Matsushita Kensuke, Ristorto Jessica, Morel Olivier, Ohlmann Patrick
Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 1 place de l'Hôpital, 67091 Strasbourg, France.
UMR 1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, 74 route du Rhin, 67401 Illkirch, France.
Eur Heart J Case Rep. 2019 Dec;3(4):1-6. doi: 10.1093/ehjcr/ytz173. Epub 2019 Oct 9.
Spontaneous coronary artery dissection (SCAD) is a rare disease that predominantly affects woman. Percutaneous coronary intervention (PCI) is recommended only in patients with ongoing ischaemia because it carries a high risk of procedural complications in SCAD patients.
A 51-year-old woman was admitted to our institution owing to severe chest pain. Coronary angiography showed a diffuse narrowing and radiolucent luminal flap which runs parallel to the vessel wall in the proximal left circumflex coronary artery and SCAD was diagnosed. After PCI was undertaken, optical coherence tomography disclosed a circular haematoma at the stent distal segment and an intimal tear at the distal left main coronary artery. A conservative approach was decided owing to patient stability without evidence of ongoing ischaemia and normal coronary flow. Thirty minutes later, the patient started to complain of chest pain with the ST-segment elevation in leads I, aVL, and V2-3. Coronary angiography demonstrated a total occlusion of the second diagonal brunch and double lumen morphology at the proximal-potion of left anterior descending with TIMI2 distal flow suggesting the extension of coronary dissection. Optical coherence tomography imaging revealed that the entry door of the dissection was located where the small intimal tear was found. Percutaneous coronary intervention was successfully performed, and the patient was discharged without any complication.
Although the underlying mechanism of recurrent SCAD remain largely unknown, our case suggests that the residual inlet of the dissection may associate with the extension of the coronary dissection.
自发性冠状动脉夹层（SCAD）是一种罕见疾病，主要影响女性。仅在有持续性缺血的患者中推荐进行经皮冠状动脉介入治疗（PCI），因为在SCAD患者中其具有较高的手术并发症风险。
一名51岁女性因严重胸痛入住我院。冠状动脉造影显示弥漫性狭窄以及在左回旋支冠状动脉近端与血管壁平行的透光性管腔内瓣片，诊断为SCAD。进行PCI后，光学相干断层扫描显示支架远端节段有圆形血肿，左主干冠状动脉远端有内膜撕裂。由于患者病情稳定，无持续性缺血证据且冠状动脉血流正常，决定采取保守治疗方法。30分钟后，患者开始抱怨胸痛，I、aVL及V2 - 3导联ST段抬高。冠状动脉造影显示第二对角支完全闭塞，左前降支近端呈双腔形态，TIMI2级远端血流，提示冠状动脉夹层扩展。光学相干断层扫描成像显示夹层的入口位于发现小内膜撕裂处。成功进行了经皮冠状动脉介入治疗，患者出院时无任何并发症。
尽管复发性SCAD的潜在机制在很大程度上仍不清楚，但我们的病例表明夹层的残余入口可能与冠状动脉夹层的扩展有关。
