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Background: Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction. Acute myocardial infarction due to coronary artery dissection after blunt chest trauma is rare and may be life threatening. Differential diagnosis of acute myocardial infarction from cardiac contusion at this setting is not easy.Case Presentation: Here we demonstrated a case of blunt chest trauma, with computed tomography detected myocardium enhancement defect early at emergency department. Under the impression of acute myocardial infarction, emergent coronary angiography revealed left anterior descending artery occlusion. Revascularization was performed and coronary artery dissection was found after thrombus aspiration. Finally, the patient survived after coronary stenting.Conclusion: Perfusion defects of myocardium enhancement on CT after blunt chest trauma can be very helpful to suggest myocardial infarction and facilitate the decision making of emergent procedure. This valuable sign should not be missed during the initial interpretation. [ABSTRACT FROM AUTHOR]

ImportanceAutosomal dominant polycystic kidney disease (ADPKD) has been associated with cardiovascular abnormalities such as intracranial and aortic aneurysms.ObjectiveTo systematically review the case reports and case series of ADPKD patients with coronary artery dissection or aneurysm.Evidence reviewSystematic review registration number: CRD42015015723. Data sources: MEDLINE, Web of Science and OpenGrey, reference lists of studies. Study selection: Published case reports and case series. Data extraction: Two parties analyzed the studies. Disagreements were solved by consensus or by a third party. Funding: none.FindingsThe reports of 23 patients (22 from 17 studies – six with coronary artery dissection and 16 with coronary artery aneurysm – and one with coronary dissection) were analyzed and reported here. Most patients were symptomatic. Coronary dissection showed female and left descending anterior artery predominance, features similar to non-ADPKD patients, but a median diagnostic age below expected (41 vs. 50 years old). Coronary aneurysms had male and right coronary artery predominance but lower median diagnostic age (44 years old) and higher rate of multiple vessel affection than reported for non-ADPKD patients.Conclusion and relevanceClinical disparities may suggest a different mechanism of aneurysm formation compared to the population without ADPKD. Nevertheless, lack of access to data of one patient and text of one article limited our conclusions. Coronary aneurysms and dissections represent a source of coronary syndromes and death in ADPKD. Mutation of ADPKD-related genes may predispose to coronary abnormalities, especially aneurysms. Further analysis regarding this association is necessary. [ABSTRACT FROM AUTHOR]

We present a case of a 46-year-old woman who presented to the emergency room after a syncopal episode. Most of her initial workup did not lead to any diagnosis. However, the transthoracic echocardiogram showed new onset left ventricular dysfunction. Further, cardiac evaluation showed a chronic coronary artery dissection in the proximal left anterior descending artery. Syncope was related to vasovagal event but rapid plasma reagin being positive led to the question of whether the coronary artery dissection was secondary to vasculitic manifestation of prior syphilis infection. More research is needed to answer this question and to find such an association. < Learning objective: Spontaneous coronary artery dissection (SCAD) is a rare disease of young adults that can present acutely as an acute coronary syndrome (ACS) with chest pain, as malignant ventricular arrhythmia, and even as sudden cardiac death. Our report is focused on evaluation and management of SCAD, more importantly to consider SCAD as a differential diagnosis in ACS in young patients, especially females. Our review also stresses the need for further research toward development of consensus on management of such patients.> [ABSTRACT FROM AUTHOR]

Introduction: Spontaneous coronary artery dissection (SCAD) represents 1-4% of all acute coronary syndromes (ACS), and is a particularly important cause among young women and individuals with few cardiovascular risk factors., Objectives: To characterize clinical background, therapeutic management and clinical outcomes in a SCAD population., Methods: We retrospectively analyzed all consecutive patients diagnosed with SCAD at a tertiary center between August 2009 and May 2020, with a median follow-up of 40 months (IQR 14-95 months). SCAD was classified according to the Saw angiographic SCAD classification., Results: A total of 36 patients were included, 94% female, mean age 51 years (±11 years). A trigger was only detected in 8% and associated conditions in 31% of patients, mainly inflammatory or autoimmune systemic diseases and migraine. Most patients had non-ST-elevation ACS and 33% presented with ST-elevation ACS. The most frequent culprit lesion was the left anterior descending (LAD) artery (67%); mid to distal segments were the most affected (94%) and type 2 dissection the most prevalent (60%). Almost all patients were successfully medically managed, with only four undergoing percutaneous intervention. During follow-up, ischemic events recurred in 15% of patients and no patient died. Patients with type 2 dissection exhibited lower risk of recurrence compared to type 1 (p=0.049, OR=0.13)., Conclusion: SCAD patients were mainly young or middle-aged women; the LAD artery was the most affected vessel and type 2 dissection the most prevalent. This report showed for the first time a correlation between type 2 SCAD and lower risk of recurrence., (Copyright © 2023 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives The authors sought to understand the clinical and angiographic outcomes of dissections left after drug-coated balloon (DCB) angioplasty. Background Second-generation DCB may be an alternative to stents in selected populations for the treatment of native coronary lesions. However, the use of these devices may be hampered by a certain risk of acute vessel recoil or residual coronary dissection. Moreover, stenting after DCB has shown limited efficacy. Little is known about when a non–flow-limiting dissection is left after DCB angioplasty. Methods This was a prospective observational study whose aim was to investigate the outcome of a consecutive series of patients with native coronary artery disease treated with second-generation DCB and residual coronary dissection at 2 Italian centers. We evaluated patient clinical conditions at 1 and 9 months, and angiographic follow up was undertaken at 6 months. Results Between July 2012 and July 2014, 156 patients were treated with DCB for native coronary artery disease. Fifty-two patients had a final dissection, 4 of which underwent prosthesis implantation and 48 were left untreated and underwent angiographic follow-up after 201 days (interquartile range: 161 to 250 days). The dissections were all type A to C, and none determined an impaired distal flow. Complete vessel healing at angiography was observed in 45 patients (93.8%), whereas 3 patients had persistent but uncomplicated dissections, and 3 had binary restenosis (6.2%). Late lumen loss was 0.14 mm (−0.14 to 0.42). Major adverse cardiovascular events occurred in 11 patients in the entire cohort and in 4 of the dissection cohort (7.2% vs. 8.1%; p = 0.48). We observed 8 and 3 target lesion revascularizations, respectively (5.3% vs. 6.2%; p = 0.37). Conclusions In this cohort of consecutive patients treated with new-generation DCB and left with a final dissection, this strategy of revascularization seemed associated with the sealing of most of dissections and without significant neointimal hyperplasia. [ABSTRACT FROM AUTHOR]

Chest trauma has a high rate of mortality. Coronary dissection causing myocardial infarction (MI) following blunt chest trauma is rare. We describe the case of an anterior MI following blunt chest trauma. A 39-year-old male was received in our hospital following a motorcycle accident. The patient was asymptomatic before the accident. The patient underwent craniotomy for evacuation of hematoma. He developed severe chest pain and an electrocardiogram (ECG) revealed anterior ST segment elevation following surgery. Acute coronary event was medically managed; subsequently, coronary angiogram was performed that showed dissection in the left anterior coronary artery, which was stented.

Spontaneous coronary artery dissection (SCAD) is non-iatrogenic longitudinal separation of the coronary arterial walls, generating true and false lumens. Although it wasknownas a disease of the young females without cardiovascular risk factors, recent evidences have revealed that SCAD can also be seen in older patients having traditional risk factors for ather-osclerosis. In this report, we present a 50-year-old female patient with theSCADof left anterior descending artery (LAD) leading to anteriormyocardial infarction, ten days previously and persisting angina. She was successfully treated using intravascular ultrasound (IVUS) by stenting dissected segment. She has done well since then, and stent patency was demonstrated with coronary computed angiography (CTA) at the fifth-year follow up.

Cardiac rupture (CR) is one of the most serious and life-threatening complications of blunt chest trauma (BCT) usually associated with high mortality. Moreover, its diagnosis and treatment strategies may be extremely challenging for clinicians due to various anatomical localisations of the tear. Whereas most injuries fall under the category of right atrial ruptures, left ventricular lesions represent a rare type of this injury, with greater mortality, particularly in cases of multi-chamber injuries. However, not only cardiac chamber or great vessel ruptures may occur as a result of BCT; a growing number of reports also describe BCT-induced isolated coronary artery injuries, including ruptures. Whereas CR requires immediate surgical treatment, less invasive interventional techniques, such as stent placement and closure with fibrin glue or coils, can be the treatment of choice in selected cases of hemodynamically less relevant coronary artery ruptures. In this report, we present a rare case of a ventricular rupture following BCT, with the tear localized in the right ventricular wall and an occult connection to the left ventricle without ventricular septum injury. Also, another contemporaneous emergency in our department that had to be managed at the same time resulted in challenging the decision-making process. As such an emergency constellation is difficult to manage, this report may help clinicians in difficult situations in terms of diagnosis and choosing the right treatment strategy. [ABSTRACT FROM AUTHOR]

Spontaneous coronary artery dissection is a rare cause of myocardial infarction predominantly associated with young women during the third trimester of pregnancy or during the postpartum period. Multivessel spontaneous coronary artery dissection is an even less frequent condition with limited reports in medical literature. Hormonal changes as well as hemodymanic stress are some of the factors that have been implicated in the etiology of this condition. However, the exact pathophysiological process leading to spontaneous coronary artery dissection has not yet been elucidated. The spectrum of clinical presentation ranges from mild symptoms to cardiac arrest. Herein, we report the case of a 39-year-old woman with spontaneous two coronary vessel dissection during her postpartum period presented with ST elevation myocardial infarction on electrocardiogram complicated with pulmonary edema and cardiorespiratory arrest. [ABSTRACT FROM AUTHOR]

Background: Spontaneous coronary artery dissection (SCAD) is often treated conservatively due to revascularization risks. Yet, an important number of SCAD patients have high acuity characteristics necessitating revascularization, with uncertain long-term outcomes., Objectives: Document revascularization utilization and long-term outcomes in high acuity SCAD., Methods: Prospective/retrospective analysis of consecutive patients with acute myocardial infarction (AMI) due to first SCAD event presenting directly to the Minneapolis Heart Institute 2002-2021, median follow-up 3.8 years., Results: Among 139 patients (age 49 ± 12 years, 96% female), revascularization was performed in 60 (43%), utilizing percutaneous coronary intervention (PCI) (n = 56, successful in 80%) or coronary artery bypass graft (n = 4). In the entire cohort, 90 (65%) unique patients had one or more high acuity characteristic: ST-elevation (38%), proximal dissection (38%), cardiogenic shock (6.5%), cardiac arrest (9.4%), left main dissection (6.5%), peripartum dissection (7.2%). High acuity patients accounted for 51 of 60 (85%) revascularizations. Revascularization rates were: ST-elevation (60%), proximal dissection (62%), cardiogenic shock (89%), cardiac arrest (62%), left main dissection (100%), peripartum dissection (70%). Survival was 97% (revascularized) vs 100% (nonrevascularized); p = 0.2. Adverse outcomes (revascularized vs. nonrevascularized) included recurrent AMI:16.7% versus 8.9%; p = 0.2, SCAD recurrence: 13.3% versus 6.3%; p = 0.1, stroke: 5% versus 2.5%; p = 0.44, implantable cardioverter-defibrillator: 6.7% versus 6.3%; p > 0.9. Reintervention was necessary in 21% of PCI-treated patients., Conclusions: High-acuity characteristics were present in nearly two-thirds of this SCAD cohort; the vast majority of revascularizations were performed in high-acuity patients. Despite high acuity, long-term survival was favorable in revascularized patients., (© 2022 Wiley Periodicals LLC.)

Introduction Atherosclerosis is the most common cause of coronary affections, but coronary dissection is certainly more insidious. This is the separation of the media apart from the other layers of the vessel wall, with or without intimal tear. Spontaneous coronary dissection is a rare event, especially in young men: only 150 cases were reported till 1986 and over 300 till date. The main consequence is an acute coronary occlusion with myocardial infarction and sudden death.Case report We report the case of a 28-year-old man, presented with a mild symptomatic spontaneous coronary dissection, consisting of a strange weakness, remained undetected until fortuitous medical analyses suggested the opportunity of further investigations. A clinical examination and an EKG showed the opportunity to perform a bidimensional echocardiogram at first, a low-dose dobutamine stress echocardiogram, then a regional myocardial perfusion and a non-invasive coronary flow reserve assessment. The patient has been properly and quickly screened and is now enlisted for cardiac transplantation.Conclusions In such cases the immediate identification and treatment of the affection can be crucial. In our experience the basic and advanced echocardiography allowed a sooner diagnosis than the usual proceeding based on coronarographic examination.

Abstract: Spontaneous coronary artery dissection is a rare cause of myocardial infarction in young, otherwise healthy people. We present a case report of a 37-year-old woman, without cardiovascular risk factors, who survived a major acute myocardial infarction due to multi-vessel spontaneous coronary artery dissection which was complicated by cardiogenic shock in the third week postpartum. She fully recovered with medical therapy in combination with angioplasty. [Copyright &y& Elsevier]

Coronary artery dissection is a well-known albeit unusual complication of blunt chest trauma. It is also an uncommon cause of myocardial infarction. Only a few such cases have been reported, probably due to the high rate of sudden death. We report a case of left anterior descending (LAD) coronary artery dissection in a healthy 38-year-old female caused by blunt chest trauma. The patient was referred to our hospital with a complaint of chest pain. Electrocardiography showed T-wave inversion, echocardiography a revealed circumferential pericardial effusion, and the coronary angiogram demonstrated a thrombotic dissection of the LAD. Troponin I was the only biomarker with elevated level. CT coronary angiography was performed using the subtotal occlusion of the LAD and illustrated a relatively good LAD run-off, and thallium scintigraphy displayed viable myocardium in this territory. Despite the total occlusion of the LAD in our case, myocardial injury was not significant due to the relatively good LAD run-off. She underwent coronary artery bypass graft surgery with an excellent result. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to investigate the frequency, predictors, and detailed qualitative and quantitative assessment of optical coherence tomography (OCT)-detected stent edge dissections. Its impact on subsequent management and clinical outcomes were also investigated. Background: OCT is a high-resolution imaging modality that can lead to more frequent recognition and accurate assessment of vascular injuries during percutaneous coronary intervention (PCI). Methods: From September 2010 to June 2011, all patients with OCT post-PCI were enrolled. Edge dissections were defined as disruptions of the arterial lumen surface in both the 5-mm distal and proximal stent edges. Qualitative and quantitative analyses of all edges were performed at 0.2-mm intervals. Results: In total, 395 edges (249 lesions in 230 patients) were analyzed. The overall incidence of OCT-detected edge dissection was 37.8%, and most (84%) were not apparent on angiography. Independent predictors for OCT-detected dissections were presence of atherosclerotic plaque at stent edges, calcification angle, minimum fibrous cap thickness, thin-cap fibroatheromas, stent/lumen eccentricity, and vessel overstretching. Mean dissection length measured 2.04 ± 1.60 mm, 96.2% appeared as flaps, and 52.8% extended beyond the intima/atheroma layer. Additional stenting was performed in 22.6% of all dissections, which were longer, had bigger dimensions, and promoted deeper vascular injury. The 12-month major adverse cardiac event rate was similar between patients with (7.95%) and without (5.69%, p = 0.581) dissections. Conclusions: High rates of stent edge dissections were detected by OCT, usually related to the presence of atherosclerosis at stent edges and to PCI technique. Detailed OCT assessment of dissection severity was possible and affected the subsequent management of this complication. Non–flow-limiting, small, and superficial dissections left untreated proved benign. [Copyright &y& Elsevier]

Abstract: An acute coronary ischemic insult may “cause” prolonged post-ischemic myocardial stunning. In spite of being a major stress factor, acute coronary syndrome is regarded as an exclusion criterion for takotsubo syndrome. We describe the case of a 39-year-old female patient presented with anterior ST-elevation myocardial infarction. Emergency coronary angiography revealed spontaneous coronary artery dissection confirmed with intravascular ultrasound examination. The patient developed clinical, angiographic and cardiac image features consistent with both post-ischemic myocardial stunning and takotsubo syndrome. Complete healing of the coronary dissection occurred with conservative treatment. There was also resolution of the greatest part of the left ventricular dysfunction. The findings in the present case indicate that the post-ischemic myocardial stunning and takotsubo syndrome are two different names for the same clinical condition and that the acute coronary syndrome triggers rather than excludes takotsubo syndrome. [Copyright &y& Elsevier]

Despite the reserve for recovery in pediatric trauma, blunt force chest trauma can cause insidious injuries that are easy to miss. Coronary artery dissection is a rare injury associated with blunt force chest trauma in the pediatric population and can present with vague or atypical symptoms. Pediatric patients can be unreliable in reporting symptoms, and providers can mistake coronary artery injuries for myocardial contusion, especially with improving laboratory tests and equivocal imaging. We report a case showing the importance of a high index of suspicion when presented with this trauma pattern in a pediatric patient., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Okeke et al.)

Objectives: We sought to evaluate the prevalence of fibromuscular dysplasia (FMD) and other predisposing conditions among spontaneous coronary artery dissection (SCAD) patients. Background: Spontaneous coronary artery dissection is considered rare. However, we observed many young women with SCAD and concomitant FMD. Methods: Spontaneous coronary artery dissection patients were identified prospectively and retrospectively at Vancouver General Hospital over the past 6 years. Coronary angiograms were meticulously reviewed by 2 senior interventional cardiologists. Identified patients were contacted for prospective evaluation at our SCAD clinic, and screening for FMD of renal, iliac, and cerebrovascular arteries was performed with computed tomography angiography or magnetic resonance angiography, if not already screened during the index angiogram. Potential predisposing and precipitating conditions for SCAD were extracted from clinical history. Results: We identified 50 patients with nonatherosclerotic SCAD from April 2006 to March 2012. Average age was 51.0 years, and almost all were women (98.0%). All presented with myocardial infarction (MI), 30.0% had ST-segment elevation, and 70.0% had non–ST-segment elevation MI. Only 1 was postpartum, and 2 were involved in intense isometric exercises. Emotional stress was reported in 26.0% before the MI. Twelve percent had >1 dissected coronary artery. Most SCAD patients had FMD of ≥1 noncoronary territory (86.0%): 25 of 43 (58.1%) renal, 21 of 43 (48.8%) iliac, and 20 of 43 (46.5%) cerebrovascular (6 of 43, 14.0% had intracranial aneurysm). Five had incomplete FMD screening. Conclusions: Nonatherosclerotic SCAD predominantly affects women, and most have concomitant FMD. We suspect these patients have underlying coronary FMD that predisposed them to SCAD, but this requires proof from histology or intracoronary imaging of the affected coronary arteries. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Atherosclerosis is the most common cause of coronary affections, but coronary dissection is certainly more insidious. This is the separation of the media apart from the other layers of the vessel wall, with or without intimal tear. Spontaneous coronary dissection is a rare event, especially in young men: only 150 cases were reported till 1986 and over 300 till date. The main consequence is an acute coronary occlusion with myocardial infarction and sudden death. Case report: We report the case of a 28-year-old man, presented with a mild symptomatic spontaneous coronary dissection, consisting of a strange weakness, remained undetected until fortuitous medical analyses suggested the opportunity of further investigations. A clinical examination and an EKG showed the opportunity to perform a bidimensional echocardiogram at first, a low-dose dobutamine stress echocardiogram, then a regional myocardial perfusion and a non-invasive coronary flow reserve assessment. The patient has been properly and quickly screened and is now enlisted for cardiac transplantation. Conclusions: In such cases the immediate identification and treatment of the affection can be crucial. In our experience the basic and advanced echocardiography allowed a sooner diagnosis than the usual proceeding based on coronarographic examination. [Copyright &y& Elsevier]

Coronary artery dissection is a rare, sometimes fatal traumatic condition, with 80% of cases affecting women. The coronary artery develops a tear, causing blood to flow between the layers, which force them apart. We describe the case of a 35-year-old multiparous woman with acute myocardial infarction secondary to right coronary artery dissection at 32 weeks' gestation. The patient underwent successful primary per- cutaneous coronary intervention with the placement of 4 coronary stents. She subsequently experienced preterm labor and preeclampsia 11 days following the procedure. Elective cesarean delivery under general anesthesia was performed uneventfully at 35 weeks' gestation. [ABSTRACT FROM AUTHOR]

Spontaneous coronary dissection of a coronary artery is a rare cause of acute coronary syndrome. Optimal treatment has not yet been established. We describe a woman with spontaneous dissection of the left anterior descending artery who presented transitory angina and electrocardiographic ST segment elevation in precordial leads. Conservative treatment was carried out. The angina and electrocardiographic changes recurred 3 days later. An intravascular vascular ultrasound was performed and the patient was stabilized following stenting. Stress testing was negative at 6-month follow-up and she remained asymptomatic at 18 months. We discuss the usefulness of an intravascular ultrasound study to establish the therapeutic strategy. [ABSTRACT FROM AUTHOR]

Abstract: Purpose of the study: Extensive coronary dissection is a rare complication of intraluminal angioplasty. We report a retrospective study of 19 patients who consulted in a general hospital without cardiac surgery. Patients and methods: After consulting our coronarography and angioplasty database, we included the extensive coronary dissections (type D, E and F) in our study. The medical files of the selected patients were analysed. Results: Between January 2003 and March 2010, 19 coronary angioplasty (total: 2542) were complicated with extensive dissections (incidence 0,75%). For 62,3% of the patients, the dissection was related to the guiding catheter. Eleven patients had type A and B1 lesions. The dissections affected the right coronary artery for 16 patients, the left anterior descending coronary artery for two patients and the left main coronary artery for one patient. After angioplasty, a final TIMI flow 3 was obtained for only 11 patients. In nine cases, we observed a limited extension to the aorta that did not need a chirurgical intervention and had no influence on the prognosis. The complications were common, such as death (n =1), coronary bypass (n =2), myocardial infarction (n =8), cardiogenic shock (n =2) and circulatory assistance (n =2). Conclusion: Extensive coronary dissection is a rare complication of angioplasty. The right coronary is the most frequent vessel concerned and an extension to aorta is usual. The treatment is usually based on sealing the entry with a coronary stent. The complications are common and serious and we did not find any predicting factors to extensive coronary dissections that are unpredictable. [Copyright &y& Elsevier]