Spontaneous Coronary Artery Dissection in a Woman With Polycystic Kidney Disease

Abstract

Autosomal dominant polycystic kidney disease (ADPKD), characterized by renal cyst formation, is known to cause such vascular abnormalities as arterial dilatation and dissection. However, spontaneous coronary artery dissection (SCAD) is observed only rarely in patients with ADPKD. We report a patient with ADPKD who developed SCAD and presented with acute myocardial infarction. Her coronary angiography showed a long spiral dissection of the left anterior descending coronary artery. She underwent successful coronary angioplasty with insertion of 3 drug-eluting stents. To the best of our knowledge, this is the first reported case of percutaneous coronary intervention for coronary dissection in a patient with ADPKD. The pathophysiological characteristics of vascular complications in patients with ADPKD are discussed. Polycystins are strongly expressed in human adult vascular smooth muscle cells, and the vascular abnormalities in patients with ADPKD may be related to altered expression of polycystins. Because early recoginition and prompt efforts at mechanical reperfusion, if indicated, are crucial for successful management of SCAD, it would be worthwhile to consider SCAD in the differential diagnoses of acute coronary syndrome in patients with ADPKD.

Autosomal Dominant Polycystic Kidney Disease and Intracranial Aneurysms: Is There an Increased Risk of Treatment?

“…Other case reports have also suggested an increased risk of spontaneous dissection of the aorta and internal carotid, vertebral, basilar, and coronary arteries in ADPCKD. 2,19,20 As with any case report, however, conclusions must be interpreted with caution. Our study builds on this body of knowledge by offering a much larger sample size and additional data analysis and a comparison between endovascular coiling and microsurgical clipping risks.…”

Computed Tomography Angiographic Demonstration of an Unexpected Left Main Coronary Artery Dissection in a Patient With Polycystic Kidney Disease

“…Subsequent coronary angiograms disclosed long linear dissection in the left anterior descending artery. [1][2][3] In contrast, a short dissection with the involvement of the left main coronary artery extending to the proximal left descending artery was shown in our patient. Although higher relative risks of intracerebral aneurysm and cervical artery dissection in ADPKD patients have been reported, 1-4 it has not yet been clarified whether coronary artery dissection is part of the extrarenal manifestations of ADPKD.…”

“…7 Other causes include aortic dissection, trauma, intense physical exercise, Marfan syndrome, connective tissue diseases, vasculitis, coronary angiography, and surgical manipulation. [1][2][3][4][5][6][7][8] However, none of these causes were noted in our patient.…”

“…[3][4][5] The most common clinical presentation of coronary artery dissection is sudden death (60% to 80%), and the diagnosis is made at necropsy. It can also present as acute coronary syndrome with severe chest pain with or without ST-segment elevation, arrhythmia, or heart failure.…”

“…All 3 cases manifested with severe chest pain with clinically evident myocardial infarction, and dissection of the coronary artery was revealed by coronary angiography. [1][2][3] Herein, we describe the coronary computed tomography angiographic (CTA) diagnosis of spontaneous coronary artery dissection in an ADPKD patient who presented with mild intermittent chest discomfort.…”