Combined dissection of the right coronary artery and right coronary cusp during coronary angiography

Dissection of coronary arteries during diagnostic coronary angiography is infrequent; dissection of the coronary cusp is extremely rare. The combination of coronary artery and coronary cusp dissection has not been reported previously. A case of right coronary artery dissection and right coronary cusp dissection during diagnostic coronary angiography is described. © 1995 Wiley-Liss, Inc.     

Spontaneous left main coronary artery dissection

Spontaneous coronary artery dissection (SCAD) is a very rare clinical condition. Physiopathology of SCAD is still mostly unclear. Clinical presentation of SCAD ranges from atypical symptoms to sudden cardiac death. The diagnosis of dissection is generally made by using conventional coronary angiography. Invasive or conservative treatment is reasonable.     

老年StandfordB型主动脉夹层患者冠状动脉造影的临床意义

目的探讨老年StandfordB型主动脉夹层患者中冠状动脉粥样硬化性心脏病（冠心病）的检出率及其相关危险因素。方法回顾性分析134例50岁以上同时进行主动脉造影和冠状动脉造影的StandfordB型主动脉夹层患者的临床资料及影像学资料．对数据进行统计分析。结果134例患者中,冠心病的检出率为26．1％（35例）,其中单支病变22例（16．4％）,2支病变9例（6．7％）,左主干或3支病变4例（3．0％）。多因素Logistic回归分析显示．男性（OR=6．682,95％CI1．01—44．13,P=0．049）及吸烟（OR=3．513,95％CI1．05-11．70,P=0．041）是StandfordB型主动脉夹层合并冠心病的预测因素。结论50岁以上StandfordB型主动脉夹层患者共患冠心病的比例较高,在主动脉造影时有必要常规进行冠状动脉造影检查,以免漏诊。     

Spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute myocardial ischemia with complex pathophysiology. This paper reviews the major diagnostic and therapeutic issues of this rare but important disease. The diagnosis of SCAD should be strongly considered in any patient who presents with symptoms suggestive of acute myocardial ischemia, particularly in young subjects without traditional risk factors for coronary artery disease (especially in young women during the peripartum period or in association with oral contraceptive use). Urgent coronary angiography is indicated to establish the diagnosis and to determine the appropriate therapeutic approach. The decision to pursue medical management, percutaneous coronary intervention, or surgical revascularization is based primarily on the clinical presentation, extent of dissection, and amount of ischemic myocardium at risk.     

Spontaneous coronary artery dissection of the left anterior descending artery in a patient with COVID-19 infection

A 48-year-old woman with a past medical history of migraines and hyperlipidemia presented due to severe retrosternal chest pain with no other associated signs or symptoms. The patient was hemodynamically stable and was found to have an elevated troponin with electrocardiogram showing no ischemic changes. Computed tomography of the coronary arteries showed a left dominant system with dissection extending from the mid-to-distal left anterior descending (LAD) artery. The patient was subsequently discharged on medical therapy but returned 3 days later due to worsening chest pain. Electrocardiogram revealed inferior and anteroseptal ST segment changes with peak troponin of 14.9 ng/ml (reference range <0.80 ng/ml). Coronavirus disease 2019 (COVID-19) nasopharyngeal swab was performed prior to urgent coronary angiogram. Coronary angiogram was performed with full personal protective equipment for respiratory and droplet precautions due to pending COVID-19 testing results. Angiogram revealed spontaneous coronary artery dissection (SCAD) extending from the ostium of the LAD to the distal vessel. COVID-19 testing returned positive while in intensive care unit. The patient was not a percutaneous coronary intervention candidate due to the extent of the dissection and was not a surgical candidate due to a lack of graftable target and medical management was continued. To our knowledge, this case is the first in which SCAD has been reported in the LAD in a patient with COVID-19 with no other symptoms of respiratory illness or symptoms classically associated with the novel coronavirus. SCAD should be considered on the differential as one of the various cardiac manifestations of COVID-19 infection.     

Spontaneous coronary artery dissection in mitral stenosis

Spontaneous coronary artery dissection is a rare disease thatoccurs most commonly in young people, especially in peripartumor postpartum women. It has rarely been diagnosed during lifeand has never before been observed associated with any othernon-ischaemic heart disease. We report a case associated withmitral stenosis, in which successful valvular and coronary surgerywere carried out. We speculate whether rheumatic coronary arteritiswas a cause of the dissection.     

Spontaneous coronary artery dissection: A Western Denmark Heart Registry Study

Background : Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS) that associates with a high acute‐phase mortality rate, whereas long‐term outcome is less well described. Objective : To describe the incidence, predictors, and prognosis of SCAD. Design : Retrospective case‐identification study from the Western Denmark Heart Registry and the database of the Forensic Institute at Aarhus University from 1999 through 2007. Results : SCAD was documented in 22 of 32,869 (0.7‰) angiograms in the angiographic registry. The SCAD incidence among cases of ACS was 22 of 11,175 (2.0‰). None was seen in the forensic database. The mean age was 48.7 ± 8.9 years (range: 37–71 years). Females constituted 17 of 22 (77%) patients and all had undergone one or more pregnancies; two cases occurred in the postpartum period. The left descending artery (LAD) was the predominant site of entry. The age distribution, prevalence of the cardiovascular risk factors, presence of coronary atherosclerosis, and entry of the dissection were comparable among genders. Treatment was percutaneous coronary intervention in 13 of 22 (59%), coronary artery bypass operation in 2 of 22 (9%), and medical treatment in 7 of 22 (32%) patients. The mean follow‐up period was 3.6 ± 2.9 years. One patient suffered from recurrent SCAD; another patient died suddenly. The MACE‐ (cardiac death, nonfatal myocardial infarction, and new revascularization) free survival was 81% after 24 months. Conclusion : SCAD is a rare disease that mainly affects younger women. Compared with earlier reports, the prognosis seems to be improved by early diagnosis and interventional treatment. © 2009 Wiley‐Liss, Inc.     

Postpartum dissection of the left main coronary artery

Peripartum coronary artery dissection is rare, but it is an increasingly recognized risk to women of childbearing age. Literature reviews reveal that about 80% of the population with spontaneous coronary artery dissections (SCAD) are female, and approximately 25-33% of cases occurred while the woman was pregnant or in the peripartum phase. Most cases have presented within 2 weeks of delivery. The left anterior descending is the most commonly affected vessel. The etiology is poorly understood, but many reports suggest that SCAD occurs as a result of protease release secondary to an eosinophilic vasculitis resulting in vessel lysis. Many investigators have examined the correlation between peripartum SCAD and estrogen levels; however, case studies have shown conflicting results regarding estrogen levels as the putative causative factor. Optimal treatment remains controversial. Presently, stenting appears to be best employed in the patients who have single-vessel dissection not involving the left main coronary artery (LMCA). Surgical revascularization via coronary artery bypass graft remains the optimal therapy in patients whose dissection involves the LMCA, in patients with concurrent multivessel dissection, and in patients with disease refractory to medical management. It is important to consider coronary artery dissection in the differential of any young woman who presents with signs or symptoms consistent with acute coronary syndrome, particularly if she is peripartum. Furthermore, once suspected, it is imperative that a definitive diagnostic study, that is, coronary angiography, be completed prior to the initiation of treatment whenever possible.     

64层CT冠状动脉成像技术和冠状动脉造影对冠状动脉疾病诊断的对照研究

目的比较64层计算机断层摄影扫描冠状动脉成像技术(64-slice computed tomography coronaryangiography,64-SCTCA)和冠状动脉造影(coronary artery angiography,CAG)在冠状动脉粥样硬化性心脏病(冠心病)诊断中的价值。方法回顾性分析126例疑似冠心病的患者64-SCTCA和CAG检查资料,并对两组资料进行对比分析。结果 64-SCTCA和CAG检查结果中可用于评价的病变血管段支数比较,差异无统计学意义(P0.05)。CAG共发现≥50%狭窄节段242个,64-SCTCA共发现≥50%狭窄节段199个,两种检查方法对病变狭窄的显示情况比较,差异无统计学意义(P0.05)。全部126例冠心病患者中有91%通过64-SCTCA发现(110/121)。64-SCTCA诊断冠状动脉病变血管的敏感性、特异性、阳性预测值、阴性预测值分别为81.6%、98.8%、79.5%、99%。结论 64-SCTCA可作为冠心病无创、便捷、可靠的检查方法。     

Catastrophic left main coronary artery occlusion following diagnostic coronary angiography: Salvage by emergency left main coronary artery stenting

Acute occlusion of left main coronary artery after diagnostic angiography can be rapidly fatal. We describe two patients with left main disease that developed cardiac arrest shortly after diagnostic coronary angiography. They were both successfully treated with emergency left main stenting while cardiopulmonary resuscitation was being performed. Patients with left main disease should be carefully monitored after diagnostic angiography to allow prompt recognition of acute occlusion. Emergency stenting may be required for salvaging the patients.     

Bail-out stenting for left main coronary artery dissection during catheter-based procedure: acute and long-term results

BACKGROUND: The optimal treatment of patients with left main coronary artery (LMCA) dissection during catheter-based procedure remains uncertain. HYPOTHESIS: In cases with significant LMCA dissection occurring during catheter-based procedure, prompt stent implantation may be safe and associated with favorable clinical outcome. METHODS: We evaluated the acute and long-term results of bail-out stenting for LMCA dissection occurring during a catheter-based procedure in 10 patients. RESULTS: Initially, there was no significant stenosis of LMCA segments in these patients. Catheter-induced dissection occurred in eight patients (during diagnostic angiography in three patients and during guiding catheter manipulation in five patients). Two patients suffered dissection in the setting of stent deployment in other vessels. Therefore, bail-out stenting for LMCA dissection was performed in a total of 10 patients. In four patients, hypotension developed and an intra-aortic balloon pump was placed during the procedure. Stents were successfully deployed in all patients; there was no in-hospital mortality. Six-month angiographic follow-up was performed in eight patients. No angiographic restenosis (diameter stenosis > or = 50%) was observed in any patient at follow-up study. During a mean follow-up of 31 +/- 25 months after hospital discharge, there was no major adverse cardiac event (death, myocardial infarction, and target lesion revascularization). CONCLUSIONS: Bail-out LMCA stenting is technically feasible and showed good acute and long-term results in a small series of patients.     

颈动脉介入治疗患者行冠状动脉造影的意义分析

目的探讨接受颈动脉介入治疗的严重颈动脉狭窄（carotid artery stenosis,CAS）患者术前行冠状动脉（冠脉）造影（coronary angiography,CAG）的意义。方法连续入选2002年6月至2013年10月之间197例行颈动脉介入治疗的严重CAS患者,所有患者在行颈动脉介入治疗前常规进行CAG。据造影结果分析CAS和冠状动脉疾病（coronary artery disease．CAD）的关系。结果CAS合并CAD共155例,共患率为78．68％。不同CAS病变血管数不同冠脉狭窄程度的患者比例比较,差异无统计学意义（χ2=6．812,P=0．078）。不同CAS病变血管数不同冠脉病变血管数的患者比例比较,差异有统计学意义（χ2=11．726,P=0．008）。以分类变量CAS有无合并CAD为因变量进行多元回归的Logistic回归分析,未发现在CAS患者中发生CAD的独立危险因素。线性回归分析显示,CAS病变血管数与冠脉病变血管数正相关（r=0．328,P=0．030）。结论CAS与CAD的共患率较高,颈动脉病变血管数与冠脉病变血管数存在正相关,这对患者的整体治疗策略有重要指导意义。     

Idiopathic coronary artery dissection: a rare in vivo diagnosis

A 42-year-old white female, who had an acute myocardial infarction, developed postinfarction angina and underwent coronary angiography seven weeks after the event. Coronary angiogram demonstrated a primary dissection of the left anterior descending artery. To our knowledge this is the sixth such report of a patient with primary dissection of a coronary artery demonstrated by angiography and the fourth such patient reported to achieve and maintain asymptomatic status without operative intervention.     

冠心病心电图诊断与冠脉造影结果的对比研究

目的探讨有典型心前区疼痛和高血压史患者的心电图ST-T改变与冠状动脉造影结果的相关性。方法对80例有典型心前区疼痛史伴心电图ST-T改变,临床拟诊断冠心病患者的冠状动脉造影结果进行回顾性分析,其中男44例,女36例,年龄35～78岁。结果80例患者中冠状动脉造影阳性(冠状动脉狭窄直径≥50%)39例(48.75%),阴性41例(51.25%);冠心病组39例患者中,心电图ST-T改变29例(74.36%),非冠心病组41例患者中,心电图ST-T改变20例(48.78%)。结论临床依据心电图ST-T改变诊断冠心病应慎重。     

Spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) is a relatively rare and unexplored type of coronary disease. Although atherosclerosis, hormonal changes during pregnancy and connective tissue disorders might represent a sufficiently convincing explanation for some patients with SCAD, the many remaining cases display only a weak relationship with these causes. While on one side the clinical heterogeneity of SCAD masks a full understanding of their underlying pathophysiologic process, on the other side paucity of data and misleading presentations hamper the quick diagnosis and optimal management of this condition. A definite diagnosis of SCAD can be significantly facilitated by endovascular imaging techniques. In fact, intravascular ultrasound (IVUS) and optical coherence tomography (OCT) overcome the limitations of coronary angiography providing detailed endovascular morphologic information. In contrast, optimal treatment strategies for SCAD still represent a burning controversial question. Herein, we review the published data examining possible causes and investigating the best therapy for SCAD in different clinical scenarios.     

Coronary artery dissection secondary to coronary arteriography: Presentation of three cases and review of the literature

Three cases of coronary artery dissection secondary to coronary arteriography are presented. Two of these include autopsy material demonstrating medial degeneration in the coronary arteries, which may have predisposed these arteries to dissect The literature on catheter-induced coronary artery dissection is reviewed and an analysis is presented.     

Spontaneous coronary artery dissection and associated CT coronary angiographic findings: a case report and review

We report a case of an acute coronary syndrome in a 21-year-old male with invasive coronary angiography and computed tomography (CT) coronary angiography showing a spontaneous dissection of the left anterior descending artery. To our knowledge the CT coronary angiographic appearance of spontaneous coronary artery dissection has been reported only once before. We describe the role CT coronary angiography may have in the evaluation of coronary dissection as well as potential treatment options.     

冠状动脉造影与三种无创性检查诊断冠心病的对比分析

目的评价运动心电图试验（ＥＥＴ）、心肌灌注单光子发射计算机断层显像（ＳＰＥＣＴ）、多巴酚丁胺负荷超声心动图（ＤＳＥ）对冠心病的诊断价值。方法选择６４例冠状动脉造影（ＣＡＧ）检查的患者,并在同期内（间隔＜２周）接受ＥＥＴ、ＳＰＥＣＴ和ＤＳＥ检查。将ＣＡＧ结果分别与ＥＥＴ、ＳＰＥＣＴ和ＤＳＥ结果进行对比分析。结果这三种无创性检查诊断冠心病的敏感性分别为：７７．１％、９４．３％和９１４％;特异性分别为：７２．４％、７５．９％和８９．６％,准确性分别为：７１．９％、８５．９％和９０．６％。结论ＤＳＥ对冠心病的诊断具有较高的敏感性和特异性,且费用较低,是一种安全、有效的检查方法。