ABC | Volume 112, Nº4, April 2019

Case Report Daniel & Falcão Spontaneous coronary dissection - cases and review Arq Bras Cardiol. 2019; 112(4):473-476 Figure 1 – Cardiac catheterization showing stenosis in the middle/distal third of the left main coronary artery and severe segmental stenosis in the ostium/ proximal third of the anterior descending artery in the right cranial (A), right caudal (B) and left cranial (C) views. Restudy, after six months, showed a significant improvement of obstructions in the right cranial (D), right caudal (E) and left cranial (F) views. Figure 2 – Cardiac catheterization showing moderate stenosis in the middle third and moderate/severe segmental stenosis in the distal third of the anterior descending artery (ADA) in the cranial (A), right caudal (B) and left cranial (C) views. Restudy, after 3 months, showed a significant improvement of the obstruction in the distal third of the ADA, with moderate obstruction in the middle third, which was treated with the direct stenting technique (cranial view, images: D, E and F). From the angiographic point of view, the diagnosis of CAD should be considered when there is a dissection line, with or without a false lumen, sudden and significant caliber reduction, or obstruction with smooth borders without the aspect of atherosclerotic disease. 6 Because it is a two‑dimensional aluminography, the coronary angiography reveals little in relation to the coronary artery wall, where the main SCAD alteration is found.³ 474