Spontaneous coronary-artery dissection with fibromuscular dysplasia

Excerpt

A 65-year-old woman with no prior medical history was urgently brought to our hospital due to chest pain. Her electrocardiogram showed ST-segment elevation in leads II, III, and aVF. Head and chest enhanced CT scans ruled out cerebral hemorrhage and aortic dissection. The emergent cardiac catheterization revealed spontaneous coronary artery dissection (SCAD) in the right coronary artery (RCA) (Panel A). Intravascular ultrasound revealed continuous dissection (Panel B, IVUS with white arrow in Panel A). Coronary artery stents were implanted in the RCA. Following a detailed examination, cerebral CT angiography identified a giant internal carotid artery aneurysm (Panel C). An enhanced CT scan also detected stenosis and tortuosity of the right and left renal arteries, leading to a diagnosis of fibromuscular dysplasia (FMD) (Panel D). The patient was discharged 2 weeks post-admission and scheduled for brain aneurysm surgery. FMD is a systemic arteriopathy that can occur in the renal, carotid, and coronary arteries. While SCAD is rare and observed in middle-aged women, it is crucial to recognize that it can also affect the elderly [1]. Given the high prevalence of coexisting arterial abnormalities outside the heart in SCAD patients with FMD, imaging from the head to pelvis is recommended.

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