Cover Image: Spontaneous healing of recurrent coronary dissections
Nicolas Preumont and Guy Berkenboom
Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
Spontaneous coronary artery dissection is a rare cause of unstable angina and myocardial infarction. In this clinical setting, stent implantation or coronary artery bypass graft is usually preferred to conservative treatment. In the case presented here, a woman with a smoking habit experienced a first anterior non-Q wave myocardial infarction (NQWMI) when she was 45 years old, followed 3 years later by an inferior NQWMI. The first coronary angiography in 1995 demonstrated a long lesion starting at the ostium of the left anterior descending artery (LAD), angiographically compatible with a spasm but unresponsive to vasodilators (nitroglycerin or calcium antagonists). The absence of residual angina and the morphology of the lesion prompted us to choose a conservative treatment (calcium antagonist and aspirin), more especially as minimally invasive direct coronary artery bypass (MIDCAB) surgery was not routinely performed at this time in our institution. She was asymptomatic until the occurrence of a second acute coronary syndrome, probably triggered by intense physical exercise. The coronary angiography, taken in 1998, displayed a long coronary dissection of the mid-right coronary artery but a complete healing of the LAD stenosis. The evolution was again favourable and ticlopidine was added to her usual medication. Five years after the last coronary event, she complained of back pain whilst jogging. A new coronary angiography in 2003 revealed an almost complete healing of the right coronary dissection with only small irregularities near the ostium and a mild lesion in the proximal segment. To our knowledge, this is the first reported case in which a patient experienced recurrent coronary dissection with repetitive spontaneous healing, pleading therefore, for a conservative treatment.
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