Traumatic Coronary Artery Dissection After a Fall From a Roof.

BACKGROUND

Traumatic coronary artery dissection (TCAD) can result from thoracic trauma.

CASE SUMMARY: A 37-year-old man fell off a roof. An electrocardiogram documented a lateral ST-segment elevation myocardial infarction. Invasive coronary angiography revealed a culprit proximal left anterior descending artery occlusion secondary to TCAD, confirmed by intravascular ultrasound. The dissection was treated with percutaneous coronary intervention (PCI), including cutting balloon evacuation of intramural hematoma. Retrospective review of the trauma-code computed tomography (CT) scans documented an occluded left anterior descending artery.

DISCUSSION: TCAD is usually confirmed by invasive coronary angiography, but CT could play a useful diagnostic role. PCI is a viable option for the treatment of TCAD, including use of a cutting balloon to evacuate intramural hematoma.

TAKE-HOME MESSAGES: The diagnosis of TCAD relies on a high index of suspicion and typical electrocardiographic findings; CT can be used to confirm the diagnosis. PCI with a cutting balloon and stent is an effective treatment option.