Spontaneous coronary artery dissection and the role for percutaneous coronary intervention: to treat or not to treat?

Spontaneous coronary artery dissection is a rare but occasionally lethal condition that is more common in the peri- and post-partum periods. Recommendations for its management are derived from the literature only in the form of single case reports and few small case series in which successful outcomes were obtained. No consensus of opinion or guideline for optimal treatment exists. We present a case of post-partum coronary artery dissection initially treated with drug-eluting stents, but complicated by the extension of intramural hematoma and further dissection. After consideration of surgical revascularization, medical management with dual-antiplatelet therapy resulted in complete healing of the dissection and spontaneous gradual resolution of intramural hematoma after three weeks. Unfortunately development of in-stent restenosis necessitated reintervention with further coronary stenting 2 months later.