| Objective:Through the analysis of Clinical data of 1 case of spontaneous c-oronary artery dissection(SCAD),and retrieving and reinserting relevant literatures for review,to explore the clinical features,diagnosis and treatment strategies of SCAD,and deepen the knowledge belongs to clinical doctors about SCAD,th-e interventional physicians especially,and avoid missed diagnosis and misdiagno-sis,so that effective treatment aiming for the cause of disease can be taken.Methods:The clinical data and diagnosis and treatment plan of 1 SCAD patient admitted into cardiovascular internal medicine II of the people’s hospital of xiangxi tujia and miao autonomous prefecture(the first affiliated hospital of jishou university,hereinafter referred to our hospital)were analyzed,which were retrieved and sorted into the group together with relevant and domestic cases and literatures from CNKI and Wanfang database.In order to obtain clinical data and analyze their clinical features,diagnosis and treatment strategies retrospectively.Results:In this study,about 1381 relevant literatures in recent 10 years were retrieved from CNKI and Wanfang database.61 effective articles were included,in which 258 cases of SCAD patients(including the case in our hospital)were obtained after statistics,and results there included 81 males and 177 females(The ratio is 1:2),,whose age was between 22-84 years old,and mean age was(51.94±8.63)years old.Most of them presented similar symptoms of acute coronary syndrome(ACS)when admitted to hospital,and the common lesion site was in the middle and distal segment of left anterior descending branch mostly.The higher incidence of SCAD was in the left coronary artery(including the left main artery,left anterior descending branch and left circumflex branch)comparing to the right coronary artery(67.8%:32.2%)significantly.Female patients were more easily to be complicated with SCAD in the left anterior descending coronary artery and left main artery than male(69.5%:30.5%).While male patients were more likely to occur in the right coronary artery(58.0%:42.0%).Most of the cases in this study were found to be dissected by angiography(including the cases in our hospital),only 95 cases were identified by intravascular ultrasound and 36 cases were confirmed by optical coherence tomography.In terms of treatment,133 patients were treated conservative,115 patients were treated with stent implantation covering dissection(including the cases in our hospital),7 patients underwent coronary artery by pass grafting,and 3 patients died suddenly.Conclusions:(1)It is lower prevalence,and lacking clinical manifestations char-acteristics that make SCAD misdiagnosd or even missing diagnosis.So clinicians need to raise vigilance,especially interventional surgeons.(2)SCAD is more common in young and middle-aged women who lack risk factors for coronary hear-t disease(CHD),in the perinatal and postmenopausal period particularly,and inmen who has smoking history,hypertension,diabetes,dyslipidemia and other c-ardiovascular risk factors.(3)The etiology and inducement of SCAD are still controversial.In this study,the causes were mainly about strenuous exercise or overwork,traumatic trauma,use of contraceptives,intense traumatic stress,previou-s immune or connective tissue diseases,and idiopathic factors.(4)The lesion site of SCAD is in the middle and distal segment of left anterior descending bran-ch usually.The rate of spontaneous dissection of the left coronary artery is higher than that of the right coronary artery,especially in female.However,in the female case in our hospital,SCAD occurred in the right coronary artery.(5)The clinical manifestations of SCAD are diverse,and different severity,of which diagnosis still dependents on imaging techniques such as coronary angiographyand intravascular imaging mostly.(6)Currently,there is no complete consensus o-n the treatment strategy of SCAD,and the appropriate individualized treatmentplan should be selected according to the specific situation of comprehensive e-valuation. |
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