Spontaneous left main coronary artery dissection complicated with vasospasm. Case resolution

CASE RESOLUTION We decided to end the procedure because the patient became asymptomatic and the ST-segment elevation resolved. After the procedure, the blood test performed revealed a new increase of troponin I levels (4.4 ng/mL). The patient started therapy with dihydropyridine calcium channel bloc...

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Autores principales:	Cátia Costa Oliveira, Carlos Galvão Braga, Catarina Quina, João Costa, Jorge Marques
Formato:	article
Lenguaje:	EN ES
Publicado:	Permanyer 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/b1e30ec8cea44ce0a43c75c6ecc9dc86
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spelling	oai:doaj.org-article:b1e30ec8cea44ce0a43c75c6ecc9dc862021-11-08T09:14:24ZSpontaneous left main coronary artery dissection complicated with vasospasm. Case resolution10.24875/RECICE.M200001952604-7322https://doaj.org/article/b1e30ec8cea44ce0a43c75c6ecc9dc862021-11-01T00:00:00Zhttps://recintervcardiol.org/en/index.php?option=com_content&view=article&id=610https://doaj.org/toc/2604-7322CASE RESOLUTION We decided to end the procedure because the patient became asymptomatic and the ST-segment elevation resolved. After the procedure, the blood test performed revealed a new increase of troponin I levels (4.4 ng/mL). The patient started therapy with dihydropyridine calcium channel blockers due to the observed vasospasm. While in observation, the patient remained asymptomatic. Five days later, she was discharged on dual antiplatelet therapy. One month later, the patient was readmitted to undergo an elective coronary angiography to reassess the lesion. The coronary angiography only revealed the presence of irregularities without further lesions (videos 1 and 2 of the supplementary data). Therefore, the most probable diagnosis was a spontaneous coronary artery dissection (SCAD). The management of SCAD is still a matter of great discussion especially regarding left main coronary artery lesions and situations of hemodynamic instability as it is well-known that SCADs can heal spontaneously after 1 month.1-3 In this case, we decided not to proceed with the percutaneous coronary intervention because the patient became asymptomatic and the electrocardiographic alterations resolved after the administration of intracoronary nitrates and because we were not sure about the etiology of the severe vasospasm (SCAD vs atherosclerotic lesion). The reassessment coronary angiography performed...Cátia Costa OliveiraCarlos Galvão BragaCatarina QuinaJoão CostaJorge MarquesPermanyerarticleMedicineRENESREC: Interventional Cardiology (English Ed.), Vol 3, Iss 4, Pp 324-326 (2021)
institution	DOAJ
collection	DOAJ
language	EN ES
topic	Medicine R
spellingShingle	Medicine R Cátia Costa Oliveira Carlos Galvão Braga Catarina Quina João Costa Jorge Marques Spontaneous left main coronary artery dissection complicated with vasospasm. Case resolution
description	CASE RESOLUTION We decided to end the procedure because the patient became asymptomatic and the ST-segment elevation resolved. After the procedure, the blood test performed revealed a new increase of troponin I levels (4.4 ng/mL). The patient started therapy with dihydropyridine calcium channel blockers due to the observed vasospasm. While in observation, the patient remained asymptomatic. Five days later, she was discharged on dual antiplatelet therapy. One month later, the patient was readmitted to undergo an elective coronary angiography to reassess the lesion. The coronary angiography only revealed the presence of irregularities without further lesions (videos 1 and 2 of the supplementary data). Therefore, the most probable diagnosis was a spontaneous coronary artery dissection (SCAD). The management of SCAD is still a matter of great discussion especially regarding left main coronary artery lesions and situations of hemodynamic instability as it is well-known that SCADs can heal spontaneously after 1 month.1-3 In this case, we decided not to proceed with the percutaneous coronary intervention because the patient became asymptomatic and the electrocardiographic alterations resolved after the administration of intracoronary nitrates and because we were not sure about the etiology of the severe vasospasm (SCAD vs atherosclerotic lesion). The reassessment coronary angiography performed...
format	article
author	Cátia Costa Oliveira Carlos Galvão Braga Catarina Quina João Costa Jorge Marques
author_facet	Cátia Costa Oliveira Carlos Galvão Braga Catarina Quina João Costa Jorge Marques
author_sort	Cátia Costa Oliveira
title	Spontaneous left main coronary artery dissection complicated with vasospasm. Case resolution
title_short	Spontaneous left main coronary artery dissection complicated with vasospasm. Case resolution
title_full	Spontaneous left main coronary artery dissection complicated with vasospasm. Case resolution
title_fullStr	Spontaneous left main coronary artery dissection complicated with vasospasm. Case resolution
title_full_unstemmed	Spontaneous left main coronary artery dissection complicated with vasospasm. Case resolution
title_sort	spontaneous left main coronary artery dissection complicated with vasospasm. case resolution
publisher	Permanyer
publishDate	2021
url	https://doaj.org/article/b1e30ec8cea44ce0a43c75c6ecc9dc86
work_keys_str_mv	AT catiacostaoliveira spontaneousleftmaincoronaryarterydissectioncomplicatedwithvasospasmcaseresolution AT carlosgalvaobraga spontaneousleftmaincoronaryarterydissectioncomplicatedwithvasospasmcaseresolution AT catarinaquina spontaneousleftmaincoronaryarterydissectioncomplicatedwithvasospasmcaseresolution AT joaocosta spontaneousleftmaincoronaryarterydissectioncomplicatedwithvasospasmcaseresolution AT jorgemarques spontaneousleftmaincoronaryarterydissectioncomplicatedwithvasospasmcaseresolution
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Spontaneous left main coronary artery dissection complicated with vasospasm. Case resolution

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