Abstract
We present the case of a 67 year-old patient that presented to our institution with acute and severe chest pain. Optical coherence tomography high-resolution images of the coronary lumen, allowed us to confirm diagnosis of spontaneous coronary artery dissection, guide treatment, and verify the results of our intervention.
A 67-year-old female was admitted to our institution because of sudden, severe chest pain, irradiated to the left arm and interscapular region. The patient was an ex-smoker, with no other cardiovascular risk factors and no known comorbidities. The admission electrocardiogram did not show signs of ischemia. Serum troponin and CK-MB levels were increased. Transthoracic echocardiogram showed normal regional and global left ventricular function and moderate echo-lucent pericardial effusion. Transesophageal echocardiogram and contrast-enhanced computed tomography excluded aortic dissection. Coronary angiography showed a long subocclusive dissection of a large first obtuse marginal branch, starting from its origin ( Fig. 1 ). The diagnosis was confirmed by an optical coherence tomography (OCT) scan ( Figs. 2 and 3 ), showing a longitudinal dissection starting from a focal stenosis at the ostium of the marginal branch. We performed PCI with deployment of a single bare metal stent at the ostium of the marginal branch to secure the proximal circumflex artery from retrograde extension of the dissection. We then performed a second OCT scan, showing persistence of a longitudinal dissection distal to the stent, with reduction of the false lumen, compared with the initial scan ( Figs. 4 and 5 ). After 10 days, a control angiography showed a normal antegrade flow in the marginal branch, although the dissection distal to the stent was not completely healed ( Fig. 6 ).
