Karabay Kanber Ocal, Bağırtan Bayram, Geceer Gürkan
Department of Cardiology, Kadıköy Florence Nightingale Hospital, İstanbul, Turkey.
Turk Kardiyol Dern Ars. 2012 Dec;40(8):729-32. doi: 10.5543/tkda.2012.16985.
Spontaneous left main coronary artery (LMCA) dissection is an unusual cause of myocardial ischemia and sudden death. It is defined as an intramural hematoma of the media of the vessel wall. A 56-year-old male who underwent a two-vessel bypass ten years previous presented with chest pain for two hours. His blood pressure and heart rate were 60/35 mmHg and 120 beats per minute, respectively. The ECG showed inferior ST-segment elevation. Coronary angiography revealed total LMCA occlusion with dissection flap. A dissection flap was collapsing the true lumen of the LMCA. A bare metal stent was implanted after the flap was perforated and fenestrated by a stiff guide wire. Good TIMI 3 flow was achieved in the circumflex artery. Three months after the index procedure, coronary computed tomography angiography disclosed thrombosis of the false lumen beneath the patent left main stent. In conclusion, primer stenting can be successfully performed in the presence of spontaneous LMCA dissection.
自发性左冠状动脉主干（LMCA）夹层是心肌缺血和猝死的一种罕见原因。它被定义为血管壁中层的壁内血肿。一名十年前接受双支血管搭桥手术的56岁男性出现胸痛两小时。他的血压和心率分别为60/35 mmHg和每分钟120次。心电图显示下壁ST段抬高。冠状动脉造影显示LMCA完全闭塞并伴有夹层瓣。一个夹层瓣正在压迫LMCA的真腔。在用硬导丝将夹层瓣穿孔并开窗后植入了裸金属支架。回旋支实现了良好的TIMI 3级血流。在首次手术三个月后，冠状动脉计算机断层扫描血管造影显示左主干支架通畅情况下假腔血栓形成。总之，在存在自发性LMCA夹层的情况下可以成功进行初次支架置入术。
