IJCS | Volume 31, Nº6, November / December 2018

673 Figure 1 - Left coronary angiography in the right anterior oblique projection with caudal angulation demonstrates a 90% stenosis of the ostium and a negative image suggestive of a thrombus in the proximal third of the artery. Leão et al. Spontaneous coronary artery dissection Int J Cardiovasc Sci. 2018;31(6)672-675 Case Report Discussion The SCAD is a rare manifestation, which may present with all the clinical symptoms of ACS, including sudden death. 5-7 In patients with SCAD, in addition to the symptoms of ACS, in up to 50% of cases, the ECG shows ST elevation and significantly elevated troponin. 2 However, due to the rarity of this disease, it is usually forgotten as a differential diagnosis in ACS and, in most cases (70%), the diagnosis is made by necropsy, in such a way that its real incidence is underestimated. 1,3,4,9 There is a marked predominance in women, with a proportion of 3 to 1 compared to men. About one-third of cases occur during pregnancy or in the puerperal period. 7 However, Yip and Saw1 suggest, in their study, these data might have been biased in older studies, since they present selective case reports of high morbidity and mortality. In women, dissections usually occur when they are young, with a mean age of 40 years, with no risk factors for ACS, and mostly affect the left coronary artery. 3,5,7,9 In men, the impairment occurs at a higher age range, sometimes associatedwith the presence of risk factors for coronary artery disease, with a predominant involvement of the right coronary artery. 7 In general, the anterior descending artery is affected in up to 75% of cases. 3,5,7,9 Because it is a rare disease, the best treatment approach for SCAD has not been defined yet, since