Early Healing of Spontaneous Coronary Artery Dissection Confirmed by Optical Coherence Tomography

J INVASIVE CARDIOL 2023;35(3):E154-E155.

Key words: coronary imaging, optical coherence tomography, spontaneous coronary artery dissection

A 52-year-old male with current smoking and hypertension was admitted to our hospital because of inferior ST-segment-elevation myocardial infarction. Emergent coronary angiogram (CAG) showed the total occlusion at the proximal site of the right coronary artery (RCA). Intravascular ultrasound (IVUS) revealed false lumen and intramural hematoma, and intimal tear at the proximal site of RCA (Figures 1A-1C, Video Series), and we then diagnosed the spontaneous coronary artery dissection (SCAD). Thrombolysis in Myocardial Infarction (TIMI) 3 flow was temporarily obtained after plain old balloon angioplasty (POBA) using a 2.0-mm balloon; however, the coronary flow immediately deteriorated (Figure 1D). A drug-eluting stent (DES) was implanted over the intimal tear at the proximal site of the RCA (Figures 1E), because after repeated POBA, the coronary flow did not improve and TIMI flow was 1 with continuous chest pain. IVUS after stent implantation showed the residual intramural hematoma and false lumen at the distal segment of the stenting site (Figures 1F, 1G), and TIMI 3 flow was obtained after DES implantation (Figure 1H). Twenty-eight days later, OCT demonstrated completely healed SCAD (Figures 1I to 1K; Video Series) with TIMI 3 flow (Figure 1L).

OCT can visualize the 3-layered construction of the vessel wall, and accurately diagnose SCAD. This is the first presentation for an early healing of acute SCAD confirmed by OCT, and might help for the management of acute SCAD.

Affiliations and Disclosures

From the ¹Department of Cardiovascular Medicine, Shingu Municipal Medical Center, Shingu, Japan; and ²Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential

Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Acknowledgment: We thank Keisuke Satogami and Hironori Kitabata for their comments on this manuscript.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted June 23, 2022.

Address for correspondence: Yuichi Ozaki, MD, PhD, Department of Cardiovascular Medicine, Shingu Municipal Medical Center, 18-7 Hachibuse, Shingu, 647-0072, Japan. Email: you1mail0412@gmail.com