Stanford type A aortic dissection complicated with acute ST-segment elevation myocardial infarction: A case report
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摘要: Stanford A型主动脉夹层是由于升主动脉内膜破裂导致中层形成血肿的严重心血管急症。当夹层累及冠状动脉开口时可能并发急性心肌梗死，显著增加了患者急性期死亡风险。本文报道1例老年女性患者，心电图示急性下壁、正后壁心肌梗死，冠状动脉造影示右冠状动脉病变，行冠脉支架植入术。术后患者仍有持续性后背痛，胸腹主动脉CT血管造影示Stanford A型主动脉夹层，诊断为Stanford A型主动脉夹层累及右冠状动脉，并发急性下壁、正后壁心肌梗死。本文结合文献分析主动脉夹层累及冠状动脉的影像学特点，以提高临床医生对这种特殊类型冠脉病变导致急性心肌梗死的诊断意识。
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关键词:
- Stanford A型主动脉夹层 /
- 急性ST段抬高型心肌梗死 /
- 经皮冠状动脉介入治疗
Abstract: Stanford type A aortic dissection is a severe cardiovascular emergency with the hematoma forming in the media layer due to the rupture of the ascending aortic intima. When the dissection involves the coronary ostium, it may be complicated by acute myocardial infarction, which significantly increases the risk of death in the acute phase. This paper reported an elderly female patient received drug-eluting stents implantation, with acute inferior and posterior wall myocardial infarction on electrocardiogram (ECG), and right coronary artery lesion on coronary angiography. The patient still had persistent back pain after percutaneous coronary intervention (PCI), and CT angiography of the thoracic and abdominal aorta showed Stanford type A aortic dissection, and was diagnosed as Stanford type A aortic dissection involving the right coronary artery, complicated by acute inferior and posterior wall myocardial infarction. This paper combines the previous literature to analyze the imaging characteristics of coronary artery involvement by aortic dissection, in order to improve clinicians ' awareness of the diagnosis of acute myocardial infarction due to this particular type of coronary lesion. -
图 1 2021年12月13日患者冠状动脉造影术前心电图
注：18导联心电图示Ⅱ、Ⅲ、aVF、V7、V8、V9导联ST段弓背向上抬高0.1~0.2 mV。
Figure 1. Electrocardiogram of the patient before coronary angiography on December 13, 2021
图 2 支架植入前后冠状动脉造影结果
注：A示RCA全程狭窄；B示支架近端考虑超急性冠脉内血栓；C示RCA支架近端灌注较差；D示RCA血流恢复TIMI 3级。
Figure 2. Coronary angiographic results before and after stent implantation
图 3 支架植入后右冠状动脉OCT结果
注：A示近端支架贴壁不良，支架外考虑血肿；B示支架近端至开口管腔不规则，可见内膜下大片血肿。
Figure 3. OCT results of the right coronary artery after stent implantation
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