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KMID : 0880520100460020112
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Chonnam Medical Journal
2010 Volume.46 No. 2 p.112 ~ p.116
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Successful Management of Spontaneous Dissection with Spasm in both Coronary Arteries
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Choi Sun-Kyu
Jeong Seung-Jin
Park Jin-Woo
Park Seung-Wook
Kim Ju-Han
Hong Young-Joon
Kang Jung-Chaee
Jeong Myung-Ho
Sim Doo-Sun
Ahn Young-Keun
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Abstract
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Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. SCAD frequently occurs in young women during the peripartal period. There are few reports of SCAD associated with vasospasm. We report a case of a 36-year-old man who presented at our institution with SCAD with spasm. He presented with continuous chest pain for 1 hour. Initial EKG showed pathologic Q wave and ST elevation in lead II, III, and aVF. Emergent coronary angiography (CAG) revealed diffuse spastic narrowing of the left anterior descending coronary artery (LAD) and right coronary artery. On follow-up CAG, spontaneous type B dissection of the proximal LAD extending to the left main and middle LAD were detected. We decided to treat with medical therapy because he had no chest pain. Three days later, patient complained of severe chest pain. Emergency CAG revealed dissection in the left main to middle LAD and proximal left circumflex artery (LCx) with poor distal flow and spasm in the distal LAD. We performed percutaneous coronary intervention for SCAD in the LAD. The follow-up CAG performed 6 months later showed patent LAD stents. This case illustrates the successful management of SCAD that developed in both the culprit and non-culprit arteries of acute myocardial infarction associated with vasospasm.
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KEYWORD
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Coronary artery disease, Dissection, Spasm
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