When COVID-19 delays the management of an urgent heart condition: A rare case of a spontaneous dissection of two coronary arteries.

Some severe life-threatening conditions could be misdiagnosed during the current COVID-19 pandemic.

Genomics of Fibromuscular Dysplasia.

Fibromuscular Dysplasia (FMD) is “an idiopathic, segmental, non-atherosclerotic and non-inflammatory disease of the musculature of arterial walls, leading to stenosis of small and medium-sized arteries” (Persu, et al; 2014). FMD can lead to hypertension, arterial dissections, subarachnoid haemorrhage, stroke or mesenteric ischemia. The pathophysiology of the disease remains elusive. While familial cases are rare (<5%) in contemporary FMD registries, there is evidence in favour of the existence of multiple genetic factors involved in this vascular disease. Recent collaborative efforts allowed the identification of a first genetic locus associated with FMD. This intronic variant located in the phosphatase and actin regulator 1 gene (PHACTR1) may influence the transcription activity of the endothelin-1 gene (EDN1) located nearby on chromosome 6. Interestingly, the PHACTR1 locus has also been involved in vascular hypertrophy in normal subjects, carotid dissection, migraine and coronary artery disease. National and international registries of FMD patients, with deep and harmonised phenotypic and genetic characterisation, are expected to be instrumental to improve our understanding of the genetic basis and pathophysiology of this intriguing vascular disease.

Internal mammary artery graft dissection: a case-based retrospective study and brief review.

The left internal mammary artery is the preferred graft for treating left anterior descending coronary artery disease. Dissection is a rare but grave sequela of internal mammary artery graft angiography. The available medical literature is scant, perhaps as a result of under-reporting. We report a case in which dissection of the internal mammary artery graft occurred during diagnostic angiography, and we discuss its management. In addition, we review the available literature and provide a retrospective analysis of the data from our own catheterization laboratory. In our single-center analysis of 542 cases of selective internal mammary artery graft angiography, we found only the single case of internal mammary artery graft dissection (0.2%) that we report here. Our review of the literature revealed 7 reported cases of internal mammary artery graft dissection, 3 of which were iatrogenic. There were no identifiable risk factors for such dissection. After treatment with angioplasty and stenting, all patients had good outcomes during follow-up.

Fatal postpartal dissection of all coronary arteries in an in vitro-fertilized woman.

Myocardial infarction complicates approximately 1 in 10,000 pregnancies [1]. Coronary artery dissection is the leading cause of pregnancy-related myocardial infarction during the postpartum period. Proposed etiologies include altered endocrine status, hemodynamic stress, eosinophilic inflammatory infiltrate, and disruption of vasa vasorum. Definitive diagnosis is made by coronary angiography. Treatment has not been well defined. Strategies include medical management, stenting, and coronary artery bypass grafting. Here, we report the postpartal dissection of all 3 coronary arteries and of the left main coronary in an in vitro-fertilized, 40-year-old woman who, after giving birth to a newborn by cesarean section, presented with myocardial infarction and required urgent coronary artery bypass surgery. Spontaneous coronary dissection that predominantly affects young women is rare and is often dramatic. One-third of the cases occur during pregnancy or in the postpartum period. Our case report is unique; postpartum coronary artery dissection in a patient of any age that was fertilized in vitro is very rare.

The Usefulness of MDCT Angiography in the Diagnosis of Vertebrobasilar Artery Dissection

PURPOSE: To evaluate the usefulness of MDCT angiography in the diagnosis of vertebrobasilar artery dissection. MATERIALS AND METHODS: Between July 2003 and December 2005, 39 patients who underwent MDCT angiography and digital subtraction angiography with a history of suspicious vertebrobasilar artery dissection were selected. A blind interpretation of images was made by two observers, retrospectively. A diagnosis of dissection in MDCT angiography was made according to the following criteria: presence of an intimal flap, aneurysmal dilatation, abrupt or tapered luminal narrowing, alternatively dilated and narrowed lumen. The sensitivity and specificity of MDCT angiography in depicting vertebrobasilar artery dissection were determined. RESULTS: 43 vertebrobasilar artery dissections were diagnosed by MDCT angiography in 39 patients. The interobserver agreement was good (kappa =0.92). A diagnosis was made by the presence of an intimal flap (n=16, 36%), abrupt or tapered luminal narrowing (n=16, 36%), aneurysmal dilatation (n=13, 30%), alternatively dilated and narrow lumen (n=14, 32%). The sensitivities and specificities of MDCT angiography were 91%, 88% as determined by the first radiologist, and were 89%, 87% as determined by a second radiologist, respectively. CONCLUSION: MDCT angiography is a useful method for the diagnosis of vertebrobasilar artery dissection.

Treatment of Internal Carotid Artery Dissections with Endovascular Stent Placement: Report of Two Cases

Extracranial carotid artery dissection may manifest as arterial stenosis or occlusion, or as dissecting aneurysm formation. Anticoagulation and/or antiplatelet therapy is the first-line treatment, but because it is effective and less invasive than other procedures, endovascular treatment of carotid artery dissection has recently attracted interest. We encountered two consecutive cases of traumarelated extracranial internal carotid artery dissection, one in the suprabulbar portion and one in the subpetrosal portion. We managed the patient with suprabulbar dissection using a self-expandable metallic stent and managed the patient with subpet-rosal dissection using a balloon-expandable metallic stent. In both patients the dissecting aneurysm disappeared, and at follow-up improved luminal patency was observed.