Successful coronary intervention for spontaneous coronary dissection in a patient with fibromuscular dysplasia.

ABSTRACT

Spontaneous coronary artery dissection (SCAD) is a reported rare cause of acute coronary syndrome (ACS) and sudden death among middle-aged women. Some institutes have recently reported fibromuscular dysplasia (FMD) concomitant with SCAD. Therefore, a survey of the presence of comorbid FMD in SCAD patients is important to obtain a definitive diagnosis and for the prediction of possible SCAD recurrence. The optimal treatment of ACS due to SCAD remains undetermined, and technical failures are frequently encountered in primary percutaneous coronary intervention (PCI) owing to the unusual non-atherosclerotic cause of the disease. We report a case of SCAD successfully treated with cutting balloon PCI under intravascular ultrasound guidance without stent implantation, in which FMD was detected in the right external iliac artery through screening by noncoronary angiography, not duplex ultrasound. <Learning objective: SCAD is a rare cause of ACS. Intravascular ultrasound is helpful to avoid the technical failures associated with primary percutaneous coronary intervention in the treatment of ACS due to SCAD. FMD has been recently reported to be concomitant with SCAD. Therefore, this report aimed to survey the presence of comorbid FMD in SCAD patients given its important role in obtaining a definitive diagnosis and predicting the possible recurrence of SCAD.>.