Spontaneous Dissection of Circumflex Coronary Artery in a Young Male Patient

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare but sometimes life-threatening cause of acute coronary syndrome. Patients may present with various clinical conditions ranging from angina pectoris to cardiogenic shock to sudden cardiac death. SCAD is diagnosed with coronary angiography, coronary computed tomography angiography or intravascular ultrasound. The selection of treatment strategy depends upon the clinical manifestation, location and the extent of dissection and amount of ischemic myocardium at risk. Herein, we present the case of a 33-year-old man who presented with post exercise chest pain. Diffuse spontaneous dissection of circumflex coronary artery was diagnosed with coronary computed tomography angiography instead of conventional coronary angiography due to the absence of additional risk factors, ECG changes, and cardiac enzyme abnormalities. He was treated with percutaneous coronary stenting and had a favorable clinical course and was discharged on medical therapy. Re-stenosis developed at one month later and re-stenting was performed successfully. We also provide a comprehensive review of published literature related to this clinical entity.