Percutaneous treatment of spontaneous left main coronary artery dissection extending to the left anterior descending and circumflex arteries possibly triggered by thrombolytic therapy

Abstract

Spontaneous coronary artery dissection is a rare cause of myocardial infarction and the role of thrombolytic therapy in this setting is not known. A case of acute ST elevation myocardial infarction is presented, with initial positive response to thrombolytic therapy and subsequent marked worsening of ST elevation due to extensive dissection, possibly triggered by thrombolytic therapy, which was successfully treated with percutaneous coronary intervention.

Does thrombolytic therapy harm or help in ST elevation myocardial infarction (STEMI) caused by the spontaneous coronary dissection?

“…The presented case was conservatively managed, including thrombolysis 4, 6 , glycoprotein IIb/IIIa inhibitor 9, 19 and clopidogrel 4,13,[20][21][22][23] , and the patient had no recurrence of chest pain in a long-term follow-up of two years. Also, control coronary angiography after two years was normal.…”

Extension of a Coronary Intramural Hematoma as a Complication of Early Percutaneous Coronary Intervention after Thrombolytic Therapy

“…The optimal treatment approach for coronary intramural hematomas has not been well defined, and discussion is limited to case reports [1–4]. In addition, the impact of prior thrombolytic therapy in the setting of coronary artery dissections with possible development and/or extension of an intramural hematoma is not well understood [1].…”

“…In addition, the impact of prior thrombolytic therapy in the setting of coronary artery dissections with possible development and/or extension of an intramural hematoma is not well understood [1]. We present a case of acute anterior ST segment elevation myocardial infarction (STEMI), with initial good response to thrombolytic therapy and subsequent worsening due to iatrogenic periprocedural dissection of the LAD with development and extension of an intramural hematoma towards the LM and LCX arteries.…”