Vol. 142 No. 0910 (2012)
Associated vascular lesions in patients with spontaneous coronary artery dissection
- Stefan Toggweiler
- Marietta Puck
- Christoph Thalhammer
- Robert Manka
- Michael Wyss
- Deniz Bilecen
- Roberto Corti
- Beatrice R Amann-Vesti
- Thomas F Lüscher
- Christophe Alain Wyss
AIM: To identify vascular abnormalities in patients presenting with spontaneous coronary artery dissection (SCAD).
METHODS: We performed a whole-body MR angiography and a duplex sonography of the renal and carotid arteries in 12 patients (9 women, 3 men) with SCAD to identify vascular abnormalities.
RESULTS: MR angiography revealed abnormalities of the renal arteries in 3/12 patients (25%). All 3 patients were women, 2 presented with changes suggesting fibromuscular dysplasia (FMD), 1 had a spontaneous renal artery dissection. No other vascular abnormalities were identified in any of the patients. Duplex sonography confirmed MR findings and showed non-significant renal artery stenoses in both patients with FMD.
CONCLUSIONS: Abnormalities of the renal arteries were found in 3/12 (25%) of the patients with SCAD. No other vascular abnormalities were identified. Additional diagnostic tests of the renal arteries such as renal artery angiography or duplex sonography may be considered in patients presenting with SCAD.
- Leone F, Macchiusi A, Ricci R, Cerquetani E, Reynaud M. Acute myocardial infarction from spontaneous coronary artery dissection a case report and review of the literature. Cardiol Rev. 2004;12:3–9.
- Mahenthiran J, Revankar R, Koka V, Hoo J, Shenoy M. Spontaneous coronary artery dissection presenting as acute myocardial infarction. J Natl Med Assoc. 2000;92:87–90.
- DeMaio SJ, Jr., Kinsella SH, Silverman ME. Clinical course and long-term prognosis of spontaneous coronary artery dissection. Am J Cardiol. 1989;64:471–4.
- Bac DJ, Lotgering FK, Verkaaik AP, Deckers JW. Spontaneous coronary artery dissection during pregnancy and post partum. Eur Heart J. 1995;16:136–8.
- Jorgensen MB, Aharonian V, Mansukhani P, Mahrer PR. Spontaneous coronary dissection: a cluster of cases with this rare finding. Am Heart J. 1994;127:1382–7.
- Pate GE, Lowe R, Buller CE. Fibromuscular dysplasia of the coronary and renal arteries? Catheter Cardiovasc Interv. 2005;64:138–45.
- Wyttenbach R, Braghetti A, Wyss M, Alerci M, Briner L, Santini P, et al. Renal artery assessment with nonenhanced steady-state free precession versus contrast-enhanced MR angiography. Radiology. 2007;245:186–95.
- Willinek WA, Gieseke J, Conrad R, Strunk H, Hoogeveen R, von Falkenhausen M, et al. Randomly segmented central k-space ordering in high-spatial-resolution contrast-enhanced MR angiography of the supraaortic arteries: initial experience. Radiology. 2002;225:583–8.
- Lim TK, Lim E, Dwivedi G, Kooner J, Senior R. Normal value of carotid intima-media thickness – a surrogate marker of atherosclerosis: quantitative assessment by B-mode carotid ultrasound. J Am Soc Echocardiogr. 2008;21:112–6.
- Staub D, Canevascini R, Huegli RW, Aschwanden M, Thalhammer C, Imfeld S, et al. Best duplex-sonographic criteria for the assessment of renal artery stenosis – correlation with intra- arterial pressure gradient. Ultraschall Med. 2007;28:45–51.
- Lacombe M. Isolated spontaneous dissection of the renal artery. J Vasc Surg. 2001;33:385–91.
- Paris B, Bobrie G, Rossignol P, Le Coz S, Chedid A, Plouin PF. Blood pressure and renal outcomes in patients with kidney infarction and hypertension. J Hypertens. 2006;24:1649–54.
- Spring DB, Salvatierra O, Jr., Palubinskas AJ, Amend WJ, Jr., Vincenti FG, Feduska NJ. Results and significance of angiography in potential kidney donors. Radiology. 1979;133:45–7.
- Cragg AH, Smith TP, Thompson BH, Maroney TP, Stanson AW, Shaw GT, et al. Incidental fibromuscular dysplasia in potential renal donors: long-term clinical follow-up. Radiology. 1989;172:145–7.
- Neymark E, LaBerge JM, Hirose R, Melzer JS, Kerlan RK Jr, Wilson MW, et al. Arteriographic detection of renovascular disease in potential renal donors: incidence and effect on donor surgery. Radiology. 2000;214:755–60.
- Andreoni KA, Weeks SM, Gerber DA, Fair JH, Mauro MA, McCoy L, et al. Incidence of donor renal fibromuscular dysplasia: does it justify routine angiography? Transplantation. 2002;73:1112–6.
- Lorenz EC, Vrtiska TJ, Lieske JC, Dillon JJ, Stegall MD, Li X, et al. Prevalence of renal artery and kidney abnormalities by computed tomography among healthy adults. Clin J Am Soc Nephrol. 2010;5:431–8.
- Mortensen KH, Thuesen L, Kristensen IB, Christiansen EH. Spontaneous coronary artery dissection: a Western Denmark Heart Registry study. Catheter Cardiovasc Interv. 2009;74:710–7.
- Koller PT, Cliffe CM, Ridley DJ. Immunosuppressive therapy for peripartum-type spontaneous coronary artery dissection: case report and review. Clin Cardiol. 1998;21:40–6.
- Lie JT, Berg KK. Isolated fibromuscular dysplasia of the coronary arteries with spontaneous dissection and myocardial infarction. Hum Pathol. 1987;18:654–6.
- Brodsky SV, Ramaswamy G, Chander P, Braun A. Ruptured cerebral aneurysm and acute coronary artery dissection in the setting of multivascular fibromuscular dysplasia: a case report. Angiology. 2007;58:764–7.