Treatment of spontaneous coronary artery dissection with intracoronary stenting

Spontaneous coronary artery dissection during cisplatin and capecitabine therapy

Introduction

Spontaneous coronary artery dissection is a rare cardiovascular disease that can cause acute myocardial infarction and sudden cardiac death. The mechanism of this pathology and the optimal treatment are not fully understood.

Presentation of case

An acute myocardial infarction developed while a fifty five years old woman with a rectal adenocarcinoma was receiving a cisplatin and capecitabine therapy. Coronary angiography demonstrated a multivessel occlusion of coronary arteries.

Discussion

The authors discuss several factors that may lead to the spontaneous coronary artery dissection including chemotherapy-induced vasospasm. Chemotherapy based on the cisplatin and capecitabine intake can cause a cardiotoxic effect.

Conclusion

Thus, spontaneous coronary artery dissection is a disease with an extremely complex etiololy, which does not have a special treatment guide. Management should be considered individually for each case.

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SCAD is a rare cardiovascular disease that can cause acute myocardial infarction and sudden cardiac death.

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Cisplatin and capecitabine therapy is a risk factor for SCAD.

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One of the most important side effects of chemotherapy is cardiotoxicity.

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Management should be considered individually for each case of SCAD.

Spontaneous coronary artery dissection: case report and literature review

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction and sudden cardiac death. It occurs most commonly in otherwise healthy women during pregnancy or the postpartum period. The true incidence of SCAD is underestimated, as most cases are diagnosed at autopsy. The pathophysiology of SCAD is still not fully understood, and its management can be challenging. This report describes a 35-year-old pregnant female who presented with an acute antero-lateral ST elevation secondary to spontaneous dissection of the left anterior descending artery and the circumflex artery. The diagnosis was established by coronary artery angiography. However, the patient died following cardiac tamponade. The examination of this case represented a starting point for the reviewing of the diagnosis, clinical course, and management of SCAD, and for the placing of this in context with the existing literature. This study highlights the importance of prompt diagnosis and subsequent lifesaving treatment.

Percutaneous treatment of spontaneous left main coronary artery dissection using drug-eluting stent

Background

Spontaneous coronary artery dissection is a rare cause of ischemic heart disease and sudden death. Prompt diagnosis is of paramount importance, especially in cases when it manifests with ST elevation myocardial infarction (STEMI).

Case presentation

We report a case of a 42 year-old woman, who presented with an anterior STEMI in a hospital without on-site percutaneous coronary intervention (PCI) facilities. She was transferred to our hospital and coronary angiography revealed a spontaneous dissection of the left main stem coronary artery (LM). The dissection was successfully managed with PCI.

Conclusion

PCI appears to be a potential option, for the treatment of selected cases with spontaneous LM dissection, presenting with an acute coronary syndrome.

Spontaneous Coronary Artery Dissections: Three Case Reports and Review of Literature

Primary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infarction and is mostly fatal. Previous studies report that it is mostly seen in middle-aged women in the last trimester of pregnancy and early postpartum period. Clinical presentation of the disease is variable in pattern, and its severity is related to extent and development rate of dissection. Herein we present three cases of primary spontaneous left main coronary artery dissection. Two of the patients are men and the third patient is a non-pregnant 69-year-old woman. The cases were presented and discussed with review of the pertinent literature.

Spontaneous coronary artery dissection after intense weightlifting UCSF Fresno Department of Cardiology

Spontaneous coronary artery dissection (SCAD) is a rare cause of chest pain and cardiomyopathy. This phenomenon usually occurs during the peripartum period. SCAD associated with exercise and heavy weight lifting is even rarer and has been reported in less than 10 cases in the literature. We describe a case of SCAD associated with heavy weight lifting and exercise in a 29-year-old male who presented with exertional chest pain. The patient subsequently underwent a cardiac catheterization that showed a left ventricular ejection fraction of 40% and a dissection in the left anterior descending (LAD) coronary artery after the first diagonal/septal branch with extension to the distal LAD that wrapped around the apex. He was effectively managed with the combination of medical therapy followed by a few days later with stenting. In summary, diagnosis and treatment of this rare phenomenon is a challenge, but early diagnosis and appropriate management can lead to a successful outcome.

Coronary stenting after failure of conservative treatment for spontaneous coronary dissection: Usefulness of the intravascular ultrasound

Spontaneous coronary dissection of a coronary artery is a rare cause of acute coronary syndrome. Optimal treatment has not yet been established. We describe a woman with spontaneous dissection of the left anterior descending artery who presented transitory angina and electrocardiographic ST segment elevation in precordial leads. Conservative treatment was carried out. The angina and electrocardiographic changes recurred 3 days later. An intravascular vascular ultrasound was performed and the patient was stabilized following stenting. Stress testing was negative at 6-month follow-up and she remained asymptomatic at 18 months. We discuss the usefulness of an intravascular ultrasound study to establish the therapeutic strategy.

Spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) should be considered as a cause of the acute coronary syndrome in young patients with few apparent risk factors for coronary artery disease, in females in the peripartum period, and in patients who are at a higher risk for this condition. SCAD can also present as sudden death and cardiogenic shock. Several mechanisms have been described in the pathophysiology of this condition. Urgent coronary angiography is indicated if SCAD is suspected. Percutaneous coronary artery stenting and coronary artery bypass grafting are the main treatment strategies.

Spontaneous coronary artery dissection in the postpartum period

Spontaneous coronary artery dissection is a very uncommon cause of acute coronary syndrome. It occurs predominantly in young to middle-aged women during or after pregnancy. The aetiology remains uncertain. Possible factors are hormonal changes, haemodynamic stress and changes in autoimmune status. In case of single-vessel dissection and normal blood flow, conservative treatment often leads to complete angiographic resolution. This case report describes the clinical presentation, diagnosis and therapy of spontaneous coronary artery dissection in a 37-year-old woman in the postpartum period. (Neth Heart J 2008;16:412-4.).

Progression of dissection due to residual dissection after intracoronary stenting for spontaneous coronary dissection at bifurcation site of LAD and diagonal artery

A 34-year old male patient visited our hospital due to severe chest pain. Initial ECG showed ST elevation at precordial leads and all cardiac enzymes were markedly elevated. Coronary angiography showed a long, longitudinal coronary dissection with dissected flap extending from the proximal LAD to the mid segment of the vessel and proximal diagonal artery. IVUS showed dissected flap and false lumen communicating with true lumen from proximal to mid-LAD. We implanted two paclitaxel-eluting stents using crushing technique at bifurcation lesion and overlapped another paclitaxel-eluting stent at proximal LAD for full coverage of dissection. Final angiography showed good distal flow. However, despite of maximal pressure of post stent ballooning, a residual dissection was noted at proximal LAD. IVUS examination also showed encircling gap that was noted between stent and vessel wall at proximal LAD stent area. Because distal flow was good and there was no ischemic symptom and sign, the patient was discharged. Six months later from index procedure, routine follow-up angiography and IVUS examination were performed and revealed more progressed previous residual coronary dissection at proximal LAD which was extended to bifurcation site. Our case showed, although intracoronary stenting might be an attractive approach by closure of the inlet and the false lumen, complete resolution of dissection by stenting is very important for long-term prognosis.

Spontaneous coronary artery dissection of the left circumflex artery causing cardiac tamponade and presenting with atrial fibrillation: a case report and review of the literature

Spontaneous coronary artery dissection is rare. When it does occur, it can present in a myriad of ways and can mimic more common clinical scenarios. Undiagnosed it can be fatal. In this article, the authors present a case of coronary artery dissection in a middle aged man presenting as fast atrial fibrillation with hemodynamic compromise. He was unsuccessfully cardioverted and later arrested and died. Postmortem showed a ruptured dissection of the left circumflex artery causing cardiac tamponade and death. Incidence, associations, pathophysiology, investigations, and treatment options are reviewed.

Intravascular ultrasound-guided coronary artery stenting for spontaneous coronary artery dissection in a case of acute myocardial infarction associated with vasospasm in a non-culprit coronary artery during the hospitalization

We report a case of spontaneous coronary artery dissection (SCAD) causing acute myocardial infarction, which was complicated by vasospastic angina (VA). The patient received intravenous administration of t-PA. Emergency coronary angiography demonstrated narrowing of the left anterior descending artery (LAD) due to SCAD. During hospitalization, the patient suffered chest pain, and ECG showed ST elevation in the inferior leads. Sublingual administration of nitroglycerin provided temporary remission. Coronary stent implantation was performed electively using intravascular ultrasound imaging. This is the first reported case of SCAD associated with vasospasm in a non-culprit coronary artery during the hospitalization.

Idiopathic spontaneous coronary artery dissection: incidence, diagnosis and treatment

BACKGROUND

Less is known about characteristics, treatment and follow-up of patients with spontaneous coronary artery dissection (SCAD) without associated pregnancy or underlying atherosclerosis.

METHODS

We reviewed 5054 consecutive coronary angiographies for SCAD in patients without atherosclerosis or associated pregnancy and performed follow-up angiography in eligible patients.

RESULTS

SCAD were assessed in five patients (mean age 44 +/- 8.7 years). Interestingly, all were premenopausal women. Three had no cardiovascular risk factors, whereas two were previous smokers and one had slightly elevated cholesterol levels. Clinical presentation was acute myocardial infarction in four cases and unstable angina pectoris in one of them. Dissection was localized in the left anterior descending artery (LAD) in three cases and in the first marginal branch of the left circumflex artery in two cases. Three patients were treated conservatively with antithrombotic therapy and beta-blocker, whereas in one patient rescue-PCI with stenting of the ostium of the LAD was performed after failed thrombolysis. The fifth woman with dissected proximal LAD underwent CABG. Follow-up angiographies after 5.9 +/- 4.4 months showed complete angiographic resolution of the dissection in the medically treated patients and a perfect angiographic result of the stented LAD. All patients were free of symptoms after a mean follow-up of 13 +/- 10 months.

CONCLUSIONS

Idiopathic SCAD is a rare cause of acute coronary syndrome in premenopausal women. In case of single vessel dissection and normal blood flow of the dissected vessel, medical treatment with aspirin, clopidogrel and beta-blockade leads to complete angiographic resolution within a few months.

Spontaneous coronary artery dissection involving the left main stem: assessment by intravascular ultrasound

This case report describes the devastating consequences of spontaneous coronary dissection in a 36 year old female patient who otherwise had a normal coronary arteriogram. Intravascular ultrasound showed coronary artery dissection and intramural haematoma at the left main stem coronary artery. Acute coronary syndrome developed and subsequently surgical revascularisation was performed successfully.

Large spontaneous coronary artery dissections-a study of three cases, literature review, and possible therapeutic strategies

Spontaneous coronary artery dissection is rare, but is now being increasingly recognized as a prominent cause of acute ischemic coronary events occurring usually in relatively young patients, predominantly females. The authors describe the clinical course of 3 patients (1 woman) in whom large spontaneous coronary artery dissections developed. All had diverse clinical presentations;1 presenting with heart failure, the second with post-myocardial infarction angina, and the third with syncope. The second patient underwent coronary angioplasty with multiple overlapping stents while in the other two, it was the considered opinion to continue aggressive medical therapy. The 1-year follow-up was uneventful in all 3 patients. The risk factors ascertained in our patients were diabetes mellitus, smoking, and hypertension.

[Spontaneous coronary artery dissection. An infrequent cause of acute coronary syndromes]

Spontaneous coronary artery dissection is a rare condition that may produce severe myocardial ischemia. The growth of indications for cardiac catheterization have led to an increment in the number of cases identified in patients with acute coronary syndromes. Because the therapeutic approach and prognosis are uncertain, doubts often arise regarding the optimal management of these patients. We describe here the clinical and angiographic characteristics of 7 patients with spontaneous coronary artery dissection, as well as treatment and follow-up.

Spontaneous coronary artery dissection: long stenting in a patient with polycythemia vera

Spontaneous coronary artery dissection is a rare cause of myocardial ischemia or sudden cardiac death. We describe a patient with polycythemia vera and a chronic spontaneous coronary artery dissection who was treated with successful angioplasty and long stenting.

Spontaneous coronary artery dissection: report of two cases and a 50-year review of the literature

Spontaneous coronary artery dissection (SCAD) is a rare condition that can cause acute myocardial infarction and sudden death. This entity occurs predominantly in women. Although several mechanisms have been postulated, no single etiology completely explains the pathogenesis of SCAD. Patients who survive SCAD have been treated with various modalities. Prompt diagnosis and early institution of appropriate treatment are usually associated with successful outcome. We report two cases of SCAD successfully identified and treated with coronary stenting as well as a comprehensive review of cases of SCAD published since 1952.

Spontaneous coronary artery dissection--a case report and review of the literature

Spontaneous coronary artery dissection remains an extremely rare cause of myocardial ischemia and infarction. The clinical picture of spontaneous coronary dissection is often sudden cardiac death or fatal myocardial infarction. This report describes a previously healthy woman who developed spontaneous coronary artery dissection. She presented with sudden onset of chest pain and was found to have evidence of acute inferior wall myocardial infarction. She received streptokinase immediately after admission to the coronary care unit. Coronary angiographic studies revealed a linear dissection involving the proximal and mid segments of the right coronary artery.

Spontaneous coronary artery dissection: the clinical spectrum

Spontaneous coronary artery dissection is a rare but increasingly reported cause of myocardial ischemia and sudden death. It is more commonly seen in younger age groups and has a predilection for postpartum women. The clinical spectrum of its presentation includes angina, myocardial infarction, cardiogenic shock, and death. No specific cardiac risk factors have been associated with its occurrence. In postpartum patients, it is presumed that dissection results from pregnancy-induced degeneration of collagen and the additional stresses of parturition. The sporadic nature of spontaneous coronary artery dissection has precluded the development of any consensus for a medical approach, and treatment is usually tailored to individual patient needs. A case of postpartum spiral dissection of the left anterior descending coronary artery with successful medical management is reported.

A young woman with chest pain

A case of a previously fit young woman admitted with chest pain, who was found at coronary angiography to have dissection of the left main stem which extended to the left anterior descending and circumflex coronary arteries, is presented. Emergency coronary artery bypass grafting was performed (vein grafts to the left anterior descending, the diagonal, and circumflex arteries). The patient made an uneventful recovery, and three years after initial presentation she remains free of cardiac symptoms.

[Spontaneous dissection of the coronary arteries: a rare cardiologic diagnosis]

A 55-year-old woman who was admitted to hospital with acute chest pain as a case of emergency suffered from an acute anteroseptal myocardial infarction. Four weeks later coronary angiography revealed a long dissection of the left anterior descending artery (LAD) as well as a significant stenosis of the left main and the proximal circumflex. Cardiovascular surgery was done subsequently. In addition to myocardial revascularization using coronary artery bypass grafts a readaptation of the dissecting artery walls and a proximal ligation of the LAD before anastomosis were performed. Clinical data, pathogenesis, and indications for medical and surgical treatment of spontaneous artery dissection are presented.

Multivessel spontaneous coronary artery dissection in a patient with severe systolic hypertension: a possible association. A case report

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of myocardial ischemia and infarction. Hypertension has not been associated with SCAD. The authors report multivessel SCAD in an elderly woman with severe systolic hypertension. They postulate that hypertension of this degree may play a pathophysiologic role in the causation of SCAD.

Treatment of symptomatic cervical carotid dissections with endovascular stents

OBJECTIVE

Symptomatic dissections of the cervical carotid artery (CCA) can be spontaneous or secondary to trauma and may be associated with pseudoaneurysms. Surgical treatment is often difficult or unavailable. We report the successful use of endovascular stents in the treatment of symptomatic dissection of the CCA.

METHODS

Five consecutive patients with symptomatic CCA dissection were seen at our institution. There were four female patients and one male patient, ranging in age from 19 to 56 years. One dissection was spontaneous. The others were secondary to a gunshot wound (one patient), blunt neck trauma (two patients), and endovascular treatment of atherosclerotic carotid bifurcation disease (one patient). Balloon-expandable and self-expanding stents were placed via a transfemoral approach.

RESULTS

Success in restoring the carotid lumen with two to five stents in each patient was angiographically demonstrated. There were no procedure-related complications. All patients experienced significant clinical improvement within the first 24 hours and complete long-term recovery.

CONCLUSION

Symptomatic dissections of the CCA can be successfully treated by using endovascular stents.

Coronary stenting in the setting of spontaneous coronary artery dissection

Spontaneous coronary artery dissection is a rare cause of myocardial ischaemia. Typically it affects young, apparently healthy females, and may result in significant myocardial loss or even death. Due to the rarity of the condition there are no clear guidelines for its management. We describe two cases of spontaneous coronary artery dissection and report successful coronary stenting of the affected artery in one patient. We believe that this interventional technique may be the treatment of choice in selected patients with this condition.

Coronary artery stenting for spontaneous coronary artery dissection: a case report and review of the literature

Spontaneous coronary artery dissection is an uncommon cause of acute coronary syndromes. It occurs in three major groups: in young women in the peripartum period, in patients with atherosclerotic disease, and in an idiopathic group. There are a number of associated conditions, but the pathogenesis remains unclear. Diagnosis can only be made at angiography. Treatments include medical therapy, coronary artery bypass grafts, and newer interventional procedures. We report on a case of spontaneous coronary artery dissection involving the left circumflex artery in a young adult male presenting with a myocardial infarction after exercise. There were no risk factors for coronary artery disease and no evidence of atherosclerosis on angiography. The dissection was treated with primary coronary artery stenting without predilation, achieving an excellent result. To our knowledge, this is the third known case of successful coronary artery stenting for this condition and the first case of primary stenting without prior angioplasty.

Polyarteritis nodosa presenting as acute myocardial infarction with coronary dissection

Coronary manifestations of polyarteritis nodosa (PAN) are rarely identified pre-mortem. We report a 51-year-old female with PAN causing a coronary dissection and new lesions developing over the next 5 days. PAN should be added to the list of differential diagnoses for spontaneous coronary dissections.

Intravascular stenting as a definitive treatment of spontaneous carotid artery dissection

We describe successful treatment with intravascular stenting of a patient with spontaneous right carotid artery dissection. This case report demonstrates the potential use of stents for treating symptomatic carotid artery dissection.