Abstract
We present a case of a 52 year old female who suffered from a sudden syncope. A coronariography was performed and spontaneous coronary dissection was diagnosed in the posterior descending artery after an optical coherence tomography (OCT) was performed. A conservative management was decided. During hospitalization the patient presented with an episode of chest pain with an anterior ST elevation on ECG. Coronariography showed total occlusion of the left descending artery and again a dissection was diagnosed by OCT. This time, 2 stents were implanted in the affected artery. The hypothesis that the coronary adventitial volume of vasa vasorum is higher in patients with spontaneous coronary artery dissection has been demonstrated in a recent small study and it was observed in this patient. Conservative management is preferred in most cases, proceeding to revascularization for patients with ongoing chest pain, hemodynamic instability and ST elevation, mostly if it affects major arteries.
Highlights
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Coronary adventitial volume of vasa vasorum is higher in patients with spontaneous coronary artery dissection.
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Diagnosis remains a challenge and when it is uncertain an intracoronary imaging technique is mandatory.
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Revascularization should be performed in patients with ongoing chest pain, hemodynamic instability and ST elevation, mostly if it affects major arteries.
A coronariography was performed to a 52 year old female patient who presented with a sudden syncope. It revealed a suboclusive distal lesion on posterolateral branch and a slight narrowed lumen of posterior descending artery (PDA). Spontaneous dissection was suspected and an optical coherence tomography (OCT) was performed. A dissection in the proximal part of the PDA ( Fig. 1 A ) and an intramural hematoma until PAD ostium ( Fig. 1 B–E) were observed. A conservative management was decided as the patient was asymptomatic and stable.
