Acta Medica Medianae
Vol. 53, No 1, March, 2014
UDC 61
ISSN 0365-4478(Printed version)
ISSN 1821-2794(Online)
 

Correspondence to:

Nemanja Stepanović

Neretvljanska 20

Serbia, 18000 Niš

E-mail: nemstep@gmail.com

Case report      

UDC: 616.132.2:616.127-005.8

doi:10.5633/amm.2014.0109

 UNSUCCESSFUL PRIMARY PCI FOR POSTPARTAL DISSECTION OF ALL THREE MAJOR CORONARY ARTERIES

Svetlana Apostolović¹, Miodrag Damjanović¹, Dragan Mihailović², Aleksandra Antović³, Miloje Tomašević^4,5, Slobodan Obradović⁶, Nemanja Stepanović⁷

University of Niš, Faculty of Medicine, Clinic of Cardiology, Niš, Serbia¹

University of Niš, Faculty of Medicine,  Institute of Pathology, Niš, Serbia²

University of Niš, Faculty of Medicine, Institute of Forensic Medicine, Niš, Serbia³

Clinical Center Belgrade, Belgrade, Serbia⁴

University of Kragujevac,  Faculty of Medicine, Kragujevac, Serbia⁵

Military Medical Academy, Belgrade, Serbia⁶ 

University of Niš, Faculty of Medicine, PHD study group, Niš, Serbia⁷

Coronary artery dissection is rare but very dangerous condition which can result in myocardial infarction. It mostly occurs in young postpartum women. The left anterior descending artery is affected in 75% of cases and in some extremely rare cases dissection may include all three coronary arteries. Treatment guides are still not consistent. While some authors recommend medical treatment other recommend surgical one. Case report. We present a 36-year-old female patient who was admitted to our hospital with intermittent chest pain and dyspnea that occurred two hours before admission. After premedication with Aspirin 300 mg per os, Clopidogrel 300 mg per os and Enoxaparin 30 mg iv, the pain disappeared. Chest pain was repeated after five days. Coronary angiography revealed spiral dissection in medial segment of LAD. After PCI attempt, dissection progressed and ended fatal. Pathological finding was intimal dissection of the coronary arteries with loss of some parts of internal elastic lamina.  It is interesting that in the literature there is no consistent opinion about therapeutic approach to SDCA and we hope that this case report will contribute to elucidating the problem. Acta Medica Medianae 2014;53(1):47-52.

      Key words: acute spontaneous coronary artery dissection, fibromuscular dysplasia, PCI treatment of SCAD