Acute Coronary Syndrome with ST-Segment Elevation in a Patient with Spontaneous Dissection of the Anterior Descending Coronary Artery Branch: Case Report and Review of the Literature

Spontaneous coronary artery dissection as a cause of acute coronary syndrome is a rare disease entity with extremely high mortality. The aetiology of spontaneous coronary artery dissection is to a large extent undetermined and it probably arises from a variety of causes involving multiple contributing factors. It is most frequently encountered in young women during pregnancy or post partum, after cocaine use, after aerobic exercise, in eosinophilic infiltration of the coronary vessel wall, in Ehlers Danlos syndrome, etcetera. The aetiology of spontaneous dissection in patients with coronary atherosclerosis is of different origin and it is likely that the following factors may be implicated: intramural haematoma, extensive rupture of an atheromatous plaque, increased apoptosis of smooth muscle fibres, increased wall stress on the intraluminal surface of atheromata, and spasm. Prompt diagnosis is vitally important for the patient’s prognosis and is based on coronary angiography, while intracoronary ultrasound may also be of assistance in some cases. Treatment is usually invasive, through performing aortocoronary bypass surgery or percutaneous coronary angioplasty with stent implantation, although in some cases a conservative strategy may be more appropriate. We present the case of an acute coronary syndrome with ST-segment elevation, treated successfully with thrombolysis, in which coronary angiography revealed extensive type C dissection of the anterior descending coronary artery branch, starting in the first third and terminating in the vessel’s periphery, with satisfactory flow.