Spontaneous coronary artery dissection by intravascular ultrasound in a patient with myocardial infarction
A 40-year-old male was admitted to our hospital because of frequent chest pain. The patient had experienced severe squeezing chest pain 3 months previously, and he had developed frequent chest discomfort with dyspnea since then.\nHe was a 20-pack-year smoker. He had been taking a calcium channel blocker, an angiotensin receptor blocker, and statin for hypertension and hyperlipidemia for the past 10 years.\nElectrocardiography showed ST elevation in the V1 to V4 leads and reciprocal ST depression in leads II, III, and aVF. Transthoracic echocardiography showed preserved LV global systolic function with no definite regional wall motion abnormality. Cardiac enzymes demonstrated mildly elevated troponin I, which was initially 0.2 ng/mL and peaked at 0.3 ng/mL during the follow-up.\nCoronary angiography showed a dual lumen defect, indicative of intimal dissection in the mid LAD (). The other coronary arteries were angiographically normal. IVUS showed an intimal flap dividing the true lumen and false lumen at the mid LAD site ().\nPercutaneous coronary angioplasty was performed, and a 4.0 × 22.0-mm zotarolimus-eluting stent (Resolute Integrity, Medtronic, Santa Rosa, CA, USA) was inserted at the mid LAD lesion.\nAfter stent insertion, resolution of the initial dissection area was confirmed angiographically ().