Spontaneous Coronary Artery Dissection Treated with Direct Coronary Stenting.

BACKGROUND Spontaneous coronary artery dissection (SCAD) is a rare medical emergency characterized by non-traumatic and non-iatrogenic tearing of the intima of a coronary artery, with an estimated incidence of 1-4%. CASE REPORT A 39-year-old woman with no known cardiac risk factors or recent trauma presented with acute chest pain, electrocardiographic (ECG) changes consistent with ST-elevation acute coronary syndrome, and elevated cardiac enzymes. Coronary angiography revealed near-complete stenosis of the distal left anterior descending (LAD) coronary artery with findings consistent with coronary artery dissection. Due to ongoing chest pain refractory to medical therapy, she underwent successful complex intervention on the distal LAD lesion with a 2.0×30 mm Onyx drug-eluting stent that was post-dilated to high pressure with a 2.5 noncompliant balloon, reducing the 99% stenosis to a 0% residual. She recovered fully and was discharged on aggressive risk factor modification with dual antiplatelet therapy (aspirin and clopidogrel) and high-intensity statin. CONCLUSIONS Spontaneous coronary artery dissection (SCAD) is a rare condition that can present with ECG changes and ischemic symptoms identical to ST-elevation transmural myocardial infarction secondary to plaque rupture. Coronary angiography is required to evaluate patients, and, depending on the catheterization findings, the patient's hemodynamic profile, and severity of ischemic symptoms, complex interventions such as direct coronary stenting can best treat patients such as ours, while medical management might be considered for others.