Cheung S, Mithani V, Watson R M
Division of Cardiology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey 07107-3001, USA.
Catheter Cardiovasc Interv. 2000 Sep;51(1):95-100. doi: 10.1002/1522-726x(200009)51:1<95::aid-ccd22>3.0.co;2-m.
Spontaneous coronary artery dissection is a rare cause of myocardial infarction. It is a condition with greater prevalence in young women, particularly in the peripartum or early postpartum period. It also has been described following intense physical exercise. The pathophysiologic characteristics remain unclear. Unlike atherosclerotic intimal dissection, the dissection plane lies within the media or between the media and adventitia. We describe a case of spontaneous coronary artery dissection in a 44-yr old menstruating woman with mitral valve prolapse, who experienced acute myocardial infarction after twisting and throwing a heavy piece of luggage. Coronary angiography showed coronary artery dissection in a left anterior descending coronary artery at the point of its emergence from its intramural course. An intimal plaque with 90-95% obstruction and reduced (TIMI I) flow was demonstrated. The patient was treated with continued glycoprotein IIb/IIIa inhibitor infusion. Angiographic resolution with return of prompt (TIMI III) flow was noted. Optimal management of spontaneous coronary artery dissection has not been established and may vary, depending upon the presence of intimal versus extramural compromise. Coronary artery bypass, stenting, and thrombolysis have been successful and also have failed, owing to extension of dissection. Our patient is the first reported patient to have received tirofiban therapy in the context of spontaneous coronary artery dissection. Medical therapy has been used most often, and angiographic resolution has been documented at 94 days, 7 mo, and 1 yr. We document the earliest case of spontaneous angiographic resolution-within 20 hr.
自发性冠状动脉夹层是心肌梗死的一种罕见病因。这种情况在年轻女性中更为常见，尤其是在围产期或产后早期。在剧烈体育锻炼后也有相关报道。其病理生理特征仍不清楚。与动脉粥样硬化性内膜夹层不同，夹层平面位于中膜内或中膜与外膜之间。我们描述了一例44岁患有二尖瓣脱垂的月经期女性发生自发性冠状动脉夹层的病例，该患者在扭转并抛掷一件沉重行李后发生了急性心肌梗死。冠状动脉造影显示左前降支冠状动脉在其从壁内走行处发出的部位出现夹层。可见一个内膜斑块导致90% - 95%的阻塞并伴有血流减少（TIMI I级）。患者接受了持续静脉输注糖蛋白IIb/IIIa抑制剂治疗。造影显示血流恢复至快速（TIMI III级）。自发性冠状动脉夹层的最佳治疗方法尚未确定，可能因内膜与壁外受累情况而异。冠状动脉搭桥术、支架置入术和溶栓治疗既有成功的案例，也有因夹层扩展而失败的情况。我们的患者是首例报道在自发性冠状动脉夹层情况下接受替罗非班治疗的患者。药物治疗最为常用，造影显示在94天、7个月和1年时病变消退。我们记录了最早在20小时内实现自发性造影消退的病例。
