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Early Recurrent Spontaneous Coronary Artery Dissection: A Case-Report

Marek M Rogowski

This paper illustrates a rare case of recurrent spontaneous coronary artery dissection (type 2a according to Yip-Saw) occurred in a 35-year-old non-pregnant woman. The invasive assessment revealed a long dissection of the mid Left Anterior Descending Artery (LAD), which could be confirmed by intravascular ultrasound and was treated successfully with two drug eluting stents. Thirty hours later, the patient developed a second event with severe symptoms and new Electrocardiogram (ECG) ischemic changes. The second angiography showed a new spontaneous dissection of the mid Circumflex Artery (CX), which was treated with one drug-eluting stent. The patient was transferred back to the intermediate care unit and was discharged on the dual antiplatelet therapy on the fifth day. The left ventricular ejection fraction was normal. The heart enzymes increased slightly and normalized within four days. The vessel screening showed no abnormalities in the extra coronary arteries. In patients with spontaneous coronary dissection, intracoronary imagining is helpful in choosing the optimal treatment strategy and should be used whenever available. The possibility of early recurrence makes it mandatory to transfer all patients for a prolonged monitoring after a coronary intervention.