Spontaneous Left Main Coronary Artery Dissection in a Male

TL;DR

This case report describes a rare instance of spontaneous left main coronary artery dissection in a 46-year-old male, highlighting its diagnosis and management.

Contribution

The paper presents a rare case of SCAD in a male involving the left main coronary artery, emphasizing diagnostic and management considerations.

Findings

The patient had SCAD confirmed via coronary angiography and intravascular imaging.

No reportable genetic variants were found in 29 genes studied, despite suspicion of connective tissue disease.

The case underscores the importance of recognizing SCAD as a cause of ACS in men.

Abstract

Spontaneous coronary artery dissection (SCAD) is one of the causes of acute coronary syndrome (ACS) that is increasingly recognized in young to middle-aged women without typical coronary risk factors. This case report describes a 46-year-old male with a rare presentation of SCAD involving the left main (LM) coronary artery. The patient underwent an emergency coronary angiogram for high-risk ACS and had percutaneous coronary intervention (PCI) of LM due to active ischemia and hemodynamic instability. The extension of intramural hematoma after the LM coronary artery stent confirmed the initial suspicion of SCAD. The diagnosis of SCAD is crucial, as its management differs from other causes of ACS. Coronary angiography is the gold standard for diagnosing SCAD, with adjunctive imaging using optical coherence tomography (OCT) and intravascular ultrasound (IVUS). In this patient, his physical examination findings and further imaging raised a suspicion for systemic connective tissue disease. Genetic analysis was executed, but no reportable variants in any of the 29 genes studied were identified. This case highlights the importance of recognizing SCAD as a potential cause of ACS even in men and emphasizes the findings during coronary angiography that can aid in an accurate diagnosis and appropriate management.

Figures