SPONTANEOUS CORONARY ARTERY DISSECTION: CASE REPORTS OF THREE TYPES OF DISSECTION.

Spontaneous coronary artery dissection (SCAD) is defined as a nonatherosclerotic, nontraumatic or iatrogenic tear within the epicardial coronary artery wall creating a false lumen or hematoma. It is more common in younger patients and women and it can cause acute coronary syndrome (ACS) in 0.1 to 4 percent of cases. We described three cases of different types of SCAD. In the first case, we described a male patient admitted due to chest pain after excessive physical activity. Electrocardiogram (ECG) showed inferior ST-elevation myocardial infarction (STEMI). SCAD of left anterior descending (LAD) was found by coronary angiography. Because of chest pain and signs of ischemia on ECHO, a stent was implanted. After procedure, the patient was pain-free and hemodynamically and rhythmically stable. In the second case, we presented a young multiparous woman with signs of acute coronary syndrome (ACS). A coronary angiogram showed a homogeneous stenosis of proximal LAD. Optimal medical therapy (OMT) was the initial therapy of choice. After a few days due to the recurrence of chest pain and an increase in troponin level, recoronarography was performed. It showed a dissection of the left main (LM), left circumflex artery (LCx) and LAD. It was treated with the two-stent technique procedure, after which, the patient was stable and pain free. In the third case, we showed a postmenopausal patient with subclinical hypothyroidism. In this case, it is difficult to say whether the dissections of LCx, LM and LAD that occurred after the balloon dilatation of LCx and the stent implantation in the right coronary artery (RCA) were result of atherosclerotic lesions or hormonal changes that can cause SCAD.