Evolutive Recanalization of Spontaneous Coronary Artery Dissection

A 50-year-old man, a former smoker, presented with an ST-segment elevation anterior myocardial infarction that was treated with thrombolysis in another center. Because of the absence of reperfusion criteria, he was referred to our hospital for a rescue coronary intervention. A transthoracic echocardiogram showed that the overall left-ventricle systolic function was preserved but with apical akinesia. Coronary angiography revealed an occlusive lesion (100%) in the mid-left anterior descending coronary artery distal to a segment with a tapering caliber (Figure 1A). At that time, the patient was asymptomatic, and, therefore, a conservative management was decided, including dual antiplatelet therapy and full anticoagulation. Biomarkers included elevated creatine kinase (peak: 926 U/L; n<190), creatine kinase-MB peak (peak: 36.4 ng/mL; n<5), and troponin I peak (peak: 15.90 ng/mL; n<0.2). A new coronary angiogram performed 7 days later revealed a complete recanalization of the left anterior descending …