CORONARY - Acute Coronary Syndromes (STEMI, NSTE-ACS)
Spontaneous Coronary Artery Dissection Complicating ST Elevation Myocardial Infarction in Young Women: To Stent or Not To Stent
Safir Sungkar1, Amir Aziz Alkatiri2, Nanda Iryuza1, , Doni Firman3
National Cardiovascular Center Harapan Kita, Indonesia1, National Cardiovascular Center Harapan Kita Jakarta, Indonesia2, Harapan Kita National Heart Center, Indonesia3,
A 36-year-old woman, referred to our hospital after fibrinolytic therapy due to anterior MI 2 weeks ago. She had recurrent chest pain. No shortness of breath or palpitation. She had no history of traditional atherosclerotic risk factors. History of preeclampsia 1 year ago. Blood pressure was 120/70 mmHg, HR: 75 bpm, no abnormalities on physical exam.
Electrocardiogram showed pathological Q wave and biphasic T wave at precordial leads. Cardiac troponin was elevated and echocardiography revealed hypokinesia at anterior segment and preserved systolic function (LVEF 53%). Echo-short axis.mp4 Echo-4ch.mp4
We then proceeded with percutaneous coronary intervention (PCI) of the LAD using GC 3.5/6F. Floppy wire was inserted to distal LAD with microcatheter support, multiple predilatation with SC balloon 2.5 x 20 mm. OCT revealed intramural hematoma 2.5 x 30 mm causing compromise of the true lumen and medial dissection at proximal LAD. Then predilation with NC scoring balloon 2.5 x 20 mm. Stenting DES 3.0 x 38 mm at proximal-mid LAD. Angiographic evaluation showed TIMI 3 flow, no residual stenosis, residual hematoma at proximal LAD. OCT evaluation revealed well apposed and well expanded stent with MSA 6.9 mm2
, expansion rate 111%, hematoma and disscetion was covered by stent. At 1 month follow up, coronary angiography revealed complete resolution of SCAD and she had no symptom.
SCAD is infrequent and often missed diagnosis among patients presenting with acute coronary syndrome. In cases where revascularisation is necessary, PCI is generally preferred over CABG if technically feasible. Due to limitation of coronary angiography, OCT provides detailed morphology of the lumen coronary artery including entry tear, intimomedial flap, double-lumenmorphology, intramural hematoma, and associated thrombus and may increase the diagnostic yield as well as guided treatment strategy.