Spontaneous coronary artery dissection: Successful results (with reply by Marc W. Klutstein, MD)

✍ Scribed by Kapoor, Aditya ;Sinha, Nakul

• Publisher: John Wiley and Sons
• Year: 1997
• Tongue: English
• Weight: 12 KB
• Volume: 42
• Category: Article
• ISSN: 0098-6569
• DOI: 10.1002/(sici)1097-0304(199711)42:3<356::aid-ccd29>3.0.co;2-i

✦ Synopsis

In response to the article regarding treatment of spontaneous coronary artery dissection, by Klutstein et al. [1], we wish to make the following comments:

1. The authors mention that balloon angioplasty has been performed in such cases with unsatisfactory results. They quote the cases reported by Fish and by Gonzalez et al. in this regard [2,3]. However, we would like to differ on this point. We have reported a case of successful coronary angioplasty in a case of spontaneous coronary dissection . This patient was a 54-year-old male who had long standing diabetes mellitus and end stage renal disease. Prior to a prospective renal transplant, he underwent a routine coronary angiogram, which revealed a linear area of dissection and adjacent severe stenosis in the proximal right coronary artery (RCA). The left coronary artery did not have significant disease. Though the patient denied any history of angina or myocardial infarction, it was decided to dilate the RCA lesion in view of the severity of the lesion and the fact that he had to undergo major non-cardiac surgery (renal transplantation) at a later date. The RCA was intubated with a JR4 Super Soft guiding catheter (USCI) and the lesion crossed with a .014Љ Reflex guidewire (Cordis). The lesion was dilated using a 3.0mm Agil (USCI) balloon with an excellent result. This patient underwent a successful live-related donor renal transplant one month later.

2. Klutstein et al. also state that theirs is the first reported case of successful coronary stenting in spontaneous coronary dissection. However, this is factually incorrect. Hong et al. have reported a case of spontaneous coronary dissection in the mid LAD, which was managed with balloon angioplasty followed by implantation of two 4.0mm Palmaz-Schatz stents in the LAD.