Spontaneous dissection of left main coronary artery associated with hypertensive crisis: A probable fatal complication detected by intravascular ultrasound

Intravascular ultrasound-guided percutaneous coronary intervention for total occlusion of the proximal left anterior descending artery caused by spontaneous coronary dissection in a young woman

“…The LAD was involved in 78% of cases, the LMT in 24%, and multivessel dissection in 40% [1]. Coronary dissection has been reported to be associated with several factors, including pregnancy [2], hypertension [3], cocaine use [4], connective tissue and vasculitic disorder [5,6], coronary spasm [7], blunt chest trauma, and physical exercise [8]. Short term mortality following SCAD is higher than that of acute coronary syndromes and ST-elevation myocardial infarction.…”

Spontaneous Left Main Coronary Artery Dissection and the Role of Intravascular Ultrasonography

“…The reported use of IVUS in the evaluation of LMCA dissection is limited. 1,6,9,12,14,15,20 To our knowledge, our cases represent the largest reported collection of spontaneous LMCA dissections evaluated with IVUS and serve to not only illustrate the unique and complex angiographic appearances that can occur within this clinical syndrome but also show the safety and efficacy of using IVUS to promptly confirm the diagnosis of LMCA dissection and more accurately define the extent of intramural hematoma propagation. The latter potentially plays a critical role in determining the approach to therapy: conservative medical management, percutaneous revascularization, or surgical revascularization.…”

“…This proposed pathophysiologic process likely explains the unique appearance of the LMCA seen in our second patient, which has also been reported elsewhere. 7,12 It has been proposed that when present, an intimal tear may actually aid in the decompression of the false lumen and thus is protective. 30 In dissections with an intimal tear and thus false and true lumens, IVUS can permit confirmation of the true versus the false lumen as well as identify the length and morphologic characteristics of the intimal tear.…”

Causation or coincidence? A case of sudden death due to spontaneous coronary artery dissection in presence of myocardial bridging

“…Spontaneous coronary artery dissection (SCAD) is an uncommon cause of sudden death [1] and consists in a haemorrhagic separation, usually occurring in the outer third of the tunica media or between the media and external elastic lamina [2], eventually associated with a tear in the intima [3]. It results in the creation of a false lumen whose expansion (due to blood or clot accumulation) causes the distal propagation of the dissection and the subsequent compression/occlusion of the true lumen of the coronary, producing distal blood flow obstruction and myocardial ischemia, infarction or sudden death [3].…”