Primary coronary artery dissection observed at coronary angiography

Nishikawa, Hideo; Nakanishi, Shigemoto; Nishiyama, Shinichiro; Nishimura, Shigeyuki; Seki, Akira; Yamaguchi, Hiroshi

doi:10.1016/0002-9149(88)90782-5

Cited by 49 publications

(35 citation statements)

References 7 publications

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“…The left anterior descending coronary artery is most often involved (80% of patients) with the majority of dissections happening, as in our case, in the proximal part, beginning within 2cm of the ostium.1),4) The left main stem has been involved in the dissection in eighteen cases,3) and left and right coronary artery involvement has been reported in 4 patients.6),10),22), 21) The pathogenesis remains unclear but two theories have been suggested3):1) the dissection is caused by hemorrhage from the vasa vasorum into the outer media of the coronary artery, and 2) cystic medial necrosis has been reported in 25 patients with primary coronary dissection although some studies deny its presence.14), 24) The decision to bypass a dissecting coronary artery, including the left main, should be based on the degree of stenosis and the symptoms of the patient, although the report by Zelinger et al25) of a case of left main dissection that progressed to a major occlusion requiring coronary bypass supports the need for close long-term follow-up of patients treated with medication, It has been postulated3) that because most patients with primary dissection are young, internal mammary grafts may be preferred because of their higher patency rates.…”

Section: Figurementioning

confidence: 51%

Spontaneous Left Anterior Descending Coronary Artery Dissection. Case Report Presentation and Review of the Relevant Literature.

1993

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SUMMARYSpontaneous coronary artery dissection is a rare incident occurring usually in young patients, predominantly in females. It is usually fatal and found postmortem. We present the case of a middle aged man with spontaneous left anterior descending coronary artery dissection found angiographically which caused an anterior wall myocardial infarction. We also briefly review the relevant literature. (Jpn Heart J 34: 639-642, 1993) Key Words: Coronary arteriography Anterior wall myocardial infarction RIMARY or spontaneous dissecting aneurysms of the coronary arteries are very rare, and present with acute myocardial infarction or sudden death. They are discovered angiographically or postmortem.1)-4) Only 86 cases of spontaneous coronary artery dissection have been reported and the left anterior descending coronary artery is the most usual site of involvement occurring in 80% of cases2)-6) It has been reported2) that in 88% of cases the dissection was discovered at autopsy performed for evaluation of sudden death.We present the case of a patient with a spontaneous left anterior descending coronary artery dissection which caused anterior wall myocardial infarction. CASE REPORTA fifty-year-old man was admitted to our hospital because of sudden onset of substernal chest pain occurring four hours prior to his admission. The patient had no previous history of angina or other disease and his only cardiovascular risk factor was smoking (20-30 cigarettes a day for the past 25 years). His blood pressure was 140/80mmHg, his ECG showed ST-segment elevation in leads V1-V4 typical of an acute anterior myocardial infarction, and his CK was 650u/ From the

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Section: Figurementioning

confidence: 51%

Spontaneous Left Anterior Descending Coronary Artery Dissection. Case Report Presentation and Review of the Relevant Literature.

1993

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“…Common coronary artery disease can be expressed as coronary dissection. Some authors [7,8] have suggested a correlation between coronary vasospasm and SCAD but a systematic study on the relationship between them has not been done. Mark et al [7] reported a 50-year-old female, who had ST elevation in the inferior leads on chest pain that was relieved with nitrate.…”

Section: Discussionmentioning

confidence: 99%

“…However, the authors of those studies did not analyze the cause of SCAD. Although a few authors [7,8] have suggested a relationship between coronary vasospasm and SCAD, a systematic study on this correlation is lacking. Only 2 cases of vasospasm during angiography have been reported [7,9].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Coronary Dissection as an Expression of Coronary Artery Disease: Correlation with Vasospasm

Takatsu¹,

Takemoto²

2015

CMR

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Abstract:Background: Artificial coronary artery dissection is observed occasionally during percutaneous coronary intervention. However, "spontaneous" coronary artery dissection (SCAD) is not common and we tried to clarify its characteristics. Methods and Results: We reviewed the serial diagnostic coronary angiograms of 21,500 patients retrospectively. Sixty-two patients showed linear, longitudinal defects that were considered to be the angiographic expression of SCAD, in at least one major coronary artery. Vasospasm was shown in 38 patients. Among the remaining 24 subjects, 18 patients had chest pain even after all coronary narrowings of ≧50 %were treated with coronary intervention or bypass surgery. Chest pain was relieved promptly with sublingual administration of nitrate. Thus, 56 patients (90.3%) with SCAD were demonstrated or considered to have vasospasm. Fifty-two patients of these 56 individuals showed significant (≧50%) narrowing in at least one of the major coronary arteries. In the remaining 4 subjects, 3 patients subsequently developed significant coronary artery disease. Comparison of coronary risk factors was done in the 38 patients shown to have vasospasm and 144 patients with ordinary coronary artery disease. Smoking was more common in the group with vasospasm but there was no difference with regard to the other risk factors. Conclusion: SCAD seems to be an expression of coronary artery disease. However, vasospasm is a common factor in these patients.

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“…3) SCAD can also present with unstable angina, MI, or in rare instances, can be asymptomatic and detected incidentally on coronary angiography. 4)16) The incidence of SCAD is 0.1-0.3%, as based on various angiographic series.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Coronary Artery Dissection Manifested during Ergonovine Test and Treated with Intravascular Ultrasound Guided Stenting: A Case Report

et al. 2005

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Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial ischemia, which frequently presents as sudden death. The pathophysiology and treatment of SCAD have not been fully determined. Herein, a case of SCAD, manifesting as variant angina, which rapidly progressed during an ergonovine test, in which 3 drug-eluting stents were deployed using intravascular an ultrasound guidance, with an excellent immediate result, is reported. (Korean Circulation J 2005 ; 35 : 264-268) KEY WORDS：Spontaneous coronary artery dissection；Ergonovine stress；Intravascular ultrasonography；Drug-eluting stent.

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Primary coronary artery dissection observed at coronary angiography

Cited by 49 publications

References 7 publications

Spontaneous Left Anterior Descending Coronary Artery Dissection. Case Report Presentation and Review of the Relevant Literature.

Spontaneous Left Anterior Descending Coronary Artery Dissection. Case Report Presentation and Review of the Relevant Literature.

Spontaneous Coronary Dissection as an Expression of Coronary Artery Disease: Correlation with Vasospasm

Spontaneous Coronary Artery Dissection Manifested during Ergonovine Test and Treated with Intravascular Ultrasound Guided Stenting: A Case Report

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