The Spontaneous Dissection of Coronary Arteries: An Entire Still Unusual!

DATE PUBLISHED
July 9, 2019
SECTION
Articles

Abstract

Hematomas and coronary dissections are rare and little-known features of acute coronary syndrome (ACS) or even sudden death, especially in young women. Relatively large series have been published over the past five years to highlight this underestimated condition. Thus, the diagnostic and therapeutic modalities are better and better understood. We report a clinical case of coronary dissection in a 52-year-old patient due to compressional wall hematoma demonstrated in coronary angiography. The evolution was favorable under medical treatment combining platelet antiaggregants and beta blockers. Our case illustrates an approach to this particular entity while reviewing its clinical and paraclinical characteristics, its therapeutic management and its evolution.

Keywords

spontaneous dissection of coronary arteries

References

Saw J, Mancini GBJ, Humphries H. Contemporary review on spontaneous coronary artery dissection. JACC 2016;68 (3 ):297–32

Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D, et al. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv 2014; 7(5):645–55.

H. Pretty Dissecting aneurysm of coronary artery in a woman aged 42

Vanzetto G, Berger-Coz E, Barone-Rochette G, Chavanon O, Bouvaist H,Hacini R, et al. Prevalence, therapeutic management and medium-termprognosis of spontaneous coronary artery dissection: results from a data-base of 11,605 patients. Eur J Cardiothorac Surg 2009;35(2):250–4

Motreff P, Malcles G, Combaret N, Barber Chamoux N, Bouajila S, Pereira B, et al. How and when to suspect spontaneous coronary artery dissection: novel insights from a single centre series on prevalence and angiographic appearance. Eurointervention 2017;12:2236–43

Saw J, Mancini GB, Humphries K, Fung A,Boone R, Starovoytov A, et al. Angiographic appearance of spontaneous coronary artery dissection with Intramural hematoma proven on intracoronary imaging. Catheter Cardio vasc Interv 2016;87:54–61.

H.N.Z. Rashid, D.T. Wong, H. Wijesekera, S.J. Gutman, V.B. Shanmugama, R. Gulatil, et al. Incidence and characterisation of spontaneous coronary artery dissection as a cause of acute coronary syndrome – a single-centre Australian experience Int J Cardiol, 202 (2016), pp. 336-338

Saw J, Aymong E, Mancini GBJ, Sedlak T, Starovoytov A, Ricci D. Non-atherosclerotic coronary artery disease in young women. Can J Cardiol 2014;30(7):814–9.

T. Nishiguchi, A. Tanaka, Y. Ozaki, A. Taruya, S. Fukuda, H. Taguchi, et al .Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome Eur Heart J Acute Cardiovasc Care, 5 (2016), pp. 263-270

Saw J. Coronary angiogram classification of spontaneous coronaryartery dissection. Catheter Cardiovasc Interv 2014 .84 ( 7) 1115-22,

Alfonso F, Paulo M, Gonzalo N, Dutary J, Jimenez-Quevedo P, Len-nie V, et al. Diagnosis of spontaneous coronary artery dissectionby optical coherence tomography. J Am Coll Cardiol 2012;59(12):1073–9

Motreff P, Barber-Chamoux N, Combaret N, Souteyrand G. Coronary artery fenestration guided by optical coherence tomograhy before stenting: newinterventional option in rescue management of compressive spontaneousintramural hematoma. Circ Cardiovasc Interv 2015;8(4):e002266.

Maehara A, Mintz GS, Castagna MT, Pichard AD, Satler LF, Waksman R,et al. Intravascular ultrasound assessment of spontaneous coronary arterydissection. Am J Cardiol 2002;89(4):466–8

Saw J. Spontaneous coronary artery dissection. Can J Cardiol 2013,

http://dx.doi.org/10.1016/j.cjca.2012.12.018.

A.J. Dalby, L.J. Levien Spontaneous coronary artery dissection associated with fibromuscular dysplasia Cardiovasc J Afr, 26 (2015), pp. 86-90

Saw J, Ricci D, Starovoytov A, Fox R, Buller CE. Spontaneous coronaryartery dissection: prevalence of predisposing conditions including fibro-muscular dysplasia in a tertiary center cohort. JACC Cardiovasc Interv2013;6(1):44–52.

A. Yip, J. Saw Spontaneous coronary artery dissection – a review Cardiovasc Diagn Ther, 5 (2015), pp. 37-48

Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ, et al. Clinical features, management, and prognosis of spontaneous coronary arterydissection. Circulation 2012; 126(5) : 579–88.

Tweet MS, Eleid MF, Best PJM, Lennon RJ, Lerman A, Rihal CS, et al.Spontaneous coronary artery dissection: revascularization versus conservative therapy. Circ Cardiovasc Interv 2014;7(6):777–86.

Alfonso F, Paulo M, Lennie V, Dutary J, Bernardo E, Jiménez-QuevedoP, et al. Spontaneous coronary artery dissection: long-term follow-up ofa large series of patients prospectively managed with a “conservative” therapeutic strategy. JACC Cardiovasc Interv 2012;5(10):1062–70

C. Lettieri, D. Zavalloni, R. Rossini, N. Morici, F. Ettori, O. Leonzi, et al.Management and long-term prognosis of spontaneous coronary artery dissection Am J Cardiol, 116 (2015), pp. 66-73

Nakashima T, Nogush T, Haruta S, Yama moto Y, Oshima S, Nakao K, et al. Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: a report from the angina pectoris-myocardial infarction multi center investigators in Japan. Int J Cardiol 2016; 15:341–8.

Combaret N, Souteyrand G, Amonchot A, Coupez E, Motreff P. Contri-bution of guidance by optical coherence tomography (OCT) in rescuemanagement of spontaneous coronary artery dissection. Eur Heart J Car-diovasc Imaging 2013; 14(7):714.

Vrints CJM. Spontaneous coronary artery dissection. Heart 2010;96(10):801–8

S. Rogowski, M.T. Maeder, D. Weilenmann, P.K. Haager, P. Ammann, F. Rohner, et al.Spontaneous coronary artery dissection: angiographic follow-up and long-term clinical outcome in a predominantly medically treated population Catheter Cardiovasc Interv, 89 (2017), pp. 59-68

J. Saw, E. Aymong, T. Sedlak, C.E. Budler, A. Starovoytov, D. Ricci, et al.Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes Circ Cardiovasc Interv, 7 (2014), pp. 645-655.

Author Details

Lalla Fatima Ezzahra El Hassani

Salwa Cheraou

Zouhair Lakhal

Mohamed Cherty