JOURNAL ARTICLE

Spontaneous coronary artery dissection: Still a lot to learn

David Neves, Ângela Bento, Renato Fernandes, Lino Patrício, José Aguiar
Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology 2017, 36 (1): 59.e1-59.e5
27988230
Non-atherosclerotic spontaneous coronary artery dissection (SCAD) is an uncommon but probably underdetected pathological substrate for acute coronary syndrome. Clinical associations have been noted, like female gender and young age, but its pathophysiology is not yet fully understood. In this report we describe the case of a 50-year-old woman, without cardiovascular risk factors presenting with non-ST segment elevation myocardial infarction, in whom SCAD was diagnosed. Treatment was initially conservative but due to aggravation of the dissection she eventually underwent a complex percutaneous coronary intervention, requiring implantation of multiple stents, but with a good clinical outcome. The procedure was guided by optical coherence tomography (OCT). Carefully analyzing the combined pictures of OCT and angiography, the dissection appeared to be filled with a clear fluid, but not contrast.

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