Spontaneous coronary artery dissection by intravascular ultrasound in a patient with myocardial infarction
A 60-year-old male presented with dizziness and chest discomfort. The patient had experienced severe crushing chest pain with sweating 15 years ago. However, the patient did not visit the hospital at that time because the chest pain completely resolved after several hours. He was a 20-pack-year smoker and had been taking a calcium channel blocker, an angiotensin receptor blocker, and a hydrochlorothiazide for hypertension.\nElectrocardiography showed the Q wave in the V1, V2, and V3 leads. Transthoracic echocardiography showed akinesia of the mid to apical left ventricular (LV) anteroseptal wall. Cardiac enzymes were within their normal ranges and remained normal throughout the follow-up.\nCoronary angiography revealed a dual lumen separated by a flap-like defect, indicative of intimal dissection in the proximal left anterior descending artery (LAD) (). Intravascular ultrasonography (IVUS) showed an entry intimal tear proximal to the dissection site in the LAD (). shows an intimal flap dividing the true lumen from the false one at the dissection site. The false lumen had a larger area than the true lumen. demonstrates a re-entry intimal tear distal to the dissection site.\nPercutaneous coronary angioplasty was performed, and a 4.0 × 22.0-mm everolimus-eluting stent (Xience Prime, Abbott Vascular, Santa Clara, CA, USA) was inserted at the proximal LAD lesion.