RESUMO
AIMS: We sought to present a series of 13 pregnancy-associated spontaneous coronary artery dissection (P-SCAD), their angiographic and multimodal imaging findings, acute phase treatment, and outcomes. METHODS AND RESULTS: Between 2005 and 2015, 13 cases of P-SCAD were collected from a database of 11 tertiary hospitals. The mean age was 33.8 ± 3.7 years; most patients had no risk factors for coronary artery disease, and the majority were multiparous. P-SCAD occurred during the puerperium in 12 patients with a median time of 10 days. Only one patient presented with P-SCAD in the 37th week of pregnancy, and she was the only patient who died in this series. Six patients (46%) presented with ST-segment elevation acute myocardial infarction (STEMI), six (46%) presented with non-STEMI, and one presented with unstable angina; one-third of women had cardiogenic shock. In 12 patients, the dissection involved the left anterior descending or circumflex artery, and it extended to the left main coronary artery in 6 patients. Intravascular ultrasound or optical coherence tomography helped to confirm diagnosis and guide treatment in 46% of cases. Seven women were managed clinically; percutaneous coronary intervention was performed in five cases, and coronary artery bypass grafting was performed in one patient. CONCLUSION: In these 13 cases of P-SCAD, clinical presentation commonly included acute myocardial infarction and cardiogenic shock. Multivessel dissections and involvement of the left coronary artery and left main coronary artery were highly prevalent. Clinicians must be aware of angiographic appearances of P-SCAD for prompt diagnosis and management in these high-risk patients.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/terapia , Imagem Multimodal/métodos , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Resultado da Gravidez , Doenças Vasculares/congênito , Adulto , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/mortalidade , Bases de Dados Factuais , Feminino , Seguimentos , Idade Gestacional , Mortalidade Hospitalar , Humanos , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/mortalidade , Período Pós-Parto , Gravidez , Complicações Cardiovasculares na Gravidez/terapia , Estudos Retrospectivos , Medição de Risco , Estudos de Amostragem , Centros de Atenção Terciária , Ultrassonografia de Intervenção/métodos , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/mortalidade , Doenças Vasculares/terapiaRESUMO
AIMS: We sought to present a series of 13 pregnancy-associated spontaneous coronary artery dissection (P-SCAD), their angiographic and multimodal imaging findings, acute phase treatment, and outcomes. METHODS AND RESULTS: Between 2005 and 2015, 13 cases of P-SCAD were collected from a database of 11 tertiary hospitals. The mean age was 33.8 ± 3.7 years; most patients had no risk factors for coronary artery disease, and the majority were multiparous. P-SCAD occurred during the puerperium in 12 patients with a median time of 10 days. Only one patient presented with P-SCAD in the 37th week of pregnancy, and she was the only patient who died in this series. Six patients (46%) presented with ST-segment elevation acute myocardial infarction (STEMI), six (46%) presented with non-STEMI, and one presented with unstable angina; one-third of women had cardiogenic shock. In 12 patients, the dissection involved the left anterior descending or circumflex artery, and it extended to the left main coronary artery in 6 patients. Intravascular ultrasound or optical coherence tomography helped to confirm diagnosis and guide treatment in 46% of cases. Seven women were managed clinically; percutaneous coronary intervention was performed in five cases, and coronary artery bypass grafting was performed in one patient...
Assuntos
Dissecação da Artéria Carótida Interna , Infarto do Miocárdio , Ultrassonografia de IntervençãoRESUMO
Coronary pseudoaneurysms are an unusual finding during coronary angiography and there are very little data on their prognosis in the literature. We report the case of a 62-year-old man admitted with an anterior myocardial infarction who developed a pseudoaneurysm in the mid left anterior descending artery some days after a type I coronary perforation during coronary angioplasty. Spontaneous closure of the pseudoaneurysm was observed during hospital follow-up. Spontaneous closure of coronary pseudoaneurysms may be more common in clinical practice than previously thought, but few cases have been reported. As the natural history of post-intervention coronary pseudoaneurysms has been little investigated, reports of their occurrence may help to clarify their evolution.
Assuntos
Falso Aneurisma , Aneurisma Coronário , Falso Aneurisma/etiologia , Aneurisma Coronário/etiologia , Vasos Coronários/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Remissão EspontâneaRESUMO
We read with great interest the case by Sengottuveluand Rajendran (1), published in the Journal regardingvascular scaffolds for spontaneous coronary arterydissection (SCAD). A SCAD is an uncommon cause ofacute myocardial infarction and has an incidence of0.1% to 1.1% of all acute coronary syndromes (2,3). Inaddition to the rarity of this condition, SCAD is alsounderdiagnosed or misdiagnosed because of the lowspatial resolution of angiography along with the lackof physician familiarity with its angiographic variants.
