Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Masih Daneshvari Hospital, Shahid Beheshti University Medical Center, Tehran, Iran.
Future Cardiol. 2020 Jul;16(4):271-274. doi: 10.2217/fca-2018-0071. Epub 2020 Mar 31.
In this report, we describe a case of spontaneous coronary dissection involving left anterior descending artery presenting with acute anterior myocardial infarction successfully treated with thrombolytic and conservative therapy with a suggestion that spontaneous resolution of thrombus occurred before coronary intervention could be performed. As we did not have initial angiogram due to patient's refusal, this assumption is speculative. However, this case suggests that dissections may heal spontaneously and could be treated with conservative approach in selected cases based on best clinical judgment. It is important to realize that the clinical course of a major coronary artery dissection remains unpredictable. Therefore, cardiologists should always treat each case individually and consider coronary interventions if conservative treatment is not leading to resolution of ST elevation or in patients with hemodynamic compromise. This case is followed by discussion about conservative versus invasive management of spontaneous coronary dissections.
在本报告中，我们描述了一例左前降支自发性冠状动脉夹层导致急性前壁心肌梗死的病例，该患者成功接受了溶栓和保守治疗，提示在进行冠状动脉介入治疗之前血栓自发溶解。由于患者拒绝进行初始血管造影，因此我们没有初始血管造影，这一假设是推测性的。然而，该病例提示夹层可能会自发愈合，并且在基于最佳临床判断的情况下，在某些情况下可以采用保守方法进行治疗。需要认识到，主要冠状动脉夹层的临床过程仍然不可预测。因此，心脏病专家应始终根据具体情况个体化治疗每个病例，如果保守治疗不能使 ST 段抬高得到缓解或患者出现血流动力学不稳定，则应考虑进行冠状动脉介入治疗。本病例后对自发性冠状动脉夹层的保守治疗与介入治疗进行了讨论。
