Multifaceted Presentation of Recurrent Spontaneous Coronary Artery Dissection
Angiography and Optical Coherence Tomography Findings
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- fibromuscular dysplasia
- intravascular ultrasound
- optical coherence tomography
- spontaneous coronary dissection
A 58-year-old woman with a previous history of hypertension, hypercholesterolemia, and cigarette smoking presented with a non–ST-segment–elevation myocardial infarction with transient (nonpersistent) anterior ST-segment–elevation suggesting ischemia on the territory of the left anterior descending coronary artery. The coronary angiogram showed no signs of atherosclerosis but depicted severely tortuous coronary arteries with a focal lumen narrowing in the mid-segment of the left anterior descending coronary artery (Figure 1A). In addition, a diffuse lesion with a double lumen was demonstrated at the mid-segment of the posterior descending coronary artery branch of the right coronary artery (Figure 1B). Moreover, the distal left circumflex coronary artery also showed an image of a double lumen (Figure 1C). These findings were highly suggestive of 3-vessel spontaneous coronary artery dissection (SCAD). As the patient was stable and asymptomatic with no signs of ongoing ischemia, a conservative medical approach was selected, and she was eventually discharged on a low dose of aspirin. A control angiogram scheduled at 12 months depicted restitutio ad integrum of the left anterior descending coronary artery and posterior descending coronary artery lesions with a completely normal vessel appearance (Figure 1D and 1E). Nevertheless, the image of double lumen on the distal circumflex coronary artery remained unchanged.