Takemura Kazunori, Maegaki Masaharu, Nakamura Ryuta, Takase Tetsuro, Mitsumata Kaneto, Tanabe Tomoaki, Tei Imun
Department of Cardiology, Ayase Heart Hospital, Tokyo, Japan.
J Cardiol Cases. 2019 Dec 3;21(3):123-126. doi: 10.1016/j.jccase.2019.11.008. eCollection 2020 Mar.
Spontaneous coronary artery dissection (SCAD) usually occurs in women, which can result in significant morbidities. A 38 year-old obese man who is currently smoking was referred to our hospital with chest pain. His electrocardiography and echocardiography suggested myocardial infarction in proximal region of left coronary artery. Emergent coronary angiography revealed 99% stenosis at mid portion of LAD and diffuse 50% stenosis from LMT to LAD. Intravascular ultrasound identified intramural hematoma severely compressing the true lumen which extended from mid LAD to LMT suggesting SCAD. After failed fenestration of the false lumen with balloon angioplasty, emergent coronary artery bypass graft using right internal thoracic artery and saphenous vein graft was performed. Two weeks after the surgery, follow-up CAG found completely healed native coronary artery which resulted in occlusion of RITA-LAD graft. This case raises two clinical important issues. First, SCAD can be seen in middle-aged men who are likely to have atherosclerosis. Secondly, CABG is useful as temporizing strategy for unstable SCAD involving LMT. The rapid healing and temporal lifesaving CABG contributed to avoidance of lifelong antiplatelet therapy. Although SCAD is relatively uncommon manifestation of acute coronary syndrome, optimal diagnosis and treatment for each patient need to be considered. < Spontaneous coronary artery dissection (SCAD) usually occurs in women, which can result in significant morbidities. We experienced an unusual case of SCAD involving LMT in a middle-aged men who are likely to have atherosclerosis. In such a patient who has high risk features, CABG is useful as a temporizing strategy. As spontaneous healing of the native coronary artery can be achieved in a few days, temporizing CABG as a lifesaving treatment is feasible and this make lifelong dual-antiplatelet therapy unnecessary.>.
自发性冠状动脉夹层（SCAD）通常发生于女性，可导致严重的发病情况。一名38岁的肥胖男性，目前仍在吸烟，因胸痛被转诊至我院。他的心电图和超声心动图提示左冠状动脉近端心肌梗死。急诊冠状动脉造影显示左前降支（LAD）中段99%狭窄，从左主干（LMT）至LAD弥漫性50%狭窄。血管内超声发现壁内血肿严重压迫真腔，该血肿从LAD中段延伸至LMT，提示为SCAD。在用球囊血管成形术对假腔开窗失败后，急诊进行了冠状动脉搭桥术，使用了右胸廓内动脉和大隐静脉移植物。术后两周，随访冠状动脉造影（CAG）发现自身冠状动脉完全愈合，导致右胸廓内动脉-左前降支移植物闭塞。该病例提出了两个重要的临床问题。第一，SCAD可见于可能患有动脉粥样硬化的中年男性。第二，冠状动脉搭桥术（CABG）作为一种临时策略，对累及LMT的不稳定SCAD是有用的。快速愈合和具有临时挽救生命作用的CABG有助于避免终身抗血小板治疗。尽管SCAD是急性冠状动脉综合征相对少见的表现形式，但仍需考虑对每位患者进行最佳诊断和治疗。<自发性冠状动脉夹层（SCAD）通常发生于女性，可导致严重的发病情况。我们遇到了一例不寻常的SCAD病例，累及一名可能患有动脉粥样硬化的中年男性的LMT。在这样具有高风险特征的患者中，CABG作为一种临时策略是有用的。由于自身冠状动脉可在数天内实现自发愈合，将CABG作为挽救生命的治疗方法是可行的，这使得终身双联抗血小板治疗不再必要。>
