Multivessel Spontaneous Coronary Artery Dissection With Coronary Artery Fibromuscular Dysplasia

Abstract

A 53-year-old woman underwent a cardiac catheterization for evaluation of acute coronary syndrome. The coronary angiogram revealed evidence of spontaneous coronary artery dissection in multiple coronary arteries including the left anterior descending artery, posterior descending artery, and posterior left ventricular artery. Further diagnostic imaging revealed associated bilateral vertebral artery and renal artery fibromuscular dysplasia (FMD). Follow-up coronary angiogram 6 weeks later revealed a "string of beads" appearance of the posterior descending artery. This case highlights the importance of extracoronary imaging for FMD and demonstrates angiogram findings suggestive of coronary FMD.

Cutting Balloons in Patients with Spontaneous Coronary Artery Dissection Presented with STElevation Myocardial Infarction; A Review Article

“…Conventional PCI revascularization might be challenging in patients with SCAD due to the false lumen interaction and risk of stent displacement. The success rate of revascularization is notably lower compared to atherosclerotic lesions (47%) [30]. Moreover, given the length of dissection, longer stents might be needed which can be associated with an increased risk of stent thrombosis.…”

Fibromuscular dysplasia: its various phenotypes in everyday practice in 2021

“…Extracoronary FMD in SCAD patients is mostly of the multifocal phenotype and appears to be benign and non-progressive in the short to medium term, with low reported rates of non-coronary major adverse cardiovascular events in SCADsurvivors [84,88,89]. Following discovery of the association between SCAD and extracoronary MF-FMD, and despite the extreme rarity of typical coronary string of beads, the concept of coronary FMD has been proposed [87,88,[90][91][92]. The latter should be considered in presence of marked coronary tortuosity -usually defined as ≥3 bends (defined as a ≥45° change in vessel direction) -however, the intravessel or multivessel symmetry sign, corkscrew appearance, dissection, aneurysm, distal tapering or long, smooth narrowing of the coronary arteries have all been described [92].…”