Šikić Jozica, Čerkez Habek Jasna, Strinić Dean, Bešlić Petar, Potrebica Petra
Department of Cardiovascular Diseases, Clinical Hospital "Sveti Duh", Zagreb, Croatia.
School of Medicine of the University of Zagreb.
Acta Clin Croat. 2024 Mar;63(Suppl1):30-36. doi: 10.20471/acc.2024.63.s1.6.
Spontaneous coronary artery dissection (SCAD) is defined as a nonatherosclerotic, nontraumatic or iatrogenic tear within the epicardial coronary artery wall creating a false lumen or hematoma. It is more common in younger patients and women and it can cause acute coronary syndrome (ACS) in 0.1 to 4 percent of cases. We described three cases of different types of SCAD. In the first case, we described a male patient admitted due to chest pain after excessive physical activity. Electrocardiogram (ECG) showed inferior ST-elevation myocardial infarction (STEMI). SCAD of left anterior descending (LAD) was found by coronary angiography. Because of chest pain and signs of ischemia on ECHO, a stent was implanted. After procedure, the patient was pain-free and hemodynamically and rhythmically stable. In the second case, we presented a young multiparous woman with signs of acute coronary syndrome (ACS). A coronary angiogram showed a homogeneous stenosis of proximal LAD. Optimal medical therapy (OMT) was the initial therapy of choice. After a few days due to the recurrence of chest pain and an increase in troponin level, recoronarography was performed. It showed a dissection of the left main (LM), left circumflex artery (LCx) and LAD. It was treated with the two-stent technique procedure, after which, the patient was stable and pain free. In the third case, we showed a postmenopausal patient with subclinical hypothyroidism. In this case, it is difficult to say whether the dissections of LCx, LM and LAD that occurred after the balloon dilatation of LCx and the stent implantation in the right coronary artery (RCA) were result of atherosclerotic lesions or hormonal changes that can cause SCAD.
自发性冠状动脉夹层（SCAD）被定义为心外膜冠状动脉壁内的非动脉粥样硬化、非创伤性或医源性撕裂，形成假腔或血肿。它在年轻患者和女性中更为常见，在0.1%至4%的病例中可导致急性冠状动脉综合征（ACS）。我们描述了三例不同类型的SCAD。在第一例中，我们描述了一名男性患者，因过度体力活动后胸痛入院。心电图（ECG）显示下壁ST段抬高型心肌梗死（STEMI）。冠状动脉造影发现左前降支（LAD）发生SCAD。由于胸痛和超声心动图（ECHO）显示的缺血迹象，植入了支架。术后，患者疼痛消失，血流动力学和节律稳定。在第二例中，我们介绍了一名有急性冠状动脉综合征（ACS）体征的年轻经产妇。冠状动脉造影显示LAD近端均匀狭窄。最佳药物治疗（OMT）是最初的治疗选择。几天后，由于胸痛复发和肌钙蛋白水平升高，进行了再次冠状动脉造影。结果显示左主干（LM）、左旋支动脉（LCx）和LAD发生夹层。采用双支架技术进行治疗，此后患者病情稳定且无疼痛。在第三例中，我们展示了一名患有亚临床甲状腺功能减退的绝经后患者。在这种情况下，很难说在LCx球囊扩张和右冠状动脉（RCA）支架植入后发生的LCx、LM和LAD夹层是动脉粥样硬化病变还是可导致SCAD的激素变化所致。
