Does thrombolytic therapy harm or help in STEMI caused by the spontaneous coronary dissection? Case report and the review of the literature

Background : Spontaneous coronary artery dissection (SCAD) is a very rare disease with poor prognosis. It mainly affects young women free of risk factors for coronary artery disease (CAD) and women during the peripartum period. The prognosis for myocardial infarction caused by SCAD is poor, management is often difficult and guidelines still don’t exist. Case report : We present the woman with acute myocardial infarction of anterior wall of left ventricle, caused by spontaneous dissection of medial segment of left anterior descending coronary artery. We treated her with thrombolytic therapy and we performed coronary angiography after that. Finally we decided to do nothing. Two years later we performed coronary angiography again and founded coronary artery normal. We also have analyzed nineteen cases from 1996. to 2012. when coronary artery dissection was treated with thrombolytic agent. In a analysis that we conducted, there was only one case of nineteen, which demonstrated a complication after treating a SCAD with thrombolysis. Conclusion : Sometimes, when we have myocardial infarction in young women with no risk factors for CAD, especially young women in peripartum, we should think about SCAD.     Our case, like eight others, demonstrates that good clinical outcomes can be achieved with thrombolysis. In spite of all this, we still need more data to verify that thrombolysis does not harm the therapy for SCAD. Thrombolytic therapy could be an option.