Atherosclerotic spontaneous coronary artery dissection (A-SCAD) in a patient with COVID-19: case report and possible
Atherosclerotic spontaneous coronary artery dissection (A-SCAD) in a patient with COVID-19: case report and possible
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DOI：
10.1093/ehjcr/ytaa133
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发表时间：
2020-10-01
影响因子：
1
通讯作者：
Seresini, Giuseppe
中科院分区：
文献类型：
--
作者：
Albiero, Remo;Seresini, Giuseppe
背景自发性冠状动脉夹层(SCAD)可起源于动脉粥样硬化性(A-SCAD)或非动脉粥样硬化性(NASCAD)。“SCAD”一词的现代用法通常与NA-SCAD同义词。新冠肺炎可以诱导局部位于冠状动脉外膜和外膜周围脂肪的血管炎症，并有助于易感患者易损斑块的A-SCAD的发生。冠状动脉造影术显示LAD近端的罪魁祸首病变具有非常复杂和不寻常的形态，提示为A-SCAD。3年前进行的上一次冠状动脉造影术中，同一冠状动脉段存在轻度狭窄，这支持了A-SCAD的诊断。他成功地接受了经皮冠状动脉介入治疗，新冠肺炎疗程顺利，没有肺炎症状，在两次SARS-CoV-2阴性检测后出院。对于疑似或确诊为新冠肺炎感染的STEMI患者，建议的“先溶栓”方法对于潜在的A-SCAD患者可能是不安全的。
Background Spontaneous coronary artery dissection (SCAD) may be atherosclerotic (A-SCAD) or non-atherosclerotic (NASCAD) in origin. Contemporary usage of the term 'SCAD' is typically synonymous with NA-SCAD. COVID-19 could induce a vascular inflammation localized in the coronary adventitia and periadventitial fat and contribute to the development of an A-SCAD of a vulnerable plaque in a susceptible patient.Case summary In this report we describe a case of a COVID-19 patient with past cardiac history of CAD who was admitted for acute coronary syndrome (ACS). Coronary angiography demonstrated the culprit lesion in the proximal LAD that presented with a very complex and unusual morphology, indicative of an A-SCAD. The diagnosis of A-SCAD was supported by the presence of a mild stenosis in the same coronary segment in the last angiogram performed 3 years previously. He was successfully treated by PCI, had a favourable course of the COVID-19 with no symptoms of pneumonia, and was discharged from the hospital after two negative tests for SARS-CoV-2.Discussion A higher index of suspicion of A-SCAD is needed in patients with suspected or confirmed COVID-19 presenting with ACS. The proposed approach with 'thrombolysis first' for treating STEMI patients with suspected or confirmed COVID-19 infection could be unsafe in the case of underlying A-SCAD.