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 3 – Cardiac catheterization showing angiographic aspect compatible with spontaneous dissection of the distal third of the first left marginal branch. The left coronary is observed in the angiographic views: cranial (A) and right caudal (B). The blue arrow (B) identifies the spontaneous dissection segment of the first left marginal branch. The right coronary artery with a normal aspect in the left oblique view (C) is observed. The IVUS and optical coherence tomography (OCT) have been shown to be important tools in the diagnosis of SCAD, in cases where there is doubt regarding the angiography, since they allow a more detailed analysis of the lesion. The IVUS may also contribute to guide the percutaneous treatment whenever necessary. 4 In fact, the use of intracoronary images, through IVUS or OCT, allows better visualization of the structure and composition of the coronary wall, allowing the evaluation of the intramural hematoma, as well as the differentiation between the true and the false lumens.³ The IVUS was performed in one of the reported cases, demonstrating an image compatible with SCAD. The therapeutic management depends on the clinical severity, hemodynamic status, dissection topography, number of affected arteries, and distal coronary flow. 6 It may range from clinical treatment, stent implantation, or myocardial revascularization surgery. 7 In the cases described above, due to the clinical and hemodynamic stability with well-defined dissections, clinical treatment with dual antiplatelet therapy (clopidogrel and acetylsalicylic acid), statin and beta-blocker was initially chosen. Since percutaneous coronary intervention for SCAD is associated with a high rate of technical failures, the conservative strategy with clinical treatment and prolonged follow-up is preferable in these cases, with a high incidence of spontaneous resolution and a low incidence of adverse events. 8 Recent studies have demonstrated the recurrence of cardiovascular events in hypertensive patients in the long‑term, and beta-blocker therapy seems to have a protective effect. 9 Therefore, these patients should remain under medical supervision. In one of the cases, during follow-up, persistence of moderate obstruction was demonstrated in the middle third of the ADA, and late stent implantation was performed, aiming at preventing event recurrence. Finally, we emphasize that the diagnosis of SCAD should be considered in cases of ACS in young patients, especially women of childbearing age and without the classic risk factors for coronary artery disease. The test of choice for the diagnosis consists of coronary angiography, although in some cases it is necessary to perform IVUS or OCT as adjunct methods to corroborate the diagnosis or to determine lesion extent. Author contributions Conception and design of the research, Acquisition of data and Analysis and interpretation of the data: Daniel ECA, Falcão JLAA; Writing of the manuscript: Daniel ECA; Critical revision of the manuscript for intellectual content: Falcão JLAA. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 475