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Spontaneous coronary artery dissection is an underdiagnosed condition The aim of our report is to highlight the fundamental role of intravascular ultrasound(IVUS) in the management of STEMI due to spontaneous coronary dissection.
Method and Results
12 consecutive patients, referred to our cathlab for primary angioplasty, were managed with IVUS because of a suspicion of spontaneous coronary artery dissection. IVUS was done both for a diagnostic purpose and to guide the implantation of one or more stents. There were 8 female patients with a mean age of 40 years (28-44), with LAD involved for 6 of them, and right coronary artery in two of them ; and 4 male patients with a mean age of 34 years (20-40), one with LAD l, 2 left circumflex artery l, and 1 right coronary occlusion. All patients had ongoing STEMI at presentation and IVUS was conducted for diagnostic purpose in the setting of a totally occluded artery in 7 patients and an artery with TIMI flow 1 in 5 patients. in addition IVUS will show the incorrect position of the wire in the false channel in 5 patients and will guide the replacement of the wire in the true lumen in these patients. All patients were successfully treated with one or multiple stents under IVUS guidance, allowing us to cover the arterial dissection while preserving all collaterals. The clinical course of these patients was uneventful and the long-term outcome is excellent.
STEMI due to spontaneous coronary dissection is a relatively rare and underdiagnosed condition, especially with an occluded artery, if IVUS is not used. The diagnosis is very difficult In addition to aid diagnosis, IVUS allows a safe stenting , since it assesses the proper position of the wire in the true lumen.