Stanford A型主动脉夹层并发急性ST段抬高型心肌梗死1例

Stanford type A aortic dissection complicated with acute ST-segment elevation myocardial infarction:A case report

Stanford A型主动脉夹层是由于升主动脉内膜破裂导致中层形成血肿的严重心血管急症。当夹层累及冠状动脉开口时可能并发急性心肌梗死,显著增加了患者急性期死亡风险。本文报道1例老年女性患者,心电图示急性下壁、正后壁心肌梗死,冠状动脉造影示右冠状动脉病变,行冠脉支架植入术。术后患者仍有持续性后背痛,胸腹主动脉CT血管造影示Stanford A型主动脉夹层,诊断为Stanford A型主动脉夹层累及右冠状动脉,并发急性下壁、正后壁心肌梗死。本文结合文献分析主动脉夹层累及冠状动脉的影像学特点,以提高临床医生对这种特殊类型冠脉病变导致急性心肌梗死的诊断意识。

Stanford type A aortic dissection is a severe cardiovascular emergency with the hematoma forming in the media layer due to the rupture of the ascending aortic intima.When the dissection involves the coronary ostium,it may be complicated by acute myocardial infarction,which significantly increases the risk of death in the acute phase.This paper reported an elderly female patient received drug-eluting stents implantation,with acute inferior and posterior wall myocardial infarction on electrocardiogram(ECG),and right coronary artery lesion on coronary angiography.The patient still had persistent back pain after percutaneous coronary intervention(PCI),and CT angiography of the thoracic and abdominal aorta showed Stanford type A aortic dissection,and was diagnosed as Stanford type A aortic dissection involving the right coronary artery,complicated by acute inferior and posterior wall myocardial infarction.This paper combines the previous literature to analyze the imaging characteristics of coronary artery involvement by aortic dissection,in order to improve clinicians'awareness of the diagnosis of acute myocardial infarction due to this particular type of coronary lesion.