Spontaneous coronary artery dissection as a cause of acute myocardial infarction in young people

Introduction. Spontaneous coronary artery dissection (SCAD) represents a dissection that occurred without atherosclerosis, trauma or has not developed iatrogenically. The true prevalence of SDKA is unknown, as they are often unrecognized. It most often occurs in young women, who do not have the classic risk factors for the development of cardiovascular diseases. In only 10% of cases, it occurs in men after physical exertion.Case report. A 35-year-old man was admitted to the emergency department due to an acute myocardial infarction with ST elevation. Urgent coronarography was performed and the SCAD, type I of the first marginal branch (OM), was registered. During primary percutaneous coronary intervention drug-eluting stent was implanted in the OM branch, guided by optical coherence tomography (OCT). In the further time, the patient is without problems, hemodynamically and rhythmically stable. After a month, re-coronarography was performed, as well as OCT analysis of the first marginal branch, which registered a significant malaposition and insufficient expansion of the previously implanted stent in the distal segment OM. Dilatation with a non-compliant balloon was performed with optimal result. After OCT-guided balloon dilatation, excellent stent apposition and expansion, was registered. Optical medical treatment was indicated. In the follow-up period after three months, the patient is without problems. Conclusion. Because the SDKA are often unrecognized, careful evaluation of the angiographic findings and the use of intravascular imaging in unclear cases is necessary. In the following period, randomized controlled studies are needed to define patients who require revascularization, as well as those who require dual antiplatelet therapy and the length of its use.