Author + information
- Received June 24, 2009
- Accepted July 9, 2009
- Published online October 1, 2009.
A 54-year-old woman presented to our hospital with angina pectoris, negative precordial T waves, and normal cardiac enzymes. After medical stabilization, coronary angiography showed a focal nonsignificant (fractional flow reserve 0.95) narrowing in the proximal left anterior descending artery (Fig. 1A, arrow). Subsequent optical coherence tomography (OCT) showed a 1.13-mm long intimal flap (Fig. 1B, arrow). As she had developed symptoms shortly after cocaine abuse, we suspect a subintimal tear resulting in a spontaneous dissection due to increased endothelial shear stress as caused by the inotropic, chronotropic, and vasoconstrictive effects of cocaine. The patient was treated with aspirin, statin, and angiotensin-converting enzyme inhibition. The further course was uneventful.
Diagnosis of coronary artery dissection is generally based on coronary angiography or intravascular ultrasound. OCT is a novel diagnostic tool using short pulse lasers allowing high-quality micrometer resolution images of the coronary artery wall. Thus, OCT could be instrumental in diagnosing cocaine-induced coronary artery dissection.
- Received June 24, 2009.
- Accepted July 9, 2009.
- American College of Cardiology Foundation