Intravascular Ultrasound–Documented Healing of Spontaneous Coronary Artery Dissection

A 46-year-old woman without a history of cardiovascular disease and no coronary risk factor was urgently admitted to our hospital with rest crushing chest pain, which had started 3 hours before. The ECG demonstrated minimal anterior ST-segment elevation in leads V1 to V4 (Figure 1). In the first sample cardiac troponin T was 0.08 ng/mL. Coronary angiography was urgently performed and demonstrated a 50% smooth stenosis in the proximal left anterior descending (LAD) coronary (Figure 2) with a faint dye staining just proximal to the first diagonal branch. Because initial differential diagnosis included variant angina, intracoronary ergonovine (32 μg) was given. Diffuse LAD coronary vasoconstriction, more severe on the LAD coronary ostium, was seen. Because there was still no clear indication of a culprit lesion, intravascular ultrasound (IVUS) examination was performed, which surprisingly showed an intramural hematoma starting from the mid-LAD up to its ostium, with mild lumen compromise, and the presence of nonobstructive atheroma (Figure 2). Echo-free material, consistent with contrast medium or saline, was seen mixing with echogenic blood within the hematoma (Figure 3), indirectly indicating that the hematoma was the result of a spontaneous coronary …