Healing of spontaneous coronary dissection in the context of glycoprotein IIB/IIIA inhibitor therapy: a case report.

Spontaneous coronary artery dissection is a rare cause of myocardial infarction. It is a condition with greater prevalence in young women, particularly in the peripartum or early postpartum period. It also has been described following intense physical exercise. The pathophysiologic characteristics remain unclear. Unlike atherosclerotic intimal dissection, the dissection plane lies within the media or between the media and adventitia. We describe a case of spontaneous coronary artery dissection in a 44-yr old menstruating woman with mitral valve prolapse, who experienced acute myocardial infarction after twisting and throwing a heavy piece of luggage. Coronary angiography showed coronary artery dissection in a left anterior descending coronary artery at the point of its emergence from its intramural course. An intimal plaque with 90-95% obstruction and reduced (TIMI I) flow was demonstrated. The patient was treated with continued glycoprotein IIb/IIIa inhibitor infusion. Angiographic resolution with return of prompt (TIMI III) flow was noted. Optimal management of spontaneous coronary artery dissection has not been established and may vary, depending upon the presence of intimal versus extramural compromise. Coronary artery bypass, stenting, and thrombolysis have been successful and also have failed, owing to extension of dissection. Our patient is the first reported patient to have received tirofiban therapy in the context of spontaneous coronary artery dissection. Medical therapy has been used most often, and angiographic resolution has been documented at 94 days, 7 mo, and 1 yr. We document the earliest case of spontaneous angiographic resolution-within 20 hr.