Interventional treatment of non-spontaneously healed spontaneous coronary artery dissection: a case report

Abstract

Background Spontaneous coronary artery dissection (SCAD) is a significant cause of non-atherosclerotic acute coronary syndrome, myocardial infarction, and sudden cardiac death. Women account for 87–95% of SCAD patients, with the average age of onset ranging from 44 to 53 years. Approximately 95% of cases reported to resolve spontaneously. However, percutaneous coronary intervention (PCI) can lead to various complications, prompting guidelines to recommend conservative management for patients categorized as low-risk. Case presentation A 49-year-old woman presented with intermittent dyspnea lasting three months. Initial coronary angiography revealed severe stenosis of the left anterior descending artery (LAD). Intravascular ultrasound (IVUS) demonstrated dissection, hematoma, and thrombus in the proximal LAD. Following balloon dilation, the hematoma extended distally, resulting in no-reflow, which subsequently led to thrombosis in the left main coronary artery. A stent was deployed from the mid to proximal LAD, leading to gradual improvement in blood flow, achieving TIMI grade 3. Two months post-discharge, the patient was readmitted. Coronary angiography showed patent stents, with no significant stenosis in the previously placed stent, but a new stent was inserted in the distal segment of the LAD. Eight months later, repeat angiography revealed patent stents and no notable abnormalities in the remaining vessels. Conclusion For high-risk SCAD patients who do not exhibit spontaneous healing, vascular revascularization should be considered judiciously. Clinical trial number Not applicable. Graphical abstract