Internal carotid artery dissection associated with acute dengue virus infection: a case report / Dissecção da artéria carótida interna associada à infecção aguda pelo vírus da dengue: relato de caso

Cervical artery dissections (CAD) can occur spontaneously or as a direct result of significant trauma. Viral infections, such as SARS-CoV2, influenza, and Epstein Barr, are risk factors for spontaneous CAD. Dengue virus infections have dramatically increased in recent decades, and Brazil is one of the endemic areas. The dengue virus can cause headache and neurological complications such as encephalitis, myelitis, Guillain-Barré syndrome, and myositis. No report has yet been found in the literature of dissection of the internal carotid artery secondary to dengue infection. Our objective is to report the case of a patient with dissection of the internal carotid artery associated with acute dengue virus infection.

As dissecções da artéria cervical (DAC) podem ocorrer espontaneamente ou como resultado direto de trauma significativo. Infecções virais, como SARS-CoV2, influenza e Epstein Barr, são fatores de risco para DAC espontânea. As infecções pelo vírus da dengue aumentaram dramaticamente nas últimas décadas, e o Brasil é uma das áreas endêmicas. O vírus da dengue pode causar dor de cabeça e complicações neurológicas como encefalite, mielite, síndrome de Guillain-Barré e miosite. Ainda não foi encontrado na literatura nenhum relato de dissecção da artéria carótida interna secundária à infecção por dengue. Nosso objetivo é relatar o caso de um paciente com dissecção da artéria carótida interna associada à infecção aguda pelo vírus da dengue.

Research progress of treatment options on spontaneous isolated superior mesenteric artery dissection based on computed tomography imaging classification / 中华消化外科杂志

Because of the low incidence rate, spontaneous isolated superior mesenteric artery dissection (SISMAD) is once considered as a rare disease. In recent years, with the widespread application of enhanced computed tomography (CT), reports of SISMAD have increased. At present, there is no consensus on the optimal treatment of SISMAD, and there are various imaging classifica-tions based on CT. However, clinical management strategy for SISMAD according to any imaging classification based on CT has not yet been acknowledged. Foreign scholars believe that conservative treatment can improve symptoms in most SISMAD patients, while Chinese scholars prefer endo-vascular intervention. The authors review the research progress of treatment options on SISMAD based on computed tomography imaging classification.

Dissecção espontânea da artéria coronária, uma doença multifatorial: perspectivas da experiência de um centro / Spontaneous coronary artery dissection, a multifactorial disease: insights from a center experience

Introdução: Embora seja uma doença pouco conhecida, a dissecção espontânea da artéria coronária é uma causa importante e frequentemente subdiagnosticada da síndrome coronariana aguda não aterosclerótica, principalmente em mulheres. O objetivo deste estudo foi caracterizar uma amostra consecutiva de pacientes diagnosticados com dissecção espontânea da artéria coronária quanto a fatores predisponentes e desencadeadores; quadro clínico e angiográfico; abordagem terapêutica; ocorrência de eventos cardíacos adversos; recorrência e dissecção espontânea de artéria coronária de novo. Métodos: Estudo retrospectivo observacional longitudinal, unicêntrico, que incluiu pacientes diagnosticados com dissecção espontânea da artéria coronária (n=60) admitidos entre janeiro de 2010 e dezembro de 2020. Resultados: A mediana da idade foi de 55 anos, e 83% eram mulheres. A maioria dos pacientes (60%) não apresentava nenhum ou tinha apenas um fator de risco cardiovascular. O infarto agudo do miocárdio sem supradesnivelamento do segmento ST foi o quadro clínico em 67% dos casos. A artéria coronária mais frequentemente envolvida foi a descendente anterior (47%). A maioria das lesões (77%) aparecia na angiografia como dissecção espontânea da artéria coronária tipo 2. O tratamento conservador foi selecionado como abordagem inicial na maioria dos pacientes (72%). A incidência geral de dissecção espontânea da artéria coronária de novo não foi significativamente diferente entre os pacientes tratados primeiramente com revascularização, em comparação com os que receberam tratamento conservador (p=0,953). No entanto, a recidiva da dissecção espontânea da artéria coronária ocorreu no vaso originalmente envolvido em 3 dos 15 pacientes tratados com revascularização, em comparação com apenas um entre os 43 pacientes que foram tratados de forma conservadora (p<0,05). Conclusão: A dissecção espontânea da artéria coronária é mais frequente em mulheres jovens. O infarto agudo do miocárdio sem supradesnivelamento do segmento ST foi o quadro clínico mais observado, envolvendo principalmente a artéria descendente anterior. A revascularização não protegeu da recorrência.

Background: Although it is a poorly known disease, spontaneous coronary artery dissection is an important and frequently underdiagnosed cause of non-atherosclerotic acute coronary syndrome, particularly in women. The objective of this study was to characterize a consecutive sample of patients diagnosed with spontaneous coronary artery dissection with respect to predisposing and precipitating factors; clinical and angiographic presentation; management; occurrence of adverse cardiac events; recurrence; and de novo spontaneous coronary artery dissection. Methods: Longitudinal, observational, retrospective, single-centre study, including patients diagnosed with spontaneous coronary artery dissection (n=60) admitted between January 2010 and December 2020. Results: Median age was 55 years, and 83% were women. Most patients (60%) presented without any or just one cardiovascular risk factor. Non-ST-segment elevation acute myocardial infarction accounted for 67% of clinical presentations. The most frequently affected coronary artery was the left anterior descending (47%). Most lesions (77%) appeared on angiography as type 2 spontaneous coronary artery dissection. Conservative management was chosen as the initial approach in most patients (72%). The overall incidence of de novo spontaneous coronary artery dissection was not significantly different among patients initially managed with revascularization as compared to conservative treatment (p=0.953). However, spontaneous coronary artery dissection recurrence occurred in the originally involved vessel in 3 of 15 patients initially managed with revascularization, as compared to only one among 43 patients treated conservatively (p<0.05). Conclusion: Spontaneous coronary artery dissection occurs more often in young women. Non- ST-segment elevation acute myocardial infarction was the most frequent clinical presentation involving mainly the left anterior descending artery. Revascularization did not protect from recurrence.

Prevention and treatment of hepatic artery dissection in donors and recipients during liver transplantation / 器官移植

Hepatic artery reconstruction is one of the key procedures in liver transplantation. Accidental dissection of the hepatic artery to be reconstructed caused by donor and recipient factors or surgical factors will disrupt the surgical plan, increase the difficulty of arterial reconstruction, significantly prolong the operation time, increase the risk of postoperative arterial stenosis and thrombosis and probably lead to acute allograft failure, which requires emergency surgical interventions or even secondary liver transplantation. Understanding of how to avoid dissection of the artery to be anastomosed during liver transplantation and corresponding treatment will contribute to preventing the incidence of artery-related complications during liver transplantation and improving clinical prognosis of liver transplant recipients. In this article, the causes, prevention and treatment of hepatic artery dissection and hepatic artery reconstruction in donors and recipients during liver transplantation were illustrated.

Pregnancy-Associated Spontaneous Coronary Artery Dissection: A Case Report and the Lessons from Practice

@#Pregnancy-associated spontaneous coronary artery dissection (P-SCAD) is one of the fatal conditions that most commonly causes pregnancy-associated myocardial infarction. We herein report a case of P-SCAD in a 26-year-old multigravida woman, who complained of angina postpartum with raised cardiac biomarkers and transient ST-segment elevation on electrocardiograms. We emphasize the importance of a high degree of suspicion in the diagnosis of P-SCAD, together with the common presentation, the management approach, and its psychological impacts on the patients.

Pregnancy-related spontaneous coronary artery dissection after intravenous ritodrine infusion: a case report / 世界急诊医学杂志（英文）

@#Ritodrine hydrochloride (ritodrine) is a β2-adrenoceptor stimulant that has been effectively prescribed for the prevention of premature labor.[1] In clinical practice, one of the biggest drawbacks of β-mimetics is their adverse effects, including arrhythmias, myocardial ischemia, and pulmonary edema, due to their β-sympathomimetic effects.[2] Here, we report a rare pregnant case of spontaneous coronary artery dissection (SCAD) after intravenous infusion of ritodrine.

Disección espontánea de la arteria coronaria e infarto agudo de miocardio / Spontaneous coronary artery dissection and acute myocardial infarction

Resumen La disección espontánea de la arteria coronaria es una causa no aterosclerótica de infarto de miocardio, la cual es más común en mujeres jóvenes con pocos o ningún factor de riesgo cardiovascular. Es infrecuente, no se asocia a iatrogenia ni trauma, y se presenta por acumulación espontánea de sangre entre las capas de la pared arterial coronaria, por ruptura de la íntima; de ahí que genera una falsa luz que produce compresión externa del verdadero lumen arterial, con lo cual altera el flujo sanguíneo coronario y ocluye la arteria comprometida. Se expone el caso de una mujer de 31 años, sin factores de riesgo cardiovascular, quien ingresó a un servicio de urgencias con dolor torácico típico, de 2 horas de evolución. En el electrocardiograma se apreció elevación del segmento ST en las derivaciones de la cara anteroseptal e inferior, y troponina T de alta sensibilidad positiva, por lo que se realizó terapia trombolítica con tenecteplasa, sin obtener criterios de reperfusión. Se hizo angiografía coronaria, la cual mostró obstrucción total de la arteria coronaria descendente anterior en el tercio medio. El ultrasonido intravascular documentó flap de disección y hematoma en este segmento, los cuales confirmaron la disección coronaria espontánea. Se realizó angioplastia con implante de stent coronario y se restableció la circulación, observando mejoría de los síntomas.

Abstract Spontaneous coronary artery dissection is a non-atherosclerotic cause of myocardial infarction, more frequent in young women with few or no cardiovascular risk factors, it is infrequent, and it is not associated with iatrogenesis or trauma. It occurs due to spontaneous accumulation of blood between the layers of the coronary artery wall, due to rupture of the intima, generating a false lumen that produces external compression of the true arterial lumen, altering coronary blood flow, occluding the compromised artery. It is presented the case of a 31-year-old woman with no cardiovascular risk factors, who was admitted to an emergency department, with typical chest pain of 2 hours of evolution, showing ST-segment elevation in leads of anteroseptal and inferior face on the electrocardiogram and troponin T with high sensitivity positive. Therefore, thrombolytic therapy was performed with tenecteplase, without obtaining reperfusion criteria. Coronary angiography was performed that demonstrates total obstruction of the anterior descending coronary artery in the middle third. Intravascular ultrasound documents the dissection flap and hematoma in this segment that confirm spontaneous coronary dissection, performing angioplasty with implantation of a coronary stent, restoring circulation with improvement of symptoms.

Causa rara de parada cardíaca: um caso de extensa dissecção espontânea da artéria coronária esquerda / A rare cause of cardiac arrest: a case of an extensive left coronary artery spontaneous dissection

Um homem de 28 anos com história pregressa de abuso de drogas foi encaminhado para coronariografia de emergência após parada cardíaca. O eletrocardiograma pós-ressuscitação mostrou elevação do segmento ST em V1-V4. A angiografia mostrou dissecção espontânea da artéria coronária, multiarterial e em diversos segmentos. Devido à instabilidade clínica, o paciente foi submetido à intervenção coronária percutânea da artéria descendente anterior. A prevalência da dissecção espontânea da artéria coronária como causa de síndrome coronariana aguda em homens é infrequente. No entanto, nos casos suspeitos, ela deve ser excluída. A parada cardiorrespiratória é um quadro incomum na dissecção espontânea da artéria coronária, e a intervenção coronária percutânea como modalidade terapêutica ainda é uma questão em debate.

A 28-year-old male with a previous history of drug abuse was sent to an emergent coronary angiography, after a cardiac arrest, with a post-resuscitation eletrocardiogram showing ST- segment elevation from V1-V4. Angiography showed multivessel and multisegment spontaneous coronary artery dissection. Due to clinical instability, patient underwent left anterior descending artery percutaneous coronary intervention. Prevalence of spontaneous coronary artery dissection as the cause of acute coronary syndrome is anecdotal in men. Yet, in the right scenarios as in this case, it must be ruled out. Cardiorespiratory arrest is an uncommon presentation of spontaneous coronary artery dissection and percutaneous coronary intervention in spontaneous coronary artery dissection is still a matter of debate.

Analysis of influencing factors of therapeutic strategies for spontaneous isolated superior mesenteric artery dissection / 国际外科学杂志

Objective:To investigate the influencing factors and clinical effect analysis of the choice of treatment method for spontaneous isolated superior mesenteric artery dissection (SISMAD).Methods:The clinical data of 35 patients with SISMAD admitted to Beijing Friendship Hospital, Capital Medical University from December 2015 to November 2021 were retrospectively analyzed. They were divided into conservative group ( n=24) and surgical group (endoluminal stent group + open surgery group, n=11). The conservative group was treated with conservative methods, the endoluminal stent group ( n=10) was treated with endoluminal stent placement, and the open surgery group ( n=1) was treated with superior mesenteric artery endarterectomy + angioplasty + ileal resection. The white blood cell (WBC) count on admission, the time of abdominal pain, YOO classification, aorta mesenteric angle(AMA), and the length of hospital stay between the two groups were analyzed. All patients were followed up for more than 24 months, at the end of which the vascular remodeling rate of superior mesenteric artery (SMA) between the two groups was studied. In addition, the primary patency rate and secondary patency rate of intracavitary stents were analyzed. Measurement data that conform to normal distribution were expressed as mean ± standard deviation ( ± s), and independent samples t-test was used for comparison between groups; measurement data that do not conform to normal distribution were expressed as median (interquartile range) [ M( Q1,Q3)], the nonparametric test was used for comparison between groups. Enumeration data were compared between groups using the Chi-square test. Results:Univariate analysis showed that compared with the conservative group, the IVS type in YOO classificationin of surgical group was significantly more than the conservative group. There was no significant difference in WBC, duration of abdominal pain, or AMA at admission ( P>0.05). In addition, the length of hospital stay in the conservative group was significantly shorter than that in the surgical group. No intestinal necrosis occurred in endoluminal stent group. After 24 months of follow-up, the remodeling rate of SMA in the surgical group was higher than that in the conservative group; the primary patency rate of the endoluminal stent group was 87.5%, and the secondary patency rate was 100%. One patient in the conservative group developed SMA dissection aneurysm during 12 months of follow-up and received endovascular treatment. Conclusions:For the treatment of SISMAD, most patients can be cured by conservative treatment. However, for patients with consistent abdominal pain and IVS type in YOO classification, if there is no severe manifestation of peritonitis, it is recommended to perform endovascular stent placement as soon as possible to open the blood supply. Meanwhile, the SMA stenting has an ideal long-term patency rate and vascular remodeling rate.

Dissecção espontânea da artéria coronária em gestação gemelar no terceiro trimestre: relato de caso / Spontaneous coronary artery dissection in a twin pregnancy in the third trimester: a case report

O infarto agudo do miocárdio no período gravídico-puerperal é uma condição rara em que a principal causa é a dissecção espontânea da artéria coronária. É um evento comumente subdiagnosticado, com pouca literatura disponível e elevado índice de morbimortalidade. Esse relato descreve o caso de uma gestante de 36 semanas de gravidez gemelar, monocoriônica-diamniótica, com infarto agudo do miocárdio secundário à dissecção espontânea da artéria coronária. As equipes de cirurgia cardíaca e obstetrícia optaram pela realização de parto cesariano e histerectomia subtotal, seguido da revascularização da artéria mamária descendente anterior. Discutem-se as orientações adotadas na dissecção espontânea da artéria coronária, bem como a abordagem terapêutica e a conduta obstétrica, quando essa condição ocorre durante a gravidez.(AU)

Acute myocardial infarction in the pregnancy-puerperal period is a rare condition the main cause of which is the spontaneous coronary artery dissection. A commonly underdiagnosed event with little available literature and a high rate of morbidity and mortality. This case reports a 36-week pregnant woman of mono-chorionic-diamniotic pregnancy who had a myocardial infarction secondary to a spontaneous coronary artery dissection. In a joint discussion between the team of cardiac surgery and obstetrics, it was decided to perform a cesarean delivery and subtotal hysterectomy followed by revascularization of the mammary anterior descendant. It discusses the conducts to be adopted in a case of spontaneous coronary artery dissection as well as therapeutic approaches and obstetric conducts to be taken in a case of dissection during pregnancy.(AU)

The ratio of superior mesenteric artery diameter to superior mesenteric vein diameter based on non-enhanced computed tomography in the early diagnosis of spontaneous isolated superior mesenteric artery dissection / 世界急诊医学杂志（英文）

@#BACKGROUND: Spontaneous isolated superior mesenteric artery (SMA) dissection (SISMAD) is a rare cause of abdominal pain. The aim of the study is to investigate the role of a new parameter, the ratio of the SMA diameter to the superior mesenteric vein (SMV) diameter (SMA/SMV) based on non-enhanced computed tomography (CT), in the early diagnosis of SISMAD. METHODS: In a registry study from December 2013 to June 2021, 97 abdominal pain SISMAD patients (SISMAD group) admitted to our hospital were enrolled. Meanwhile, the matched sex and age abdominal pain non-SISMAD patients at 1:2 were collected in reverse chronological order as the control group. Student's t-test, Wilcoxon rank-sum test, and Chi-square test were used to compare differences between the SISMAD and control groups. MedCalc was used to generate receiver operating characteristic (ROC) curve. RESULTS: A total of 291 abdominal pain patients, including 97 SISMAD patients and 194 non-SISMAD patients, were included in the current study. The maximum SMA diameter, perivascular exudation, and SMA/SMV based on non-enhanced CT were significant between the two groups (all P<0.05). ROC curves showed that for the maximum SMA diameter, the area under the curve (AUC), cut-off, sensitivity, and specificity were 0.926, 9.80, 93.8%, and 79.4%, respectively. For SMA/SMV, its AUC, cut-off, sensitivity, and specificity were 0.956, 0.83, 88.7%, and 92.3%, respectively. The diagnostic efficiency of SMA/SMV was better than that of the maximum SMA diameter (P<0.05). The combined parameters of SMA/SMV and maximum SMA diameter had the best diagnostic efficiency (AUC=0.970). CONCLUSION: SMA/SMV may be a potential marker for SISMAD.

Ischemic stroke in a young patient with human immunodeficiency virus infection due to middle cerebral artery dissection: a case report / 中华神经科杂志

Middle cerebral artery dissection is an uncommon cause of ischemic stroke in young adults, which is extremely rare in the case that it occurs in HIV-infected patients. This article reported a 26-year-old acute cerebral infarction patient with HIV antigen/antibody-positive who started with capsular warning syndrome and progressed to right basal ganglia cerebral infarction. The high-resolution vessel wall imaging showed the characteristic findings of middle cerebral artery dissection including "double luminal" and "intimal flap" signs. The coexistence of HIV-associated vasculopathy and hypertension with high blood pressure variability contributed to the occurrence of middle cerebral artery dissection in the patient. Combined with literature reports, this paper will further explore the relationship between HIV infection and cerebrovascular disease and the possible mechanism of middle cerebral artery dissection.

Disección coronaria espontánea / Spontaneous coronary artery dissection

Resumen La disección coronaria espontánea es la separación de capas de la pared de una arteria coronaria epicárdica secundaria a hemorragia intramural, con o sin desgarro de la íntima, no asociada con aterosclerosis, traumatismo o iatrogenia. Esta enfermedad ha emergido como causa de síndrome coronario agudo e infarto agudo de miocardio en personas jóvenes, principalmente mujeres, cuya prevalencia de factores de riesgo cardiovasculares es menor en comparación con el síndrome coronario agudo por aterosclerosis. Su diagnóstico se hace con síntomas clínicos, exclusión de causas secundarias, arteriografía coronaria y a veces, con la ayuda de imágenes intra o extravasculares. En la mayoría de los casos el manejo es conservador, con algunas excepciones en donde se requiere intervención percutánea o quirúrgica. Se presenta el caso de un paciente masculino de mediana edad con disección coronaria espontánea, quien se presentó con un infarto agudo de miocardio con elevación del segmento ST.

Abstract Spontaneous coronary dissection is the separation of layers of the wall of an epicardial coronary artery secondary to intramural bleeding, with or without tear of the intima, not associated with atherosclerosis, trauma or iatrogenia. This condition has emerged as a cause of acute coronary syndrome and acute myocardial infarction in young people, occurring mainly in women, whose prevalence of cardiovascular risk factors is lower compared to acute coronary syndrome due to atherosclerosis. Diagnosis is made with clinical symptoms, exclusion of secondary causes, coronary arteriography and, in some cases, the help of intra- or extravascular images is required. In most cases the management is conservative, with some exceptions where percutaneous or surgical intervention is required. We present the case of a middle-aged male with spontaneous coronary dissection, who presents with an acute myocardial infarction with ST segment elevation.

Acidente Vascular Cerebral por dissecção carotídea bilateral pós-procedimento odontológico: relato de caso / Stroke from bilateral carotid dissection after dental procedure: case report

RESUMO: Introdução: A dissecção da artéria carótida (DAC) tem como uma das principais repercussões o Acidente Vascular Cerebral isquêmico (AVCi) em indivíduos jovens previamente saudáveis. É comum que nas DAC traumáticas, como em acidentes automobilísticos, o paciente seja submetido à investigação mais complexa com exames de imagem. Estes permitem um diagnóstico precoce e, portanto, um tratamento, reduzindo as chances de sequelas. Todavia, cau-sas não traumáticas com desfecho de DAC já foram relatadas, como as causas odontológicas. Objetivo: Contribuir para valorização diagnóstica da DAC não traumática e profilaxia de AVC subsequente. Métodos: Relatamos um caso de dissecção não aneurismática das artérias carótidas internas (ACI) pós-procedimento odontológico com desfecho de AVC bilateral em paciente de 52 anos. Resultados: Devido à forte associação de DAC a fatores traumáticos, em um primeiro contato com a paciente não foram levantadas suspeitas da ocorrência de DAC nem de AVC (ausência de déficit focal). Porém, tardiamente, foi identificada oclusão da ACI à esquerda e estenose na ACI direita, resultando em dois AVCs e incapacidade funcional severa na alta. Conclusão: O diagnóstico da DAC é um desafio, em especial por tratar-se de uma lesão de etiologia multifatorial. No entanto, seu reconhecimento precoce afetará diretamente o desfecho do paciente. Portanto, na presença de eventuais sintomas de alerta, faz-se necessário um meticuloso ques-tionamento sobre as últimas atividades do indivíduo. Este estudo alerta para a adoção de condutas profiláticas na ocorrência de fatores causais como hiperextensão cervical prolongada ou movimentos súbitos da cervical. (AU)

ABSTRACT: Introduction: Carotid artery dissection (CAD) has the ischemic stroke as one of the main repercussions in pre-viously healthy young individuals. It is common that in traumatic CAD, as in automobile accidents, the patient is subjected to a more complex investigation with imaging exams. These, allow an early diagnosis and, therefore, a treatment, reducing the chances of sequelae. However, non-traumatic causes with CAD outcomes have already been reported, such as dental causes. Objective: To contribute to the diagnostic valuation of non-traumatic CAD and subsequent stroke prophylaxis. Methods: We report a case of non-aneurysmatic dissection of the internal carotid arteries (ICA) after a dental procedure with evolution to bilateral stroke outcome in a 52-year-old patient. Results: Due to the strong association of CAD with traumatic factors, in a first contact with the patient there was no suspicion of CAD or stroke (absence of focal deficit). However, late, ICA occlusion on the left and stenosis on the right ICA were identified, resulting in two strokes and severe functional disability at discharge. Conclusion:The diagnosis of CAD is a challenge, especially since it is a multifactorial lesion. However, its early recognition will directly affect the patient's outcome. Therefore, in the presence of any warning symptoms, meticulous questioning about the individual's latest activities is necessary. This study alerts to the adoption of prophylactic conducts in the occurrence of causal factors such as prolonged cervical hyperextension or sudden movements of the cervical. (AU)

Traumatic Dissection of Arterial Cervical Vessels: Report of Two Cases and Literature Review

Even though traumatic dissection of cervical arterial vessels is themajor cause of stroke among adults, it is still an underdiagnosed disease in neurosurgical emergencies, since most patients do not have or present subtle clinical signs in the acute phase. The authors report two interesting cases of cervical artery dissection with different traumatic mechanisms and present a broad literature review about this subject.

Caracterización clínica e imagenológica de una serie de pacientes con disección de arterias cervicales e intracraneales / Cervicocranial arterial dissection: experience in 57 patients

Background: Cervicocranial arterial dissection (CIAD) is an important cause of stroke. Aim: To describe the clinical and imaging characteristics of patients with CIAD. Material and Methods: An anonymous registry was made including all patients admitted to a private hospital with a diagnosis of CIAD. Patients were subdivided as having an anterior or posterior circulation dissection (ACD or PCD, respectively). Results: Fifty-seven patients aged 40 ± 8 years (60% women) were included in the study, 39 with PCD and 18 with ACD. Cervical pain was the most common symptom. CIAD was diagnosed with no clinical or imaging signs of stroke in 49% of patients. Fifty one percent of patients had focal neurological deficits and 72% had a NIH stroke score below five. No significant differences between patients with ACD or PCD were found. Fifty patients received antiplatelet therapy (simple or dual), seven patients were anticoagulated and 13 were subjected to stenting due to progression of stenosis with hemodynamic involvement or bilateral dissection with scarce collaterals. The lesion was located in V3 segment in 27 patients and cervical segment of the internal carotid in 16 cases. A favorable Modified Rankin Scale (0-2) was achieved in 85.9%, with a trend towards achieving better functional prognosis in PCD. Conclusions: Due to the greater availability of non-invasive imaging methods, 50% of these patients with CIAD did not have a stroke. Thus, an earlier and more timely management is feasible.

Infarto agudo al miocardio secundario a disección coronaria espontánea biarterial: reporte de un caso y revisión de literatura / Acute myocardial infarction due to spontaneous two vessel coronary artery dissection

Resumen: La disección coronaria espontánea ha surgido como una causa interesante y poco reconocida de síndrome coronario agudo no aterosclerótico. Ocurre más frecuentemente en mujeres jóvenes, donde de forma importante puede asociarse a anomalías arteriales no coronarias. La clave para un tratamiento oportuno es el diagnóstico precoz que impida su evolución a cuadros más severos. Se presenta el caso de una mujer de 36 años con un síndrome coronario agudo secundario a una disección coronaria espontánea bi-arterial que evolucionó de forma grave a una insuficiencia cardíaca aguda. El objetivo es informar un cuadro poco usual y proporcionar evidencia que respalde el cómo debe enfrentarse.

Abstract: Spontaneous coronary dissection is an important cause of acute non-atherosclerotic coronary syndrome. It occurs more frequently in young women, often without significantly associated coronary arterial anomalies. Early diagnosis is a key to prompt treatment, in order to prevent severe complications. We report the case of a 36-year-old woman with an acute coronary syndrome secondary to spontaneous bi-arterial coronary dissection progressing to severe acute heart failure. A discussion of the management of this condition is included.

Disección coronaria espontánea en paciente trasplantada de corazón / Spontaneous coronary artery dissection in a heart transplant patient: report of one case

Spontaneous coronary artery dissection is an uncommon cause of acute coronary syndrome that predominantly affects women without cardiovascular risk factors. In transplant patients, spontaneous coronary artery dissection is an extremely rare condition, having been described in only three patients, in whom vascular damage secondary to the use of anticalcineurinics is postulated as a probable mechanism. We report a spontaneous coronary dissection in a female who received a heart transplant at 34 years of age. The diagnosis was made in a follow-up coronary angiography three years after transplantation, supplemented with optical coherence tomography. A percutaneous coronary revascularization of the involved artery was performed, with good immediate results and at one year of follow-up.

Simultaneous endovascular revascularization of external iliac artery dissection and transplant renal artery stenosis in a recent renal allograft recipient / Revascularização endovascular simultânea de dissecção da artéria ilíaca externa e de estenose da artéria renal transplantada em receptor recente de aloenxerto renal

Abstract Various vascular complications following renal transplantation include renal artery and vein thrombosis, renal artery stenosis, pseudoaneurysm, and iliac artery dissection. Transplant renal artery stenosis (TRAS) is the most common, while iliac artery dissection is the rarest of these various vascular complications. We describe an elderly male, who had both external iliac artery dissection and TRAS at 2 months following renal transplantation. He underwent successful percutaneous endovascular intervention of both complications. The post-intervention course was uneventful, with improvement in graft renal functions and left lower limb perfusion.

Resumo As diversas complicações vasculares possíveis após um transplante renal incluem trombose da veia e artéria renais, estenose da artéria renal, pseudoaneurisma e dissecção da artéria ilíaca. Entre essas diversas complicações, a estenose da artéria renal transplantada é a mais comum, enquanto a dissecção da artéria ilíaca é a mais rara. Relatamos o caso de um homem idoso que desenvolveu tanto dissecção da artéria ilíaca quanto estenose da artéria renal transplantada 2 meses após transplante renal. As intervenções endovasculares percutâneas foram bem-sucedidas em ambas as complicações. O período pós-intervenção cursou sem complicações, com melhora na função renal do enxerto e na perfusão do membro inferior esquerdo.

Presentation of cerebral and cervical arterial dissections in Botucatu, Brazil: case series / Apresentação de dissecções arteriais cerebrais e cervicais em Botucatu, Brasil: uma série de casos

Abstract Spontaneous dissection of the cervical and cerebral arteries is an important cause of stroke and disability in young patients. In this report, the authors present a case series of patients with spontaneous carotid, vertebral, or cerebral artery dissection who underwent digital angiography. A review of the published literature on this subject is also presented.

Resumo A dissecção espontânea das artérias cervicais e cerebrais é uma causa importante de acidente vascular cerebral e incapacidade em pacientes jovens. Neste relato, é apresentada uma série de casos de pacientes com dissecção espontânea da artéria carótida, vertebral ou cerebral submetidos à angiografia digital. Além disso, é fornecida uma revisão da literatura sobre esse assunto.