2022 年 86 巻 12 号 p. 2040-
Spontaneous coronary and vertebral artery dissections (SCAD and VAD) are uncommon, but risky. They are more prevalent in pregnant and postpartum women with low atherosclerotic risks than in the average population.1 Liang et al reported only 5 patients (13%) with noncoronary artery dissections on contrast computed tomography (from neck to pelvis) among 39 SCAD patients.2
A 51-year-old-woman was referred to hospital with chest pain. She had a history of right VAD at 48 years of age (Figure A,B). Invasive coronary angiography revealed total occlusion of the distal right coronary artery (Figure C; Supplementary Movie 1), and percutaneous coronary artery intervention was successfully performed (Figure D). Preoperative intravascular ultrasound was performed and detected a thrombosed false lumen and true lumen (Figure E,F; Supplementary Movie 2). Work-up for fibromuscular dysplasia, connective tissue disease, and vasculitides was unremarkable. Her last pregnancy was almost 10 years previously.
Dissection (yellow arrows) of right vertebral artery (VA) on magnetic resonance imaging (MRI; A) and angiography (B). Total occlusion of the distal right coronary artery (RCA) on coronary angiography (C, yellow arrows), and successful percutaneous coronary artery intervention (D, white arrows). Preoperative intravascular ultrasound image (E) and schematic (F) of thrombosed false lumen and the true lumen.
To the best of our knowledge, this is the first case of an adult patient with SCAD and a history of VAD without a relationship to pregnancy.
This work was partially supported by the TSUCHIYA MEMORIAL MEDICAL FOUNDATION (grant no. J17KF00167).
Y.K. is a member of Circulation Journal’s Editorial Team.
Supplementary Movie 1. Right and left coronary arteries on invasive coronary angiography.
Supplementary Movie 2. Coronary artery dissection of the distal of right coronary artery clearly seen on intravascular ultrasound.
Please find supplementary file(s);
https://doi.org/10.1253/circj.CJ-22-0230
