Vanhaverbeke M, Sarens T, Driessche L Van
Acta Clin Belg. 2014 Jun;69(3):217-20. doi: 10.1179/2295333714Y.0000000020. Epub 2014 Apr 8.
Spontaneous coronary artery dissection (SCAD) is increasingly being diagnosed as the cause of an acute coronary syndrome, especially in young patients. We report the case of a 32-year-old woman with postpartum SCAD of the left main and left anterior descending coronary artery which required the implantation of two drug-eluting stents. We present a literature study that correlates the pathogenesis of SCAD to the treatment options. Non-atherosclerotic SCAD is clearly associated with connective tissue disorders, vasculitis, and the peripartum period with its hormonal and haemodynamic changes. The coronary arteries of these SCAD patients are friable and should be approached with caution. Percutaneous coronary intervention has a reported success rate of only 65% and may cause propagation of the dissection. Lately, more and more authors suggest the possibility of a conservative approach in the absence of remaining cardiac ischaemia, even in this era of percutaneous stent implantation.
自发性冠状动脉夹层（SCAD）越来越多地被诊断为急性冠状动脉综合征的病因，尤其是在年轻患者中。我们报告一例32岁产后女性，其左主干和左前降支冠状动脉发生SCAD，需要植入两枚药物洗脱支架。我们进行了一项文献研究，将SCAD的发病机制与治疗选择相关联。非动脉粥样硬化性SCAD显然与结缔组织疾病、血管炎以及围产期及其激素和血流动力学变化有关。这些SCAD患者的冠状动脉很脆弱，处理时应谨慎。据报道，经皮冠状动脉介入治疗的成功率仅为65%，且可能导致夹层扩展。最近，越来越多的作者提出，即使在这个经皮支架植入时代，在不存在残余心肌缺血的情况下，采用保守治疗方法也是有可能的。
