Roule Vincent, Blanchart Katrien, Lemaitre Adrien, Bignon Mathieu, Sabatier Rémi, Beygui Farzin
Department of Cardiology, Caen University Hospital, 14000 Caen, France.
Department of Cardiology, Caen University Hospital, 14000 Caen, France.
Cardiovasc Revasc Med. 2018 Jan-Feb;19(1 Pt B):123-125. doi: 10.1016/j.carrev.2017.07.011. Epub 2017 Jul 19.
A 45-year-old female was admitted for a transient anterior ST-segment elevation myocardial infarction (STEMI). Coronary angiogram showed a diffuse severe stenosis of the distal left anterior descending (LAD) coronary artery, which was managed medically. Three years later, a recurrent transient anterior STEMI led to a second coronary angiography showing a tubular stenosis of the mid-LAD with normal distal coronary bed. An optical coherence tomography (OCT) revealed a spontaneous coronary artery dissection (SCAD) with an extensive compressive mural hematoma without any intimal tear. Conservative treatment was continued. A repeat systematic angiogram 3months later suggested spontaneous healing but the OCT revealed several focal residual hematomas. This case illustrates the different possible angiographic appearances of SCAD and the contribution of the OCT in doubtful situations.
一名45岁女性因短暂性前壁ST段抬高型心肌梗死（STEMI）入院。冠状动脉造影显示左前降支（LAD）冠状动脉远端弥漫性严重狭窄，采取了药物治疗。三年后，复发性短暂性前壁STEMI导致再次进行冠状动脉造影，显示LAD中段呈管状狭窄，远端冠状动脉床正常。光学相干断层扫描（OCT）显示自发性冠状动脉夹层（SCAD），伴有广泛的压迫性壁内血肿，无任何内膜撕裂。继续采取保守治疗。3个月后重复进行系统性血管造影提示自发愈合，但OCT显示有几处局灶性残留血肿。该病例说明了SCAD不同的可能血管造影表现以及OCT在可疑情况下的作用。
