Two young women, without risk factors for atherosclerotic coronary artery disease, were admitted to hospital because of an acute anterior myocardial infarction and treated with thrombolysis. Thrombolysis failed and the immediate coronary angiography performed displayed spontaneous occlusive left anterior descending artery dissection in both cases. The patients underwent successful left internal mammary artery grafting to the left anterior descending artery. The present article highlights the pathology and angiographic presentation of spontaneous coronary artery dissection as well as the possible adverse effect of thrombolysis. Evolution of a dissection into a flap and, ultimately, into a stenosis without a flap is described, and is proposed as a potential mechanism of recurrent ischemia.
Keywords: Coronary angiography; Myocardial infarction; Spontaneous LAD dissection; Thrombolysis.