Simultaneous Occurrence of Spontaneous Coronary Artery Dissection and Embolic Stroke
Ghulam Akbar *
Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA.
Ronald Pachon
Raritan Bay Medical Center, 530 New Brunswick Avenuw, Perth Amboy, NJ, 08861, USA.
Hasan Al Azzawi
Raritan Bay Medical Center, 530 New Brunswick Avenuw, Perth Amboy, NJ, 08861, USA.
Naureen Jessani
Raritan Bay Medical Center, 530 New Brunswick Avenuw, Perth Amboy, NJ, 08861, USA.
Kebir Bedran
Raritan Bay Medical Center, 530 New Brunswick Avenuw, Perth Amboy, NJ, 08861, USA.
Naeem Abbas
Bronx-Lebanon Hospital Center, 1650-Grand Concourse, Bronx, NY, 10457, USA.
Katherine Abella
Raritan Bay Medical Center, 530 New Brunswick Avenuw, Perth Amboy, NJ, 08861, USA.
Mohammed A. Islam
Raritan Bay Medical Center, 530 New Brunswick Avenuw, Perth Amboy, NJ, 08861, USA.
Ravindra Patel
Raritan Bay Medical Center, 530 New Brunswick Avenuw, Perth Amboy, NJ, 08861, USA.
Mark Niemiera
Raritan Bay Medical Center, 530 New Brunswick Avenuw, Perth Amboy, NJ, 08861, USA.
*Author to whom correspondence should be addressed.
Abstract
Acute coronary syndrome (ACS) due to spontaneous coronary artery dissection (SCAD) is rare. Further, concurrent ACS with a cerebrovascular accident is improbable, but possible. We report a case of a young man, with a history of Hodgkin’s lymphoma treated with a combination of chemotherapy and radiotherapy ten years ago, presented with acute coronary syndrome caused by an extensive dissection of the right coronary artery, together with acute ischemic stroke. Survivors of Hodgkin’s lymphoma are at increased risk for cardiovascular complications due to radiation, which can expedite atherosclerosis and can, eventually, give rise to dissection and cerebrovascular disease, as exemplified in our case. This case report and review outlines the incidence, epidemiology, causes, pathophysiology, diagnosis and treatment of spontaneous coronary artery dissection. Our case report is a remainder to clinicians to be mindful of concomitant occurrence of these two conditions and highlights the significant impact the treatment of each has on the other, especially when the literature does not have clear recommendations about simultaneous management. Spontaneous coronary artery dissection with concomitant ischemic cerebrovascular stroke poses a therapeutic dilemma and requires a multi-disciplinary team to appropriately manage the patient. q
Keywords: Spontaneous coronary artery dissection, acute coronary syndrome, accelerated atherosclerosis, embolic stroke