Dynamic separation of coronary artery medial and adventitial layers with vasospasm: New insights using OCT

摘要

A 46 year-old lady with raised body mass index but no other risk factors for coronary artery disease, presented with sudden onset of chest pain at rest and evidence of ST segment elevation in the inferior leads. Immediate angiography with intracoronary administration of nitrates demonstrated a long segment of tubular stenosis extending from the mid right coronary artery (RCA) into the posterior descending artery with preservation of Thrombolysis In Myocardial Infarction (TIMI) 3 flow. Confirmation of TIMI-3 flow with settling of the patient's symptoms led to a decision to treat conservatively, with interval angiography and intravascular imaging. The index presentation was associated with a troponin rise (troponin I peak 590 ng/L - normal< 14 ng/L) but preserved left ventricle function, assessed by transthoracic echocardiography.