Spontaneous Coronary Dissection: Its Evolution and Treatment

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Abstract

Spontaneous coronary dissection is a clinical entity of unusual presentation, frequently associated with a fatal evolution. Affected patients are relatively young and predominantly female gender. Its real incidence, etiology, pathologic features, risk factors, treatment and prognosis haven't been yet clearly defined. We report the case of an adult patient with a non-Q wave myocardial infarction who presented a new non-Q wave myocardial infarction during the in-hospital evolution. The coronary angiography showed a long spiral dissection of the left circumflex and obtuse marginal branch. Initially, we planned to perform an elective implantation of a stent in the site of the dissection. In the initial angiography, previous to the implantation, a backward progression of the dissection was observed with involvement of the left main and the anterior descending coronary artery. Then, the patient underwent a successful coronary artery bypass graft with left internal mammary artery and a vein graft. In the 30 days follow-up the patient was asymptomatic.