Interv Akut Kardiol. 2017;16(2):76-79 | DOI: 10.36290/kar.2017.005

Recurrent spontaneous coronary artery dissection. When less can be more. Case Report

Martin Šimek^{1, 4}, Andrea Steriovský¹, David Richter^{2, 4}, Jan Látal², Marie Černá^{3, 4}

1Kardiochirurgická klinika FN Olomouc, 2I. interní – kardiologická klinika FN Olomouc, 3Radiologická klinika FN Olomouc, 4Lékařská fakulta UP v Olomouci

We report the case of a 33-year old woman with a recurrent spontaneous coronary artery dissection (SCAD). Primary SCAD involving

left anterior descending coronary artery (LAD) was managed conservatively. She underwent repeated coronary angiography for

progression of exertional dyspnoea (NYHA II–III, CCS 0) 6 weeks later and new SCAD of the proximal right coronary artery (RCA) was

found. An attempt at PCI on LAD led to retrograde progression of dissection into the left main coronary artery (LM). She hemodynamically

deteriorated and complained of chest pain due to compromised LM flow (TIMI I). She underwent successfully “bail-out”

triple CABG (on LAD, obtuse marginal branch – OM, and posterior descending artery – PDA). The patient is virtually asymptomatic

(NYHA II, CCS 0) at 1-year follow up; however with borderline LV function (LVEF 45 %), and persisted apical and anteroseptal akinesis.

Keywords: spontaneous coronary artery dissection, CABG, complication

Received: February 7, 2017; Accepted: March 20, 2017; Published: May 1, 2017  Show citation