Percutaneous Coronary Intervention to Spontaneous Coronary Artery Dissection With Coexistent Takotsubo Cardiomyopathy: A Case Report

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of non-atherosclerotic acute coronary syndrome (ACS) resulting in myocardial ischemia and ventricular wall motion abnormalities (WMA). SCAD and Takotsubo Cardiomyopathy (TC) share a common risk factor profile and clinical characteristics. We report a 55-year-old female patient who presented with chest pain and elevated troponin level. Coronary angiography (CA) showed tortuosity in the first diagonal (D1) artery suspicious of SCAD. Left ventriculogram showed typical apical ballooning of TC. Because of ongoing chest pain during the procedure, we proceeded to percutaneous coronary intervention (PCI) to D1. Intracoronary optical frequency domain imaging (OFDI) of D1 showed intramural hematoma extending to proximal LAD and treated with a 2.25 × 12 mm Promus Element drug-eluting stent (DES). Transthoracic Echocardiography (TTE) showed mid anterolateral, inferolateral, and all apical hypokinesia of LV with preserved basal segments and mildly impaired systolic function. TTE after 3 months showed fully recovered LV systolic function with resolution of WMA. Repeat CA 6 months later demonstrated healing of SCAD and OFDI showed resolution of the intramural hematoma, and cardiac MRI showed normal LV systolic and full-thickness delayed enhancement in only the lateral wall.