自发性冠状动脉夹层的诊断及救治分析并文献复习

Spontaneous coronary artery dissection:A case report and review of literature

目的分析自发性冠状动脉夹层(SCAD)的临床表现尤其冠状动脉造影特征,探讨其发病机制及目前治疗进展。方法回顾性分析东部战区总医院收治的1例发病典型、诊疗资料完整的SCAD女性患者的临床表现尤其冠状动脉影像特征,并复习相关文献资料,总结其临床诊治进展。结果该例患者在因急性冠状动脉综合征(ACS)实施回旋支血管介入治疗后2年再次因ACS收住入院,复查冠脉造影并行血管内超声检查(IVUS),发现2年前造影阴性的前降支发生急性闭塞,发病原因为SCAD。经药物保守治疗后患者病情明显改善并经第3次造影检查确认罪犯血管夹层自行吸收明显。患者出院后1年随访病情稳定。结论SCAD的确切病因依然不明,好发于冠心病危险因素较少的中青年女性,常以ACS症状起病,冠状动脉造影是目前诊断SCAD的金标准,及时规范的治疗可改善SCAD患者的预后。

Objective To summarize the clinical manifestations,especially the coronary angiography of spontaneous coronary artery dissection(SCAD),and to explore its advances in pathogenesis and in current diagnosis and treatment.Methods The clinical manifestations(symptoms,ECGs and especially the coronary angiography and IVUS)of a female patient with SCAD in cardiovascular Department of the Eastern Theater Command Hospital were analyzed.The diagnosis and treatment of SCAD were summarized.Results In this case,the patient was admitted to hospital again due to acute coronary artery syndrome(ACS)2 years after her first admission of ACS with interventional therapy for circumventing artery.The coronary angiography and intravascular ultrasound examination(AVUS)revealed the acute occlusion of the anterior descending artery,which had no lesion in the previous angiography,and the cause of the disease was SCAD.After conservative treatment with drugs,the patient′s condition was significantly improved and the third angiography confirmed that the self-absorption of the criminal vascular dissection was significantly improved.At present,the patient′s conditionis stable after the follow-up of one year after discharge.Conclusion The exact etiology of SCAD is still unknown,and it often occurs in young and middle-aged women with fewer risk factors for coronary heart disease,frequently with symptoms of ACS.Coronary angiography is the gold standard for the diagnosis of SCAD at present,and timely and standardized treatment can improve the prognosis of SCAD patients.