Clinical Case of Spontaneous Dissection of Branches of The Left Coronary Artery in A Young Woman

Spontaneous coronary artery dissection (SСAD) is a rare but potentially dangerous cause of acute coronary syndrome, especially in young women without traditional risk factors for cardiovascular diseases. Etiological factors include fi bromuscular dysplasia, hereditary arteriopathies, systemic infl ammatory diseases, and hormonal changes. Despite the progress in diagnosis, the treatment of DMCA remains a diffi cult task due to the high variability of clinical manifestations and the lack of a single standard of therapy. The case of a young patient hospitalized with a ST-segment elevation myocardial infarction clinic, which occurred against the background of intense physical exertion, is presented. Coronary angiography (CAG) revealed spontaneous dissection of the branches of the left coronary artery. The progression of dissection was noted during CAH, which required repeated stenting and the use of mechanical circulatory support (VA-ECMO, IABC). Despite the treatment, the patient maintained unstable hemodynamics and the progression of multiple organ disfunction, which led to death. Histological examination revealed connective tissue dysplasia cannot be excluded, which could be a predisposing factor for the development of coronary artery dissection. Clinical recommendations suggest conservative management of stable patients, however, revascularization is indicated in the presence of complications such as cardiogenic shock. In this case, the invasive tactics did not affect the prognosis. The above case demonstrates the complexity of diagnosis and management of patients with SDCA. Further research is needed to develop optimal treatment strategies and identify genetic markers predisposing to the development of this pathology.