Spontaneous Coronary Artery Dissection and Woven Coronary Artery: Three Cases and a Review of the Literature
A 45-year-old male was presented to cardiology department with mild chest pain. The patient's history revealed a previous right carotid artery occlusion, hyperlipidemia, hypertension and severe smoking. The patient had been on clopidogrel, aspirin, and lisinopril for the last two months. The patient exhibited no ischemic ECG changes, but we determined an abnormal ST-segment depression on exercise testing. Subsequent coronary angiogram showed a dual twisted lumen in the proximal and medial segments of all coronary arteries (, , and ), and ventriculography revealed normal wall motion and LVEF of 65%. We noticed that this patient had WCAA involving all coronary arteries. The patient's right carotid angiography showed an occlusion, and other vessels were normal on CT angiogram. There have been no cases reported in the literature with WCAA involving all coronary arteries. A workup for collagen disease was negative. The patient was evaluated for revascularization due to ischemic findings, but thallium-201 myocardial perfusion imaging did not show ischemia. We did not perform optical coherance tomography (OCT) due to the probability of coronary dissection or occlusion caused by guidewire or OCT catheter. The patient was discharged receiving 81 mg of aspirin and 75 mg of clopidogrel once a day. Smoking cessation was strongly encouraged.