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Mentions: A 59-year-old woman was admitted to the emergency room of a local hospital with the sudden onset of severe chest pain radiating to her back. She had a history of hypertension and a cerebrovascular accident. At the time of presentation, she had a drowsy mental status. The cardiac enzymes were elevated on baseline laboratory testing. A chest film showed mediastinal widening (Fig. 1). The initial electrocardiogram (ECG) showed a normal sinus rhythm without significant ST-T changes (Fig. 2). An emergent chest CT scan was performed under the suspicion of an acute aortic dissection, which showed an acute Stanford type A aortic dissection (Fig. 3). The patient was then transferred to our institution for repair of the aortic dissection. She was hemodynamically unstable.
A Case of Coronary Artery Dissection After Aortic Replacement in Acute Type A Aortic Dissection
Bottom Line: Percutaneous coronary intervention (PCI) was performed with placement of stents in the left anterior descending artery (LAD) and left circumflex artery.Repeat balloon angioplasty was performed at the site of the ISR.A follow-up coronary angiogram 8-months after the PCI showed no evidence of ISR.
Affiliation: Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
A 59-year-old woman was transferred to our institution with a diagnosis of acute type A aortic dissection. During aortic replacement surgery, the dissection had not extended to the orifice of the left coronary artery. However, ST segment elevation was observed on an electrocardiogram monitor immediately postoperatively. An emergent coronary angiogram showed almost complete collapse of the lumen of the left coronary artery due to pulsatile compression of the false lumen, which was caused by extension of the aortic dissection. Percutaneous coronary intervention (PCI) was performed with placement of stents in the left anterior descending artery (LAD) and left circumflex artery. Coronary angiography and intravascular ultrasound performed 45-days after PCI showed significant instent restenosis (ISR) at the proximal portion of the LAD and residual coronary artery dissection of the diagonal branch. Repeat balloon angioplasty was performed at the site of the ISR. A follow-up coronary angiogram 8-months after the PCI showed no evidence of ISR.