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Spontaneous coronary artery dissection (SCAD) is a rare but often fatal cause of ischaemic heart disease occurring predominantly in young or middle aged, otherwise healthy subjects. Although about 250 cases of SCAD have been reported in the literature, to the best of our knowledge, spontaneous three vessel coronary dissection associated with typical effort angina has never been reported. This case illustrates coronary angiography and intravascular ultrasound images in a patient with SCAD involving all three vessels and treated by stenting.
A 57 year old man presented with exertional chest pain. His risk factors included smoking, hypertension, and hyperlipidaemia. ECG showed an abnormal Q wave in lead III and 1 mm ST depression in III, aVF. Technetium-99m sestamibi SPECT image showed a moderate fixed defect in the inferior wall and a reversible defect in the anterior wall. Selective coronary angiography revealed SCAD involving all three vessels. Right coronary angiogram showed linear dissection starting from the ostium associated with distal total occlusion (panel A). Intravascular ultrasound (IVUS) revealed prominent dissection flap with false lumen (*) (panel B). After successful angioplasty and stenting, no visible dissection flaps with full recovery of true lumen were seen (panel C). SCAD at left anterior descending artery (panels D–F) and left circumflex coronary artery (panels G–I) were also successfully treated by stenting after assessment with IVUS. Five days after intervention, the patient did not complain of chest pain and was discharged.