptomatic thereafter.
Discussion: SCAD is a vessel wall lesion that presents in the absence of iatrogenic, non- coronary or traumatic causes. There is no consensus on the treatment strategy and management should be based on endovascular imaging, degree of flow in the distal vessel and the clinical scenario. In case of a single vessel dissection with normal distal flow, dual anti platelet therapy has shown remarkable angiographic resolution after few months.
Conclusion: Our patient had repeated SCAD involving multiple coronaries and she benefited medical therapy. Future prospective multicenter studies are needed to achieve a consensus on the best treatment strategy for SCAD.
Author Disclosures: T. Mahfood Haddad: None. A.S. Abuzaid: None. M. Anantha Narayanan: None. M.J. Holmberg: None.
- © 2014 by American Heart Association, Inc.