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Vorobevskii D.A.

St. Petersburg City Hospital No.40;
St. Petersburg Institute of Bioregulation and Gerontology

Kozlov K.L.

St. Petersburg Institute of Bioregulation and Gerontology

Shcherbak S.G.

St. Petersburg City Hospital No.40;
St. Petersburg State University

Lazakovich D.N.

St. Petersburg City Hospital No.40;
St. Petersburg State University

Intravascular ultrasound for spontaneous coronary artery dissection in a patient with acute coronary syndrome

Authors:

Vorobevskii D.A., Kozlov K.L., Shcherbak S.G., Lazakovich D.N.

More about the authors

Journal: Russian Cardiology Bulletin. 2024;19(2): 67‑71

DOI: 10.17116/Cardiobulletin20241902167

Views: 336

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To cite this article:

Vorobevskii DA, Kozlov KL, Shcherbak SG, Lazakovich DN. Intravascular ultrasound for spontaneous coronary artery dissection in a patient with acute coronary syndrome. Russian Cardiology Bulletin. 2024;19(2):67‑71. (In Russ.)
https://doi.org/10.17116/Cardiobulletin20241902167

Подписка 2025 (Russian Cardiology Bulletin)
 
 
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BACKGROUND

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a rare disease. Analysis of causes and nature of coronary artery lesions may be difficult during selective coronary angiography in these patients. Intravascular imaging, including intravascular ultrasound (IVUS), is essential for accurate diagnosis and treatment options.

OBJECTIVE

To demonstrate the treatment outcome in a patient with non-ST-segment elevation myocardial infarction (NSTEMI) after IVUS-guided management.

CASE REPORT

A 60-year-old patient admitted to the intensive care unit with NSTEMI. Taking into account the data of electrocardiography and echocardiography, as well as serum troponin, we performed emergency coronary angiography. Borderline stenosis of the right coronary artery required IVUS to verify the symptom-related lesion and determine further treatment strategy. We recognized this lesion as spontaneous coronary artery dissection. The patient underwent stenting with zotarolimus-eluting stent.

CONCLUSION

Spontaneous coronary artery dissection is a rare cause of myocardial infarction. Delayed diagnosis and incorrect treatment can lead to complications. Intravascular imaging makes it possible to identify the cause of spontaneous coronary artery dissection and determine the indications for invasive treatment.

Keywords:

percutaneous coronary intervention
intravascular ultrasound
myocardial infarction with non-obstructive coronary arteries

Authors:

Vorobevskii D.A.

St. Petersburg City Hospital No.40;
St. Petersburg Institute of Bioregulation and Gerontology

Kozlov K.L.

St. Petersburg Institute of Bioregulation and Gerontology

Shcherbak S.G.

St. Petersburg City Hospital No.40;
St. Petersburg State University

Lazakovich D.N.

St. Petersburg City Hospital No.40;
St. Petersburg State University

Received:

26.02.2024

Accepted:

25.03.2024

List of references:

  1. Thygesen K, Alpert J, Jaffe A. Fourth universal definition of myocardial infarction (2018). European Heart Journal. 2019;40(3):237-269.  https://doi.org/10.1093/eurheartj/ehy462
  2. Barbarash OL, Dupljakov DV, Zatejshhikov DA. Acute coronary syndrome without ST segment elevation of the electrocardiogram. Clinical guidelines 2020. Rossiyskiy kardiologicheskiy zhurnal. 2021;26(4):149-202. (In Russ.). https://doi.org/10.15829/1560-4071-2021-4449
  3. Neumann FJ, Sousa-Uva M, Ahlsson A. 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal. 2019;40(2):87-165.  https://doi.org/10.1093/eurheartj/ehy394
  4. Byrne R, Rossello X, Coughlan J. 2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). European Heart Journal. Acute Cardiovascular Care. 2024;13(1):55-161.  https://doi.org/10.1093/ehjacc/zuad107
  5. Zhukova NS, Shahnovich RM, Merkulova IN. Spontaneous coronary artery. Kardiologiya. 2019;59(9):52-63. (In Russ.). https://doi.org/10.18087/cardio.2019.9.10269
  6. Vatutin NT, Taradin GG, Bort DV. A case of spontaneous coronary artery dissection (literature review and case report). The Russian Archives of Internal Medicine. 2019;9(1):23-30. (In Russ.). https://doi.org/10.20514/2226-6704-2019-9-1-23-30
  7. Zajnobidinov ShSh, Helimskij DA, Baranov AA. New aspects of diagnostics and treatment of patients with spontaneous coronary artery dissection. Kardiovaskulyarnaya terapiya i profilaktika. 2022;21(8):106-118. (In Russ.). https://doi.org/10.15829/1728-8800-2022-3193
  8. Rogowski S, Maeder MT, Weilenmann D. Spontaneous Coronary Artery Dissection: Angiographic Follow-Up and Long-Term Clinical Outcome in a Predominantly Medically Treated Population. Catheterization and Cardiovascular Interventions. 2017;89(1):59-68.  https://doi.org/10.1002/ccd.26383

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