ABC | Volume 115, Nº1, Suplement, July 2020

Case Report Souto et al. SCAD in a patient with CTX Arq Bras Cardiol 2020; 115(1Suppl.1):18-21 disease due to SCAD. Although several specific clinical situations, including fibromuscular dysplasia and pregnancy, have been mostly associated with SCAD, atherosclerotic conditions may be as well related to the pathogenesis of this disease. 6 As the CTX predisposes to the development of premature atherosclerosis and there are a few studies that report coronary artery disease associated to atherosclerotic thromboembolism, 5 there is evidence that the SCAD in the reported case was also associated to an atheromatous plaque formation. As far as the authors could investigate, this is probably the first case in the literature demonstrating the association between CTX and SCAD. Author contributions Conception and design of the research: Souto MJS, Sousa AC; Data acquisition: Souto MJS, Ferreira EJP, Gonçalves LFG, Sousa AC; Analysis and interpretation of the data: Souto MJS, Almeida-Santos MA, Ferreira EJP, Gonçalves LFG, Sousa AC; Writing of the manuscript: Souto MJS, Oliveira JLM, Figure 3 – Multiplanar reformation of coronary computed tomographic angiography, detecting a severe parietal irregularity in the proximal third of the anterior descending coronary artery, which suggested the presence of a noncalcified plaque or dissection of the artery (arrow). Figure 4 – A - Coronary angiography of left coronary showing dissection in the proximal and medium third of left anterior descending artery (arrow). B- Intracoronary ultrasound showing double-lumen sign in the left anterior descending artery (arrow). 20