Spontaneous Coronary Artery Dissection: A Challenge for an Interventional Cardiologist

Abstract

Background: Spontaneous Coronary Artery Dissection (SCAD) is a rare cause of acute coronary syndrome primarily affecting younger women, distinct from traditional coronary artery disease as it is not associated with atherosclerosis or conventional risk factors. Its etiology is multifactorial, encompassing hormonal, genetic, and mechanical factors. Timely diagnosis and intervention are critical due to the risk of severe complications, including cardiac arrest.

Case Presentation: A 32-year-old female with an unremarkable medical history, who had given birth 24 months prior, presented with a sudden choking sensation in the neck, chest heaviness, and diaphoresis while at work, followed by sudden cardiac arrest. Cardiopulmonary resuscitation (CPR) was initiated promptly, achieving return of spontaneous circulation within two minutes. Post-resuscitation electrocardiogram (ECG) revealed extensive anterior wall myocardial infarction (MI). Coronary angiography confirmed a type 2 SCAD in the mid-left anterior descending artery (LAD).

Results: Due to hemodynamic instability, the patient underwent percutaneous coronary intervention (PCI) with drug-eluting stent (DES) placement, successfully restoring TIMI III flow in the affected artery. The patient’s recovery was smooth, and follow-up echocardiogram at three months demonstrated normalization of left ventricular function, indicating a positive response to the intervention.

Conclusion: This case highlights the critical importance of early recognition and intervention in SCAD, especially in hemodynamically unstable patients, to facilitate favorable outcomes.