İbrahim UYAR, Engin TULUKOĞLU, Erhan KAYA, Mehmet MERİÇ

Genç Erkek Hastada Sirkumfleks Koroner Arterin Spontan Diseksiyonu ve Tedavisi

Spontan koroner arter diseksiyonu (SKAD) nadir fakat bazen akut koroner sendromun hayatı tehdit eden nedenidir. Hastalar angina pektoristen kardiyojenik şoka ve ani kardiyak ölüme kadar çeşitli klinik durumlar ile ortaya çıkabilir. SKAD koroner anjiyografi, koroner CT anjiyografi veya intravasküler ultrason ile teşhis edilebilir. Tedavi stratejisi seçimi ortaya çıkan kliniğine, lokalizasyonuna, diseksiyonun yaygınlığına ve risk altındaki iskemik miyokardium miktarına bağlıdır. Bu yazıda, ek risk faktörü olmayıp egzersiz sonrası göğüs ağrısı ile başvuran ve EKG ve kardiyak enzim anormalliği olmayan 33 yaşındaki erkek hastayı sunuyoruz. Ek risk faktörü, EKG değişikliği ve kardiyak enzim anormalliği olmaması nedeniyle konvansiyonel KAG yerine koroner CT anjiyografi ile sirkumfleks koroner arterin spontan yaygın diseksiyonu tanısı kondu, perkütan koroner stentleme uygulandı. Sorunsuz klinik seyir sonrası medikal tedavi ile taburcu edildi. Postop birinci ayda restenoz gelişen hastaya yeniden başarılı stentleme uygulandı. Ayrıca bu klinik tablo ile ilgili literatürü kapsamlı bir inceleme ile sunuyoruz.

Anahtar Kelimeler:

Spontan koroner arter diseksiyonu, akut koroner sendrom, çok kesitli bilgisayarlı tomografi, koroner anjiyografi, perkütan koroner, revaskülarizasyon

Spontaneous Dissection of Circumflex Coronary Artery in a Young Male Patient

Spontaneous coronary artery dissection (SCAD) is a rare but sometimes life-threatening cause of acute coronary syndrome. Patients may present with various clinical conditions ranging from angina pectoris to cardiogenic shock to sudden cardiac death. SCAD is diagnosed with coronary angiography, coronary computed tomography angiography or intravascular ultrasound. The selection of treatment strategy depends upon the clinical manifestation, location and the extent of dissection and amount of ischemic myocardium at risk. Herein, we present the case of a 33-year-old man who presented with post exercise chest pain. Diffuse spontaneous dissection of circumflex coronary artery was diagnosed with coronary computed tomography angiography instead of conventional coronary angiography due to the absence of additional risk factors, ECG changes, and cardiac enzyme abnormalities. He was treated with percutaneous coronary stenting and had a favorable clinical course and was discharged on medical therapy. Re-stenosis developed at one month later and re-stenting was performed successfully. We also provide a comprehensive review of published literature related to this clinical entity.

Keywords:

Coronary artery dissection spontaneous, acute coronary syndrome, multislice computed tomograpy, angiography coronary, percutaneous coronary, revascularization,

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