Necmettin ÇOLAK, Yunus NAZLI, Fatih ALPAY, Ömer ÇAKIR

eçirilmesi

Spontan koroner arter diseksiyonu (SKAD), akut koroner sendromun nadir görülen bir sebebidir. SKAD\'ları stabil angina pektoris, unstabil angina pektoris, akut miyokard infarktüsü, kardiyojenik sok ve ani kardiyak ölüme sebep olabilir. Ateroskleroz, peripartum periyod, arter duvarını etkileyen strüktürel ve inflamatuar durumlar predispozan faktörlerdir. Teshis genellikle koroner anjiografi ile konur. Klinik prezentasyon aterosklerotik koroner arter hastalıgı ile benzerdir. Koroner arter diseksiyonlu hastaların teshis ve tedavisinin hızlı yapılması sagkalımı arttırır. Tedavi seçenekleri medikal tedavi, perkütan koroner girisim ve cerrahi tedavidir. Tedavi seçimi hastanın klinigi, etkilenen koroner arter ve diseke segmentin uzunluguna göre karar verilir. Biz SKAD\'u olan ve basarı ile tedavi edilen 4 olgumuzu literatür bilgileri esliginde sunduk.

Anahtar Kelimeler:

Spontan koroner arter diseksiyonu, akut koroner sendrom, koroner arter hastalıgı, koroner arter bypass greft operasyonu

Spontaneous coronary artery dissections: Four cases and literature review

Spontaneous coronary artery dissection(SCAD) is a very rare cause of acute coronary syndrome. SCAD can cause stable angina, unstable angina, acute myocardial infarction, cardiogenic shock and sudden cardiac death. Predisposing factors include atherosclerosis, the peripartum period, structural and inflammatory conditions affecting the arterial wall. The diagnosis is usually made by coronary angiography. The clinical presentation is similar to the atherosclerotic coronary artery disease. Prompt diagnosis and treatment of patients improves survival. Therapeutic options include medical therapy, percutaneous coronary intervention and surgery. The four cases were presented an discussed with review of the pertinent literature.

Keywords:

Spontaneous coronary artery dissection, acute coronary syndrome, coronary artery disease, coronary artery bypass graft surgery,

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Waller BF. Nonatherosclerotic coronary heart disease. In: Fuster V, Alexander RW, O’Rourke R, Roberts R, King S, Wellens H, editors. 10th ed. Hurst’s the heart. New York: McGraw-Hill; 2001. p. 1162-8.
Vale PR, Baron DW. Coronary artery stenting for sponta- neous coronary artery dissection: a case report and review of the literature. Cathet Cardiovasc Diagn 1998;45:280- 286.
Pretty HC. Dissecting aneurysm of coronary artery in a woman aged 42. Br Med J 1931; 1: 667.
Hering D, Piper C, Hohmann C, Schultheiss HP, Horstkotte D. Prospective study of the incidence, pathogenesis and therapy of spontaneous, by coronary angiography diag- nosed coronary artery dissection. Z Kardiol 1998; 87: 961- 970.
Thompson E. A, Ferraris S, Gres T, Ferraris V. Gender dif- ferences and predictors of mortality in spontaneous coro- nary artery dissection: A review of reported cases. J Inva- sive Cardiol 2005; 17: 59-61.
Celik SK, Sagcan A, Altintig A, Yuksel M, Akin M, Kul- tursay H. Primary spontaneous coronary artery dissections in atherosclerotic patients. Report of nine cases with re- view of the pertinent literature. Eur J Cardiothorac Surg 2001; 20: 573-576.
Kamran M, Guptan A, Bogal M. Spontaneous coronary ar- tery dissection: case series and review. J Invasive Cardiol 2008; 20: 553-559.
Koul AK, Hollander G, Moskovits N, Frankel R, Herrera L, Shani J. Coronary artery dissection during pregnancy and the postpartum period: two case reports and review of lit- erature. Catheter Cardiovasc Interv 2001; 52: 88-94.
Robinowitz M, Virmani R, McAllister HA JrU. Spontane- ous coronary artery dissection and eosinophilic inflamma- tion: a cause and effect relationship? Am J Med 1982; 72: 923-928.
Azam MN, Roberts DH, Logan WF. Spontaneous coro- nary artery dissection associated with oral conraceptive use. Int J Cardiol 1995; 48: 195-198.
Kalaga RV, Malik A, Thompson PD. Exercise-related spontaneous coronary artery dissection: case report and li- terature review. Med Sci Sports Exerc 2007; 39: 1218- 1220.
Mark DB, Kong Y, Whalen RE. Variant angina and coro- nary artery dissection. Am J Cardiol 1985; 56: 485-486.
Steinhauer JR, Caulfield JB. Spontaneous coronary artery dissection associated with cocaine use: a case report and brief review. Cardiovasc Pathol 2001; 10: 141-145.
Mather PJ, Hansen CL, Goldman B, et al. Postpartum mul- ti-vessel coronary dissection. J Heart Lung Transplant 1994; 13: 533-537.
Bac DJ, Lotgering FK, Verkaaik APK. Spontaneous coro- nary artery dissection during pregnancy and postpartum. Eur Heart J 1995; 16: 136–8.
Tarhan İA, Yapıcı F, Arslan Y, Özler A. Spontan koroner arter diseksiyonu: Olgu sunumu ile birlikte Tıp literatürü- nün gözden geçirilmesi. Türk Kardiyol Dern Arş 2002; 30: 54-56.
Kearney P, Erbel R Ge J, Zamorano J, Koch L, Gorge G, Meyer J. Assessment of spontaneous coronary artery dis- section by intravascular ultrasound in a patient with unsta- ble angina. Cathet Cardiovasc Diagn 1994; 32: 58–61.
Kantarci M, Ogul H, Bayraktutan U, Gundogdu F, Bayram E. Spontaneous coronary artery dissection: noninvasive diagnosis with multidetector CT angiography. J Vasc In- terv Radiol 2007; 18: 687-688.
Phillips LM, Makaryus AN, Beldner S, Spatz A, Smith- Levitin M, Marchant D. Coronary artery dissection during pregnancy treated with medical therapy. Cardiol Rev 2006; 14: 155-157.
Cheung S, Mithani V, Watson RM. Healing of spontane- ous coronary dissection in the context of glycoprotein IIB/IIIA inhibitor therapy: a case report. Catheter Cardio- vasc Interv 2000; 51: 95-100.
Zampieri P, Aggio S, Roncon L, et al. Follow-up after spontaneous coronary artery dissection: A report of 5 cas- es. Heart 1996; 75: 206-209.
Erdim R, Gormez S, Aytekin V. Spontaneous healing of spontaneous coronary artery dissection: a case report. J Invasive Cardiol 2008; 20: 237-238.
Leclercq F, Messner-Pellenc P, Carabasse D. Successful thrombolysis treatment of a spontaneous left main coro- nary artery dissection without subsequent surgery. Eur Heart J 1996; 17: 320-321.
Zupan I, Noc M, Trinkaus D, Popovic M. Double vessel extension of spontaneous left main coronary artery dissec- tion in young women treated with thrombolytics. Catheter Cardiovasc Interv 2001; 52: 226-230.
Fish RD. A 37 year old woman with angina pectoris. Cir- culation 1994; 89: 898-908.
Gonzalez JL, Hill JA, Conti RC. Spontaneous coronary ar- tery dissection treated with percutaneous transluminal an- gioplasty. Am J Cardiol 1989; 63: 385–6.
Fischman DL, Leon MB, Baim DS, et al. For the STent REStenosis Study Investigators: A randomised compari- son of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 1994; 331: 496-501.
Forker AD, Rosenlof RC, Weaver W, Carveth S, Reese H. Primary dissecting aneurysm of the right coronary artery, with survival. Chest 1973; 64: 656-658.
Mohamed HA, Eshawesh A, Habib N. Spontaneous coro- nary artery dissection- a case report and review of the lit- erature. Angiology 2002; 53: 205-211.
Unal M, Korkut AK, Kosem M, Ertunc V, Ozcan M, Cag- lar N. Surgical management of spontaneous coronary ar- tery dissection. Texas Heart Inst J 2008;35:402-405.