What is the clinical evidence from this study?

Study design: Case Report. Population: Recurrent spontaneous coronary artery dissection (SCAD) (n=1). Intervention: Coronary artery bypass grafting (CABG).

What does this research mean for the field?

Coronary artery bypass grafting was necessary in a 39-year-old woman with recurrent spontaneous coronary artery dissection and cardiogenic shock after childbirth. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

January 20, 2026Clinical Case Reports0 citationsOpen Access

Recurrent Spontaneous Coronary Dissection in Puerperium Precipitating in Cardiogenic Shock Prompted Coronary Artery Bypass Grafting

LGLorenzo GiovannicoUniversity of Bari Aldo Moro GFGiuseppe FischettiUniversity of Bari Aldo Moro DPDomenico PariginoUniversity of Bari Aldo Moro

Key Result

Coronary artery bypass grafting served as a definitive treatment for recurrent spontaneous coronary artery dissection and cardiogenic shock in a 39-year-old postpartum woman after failed stenting.

Key Points

This report aims to highlight the occurrence of recurrent spontaneous coronary artery dissection in a postpartum woman and its management.
Detailed case report of a 39-year-old woman experiencing recurrent SCAD after delivering twins.
Emergency coronary angiography performed to assess the extent of dissection.
Drug-eluting stent placed initially, followed by coronary artery bypass grafting due to failure of initial intervention.
Emergency angiography revealed double-vessel SCAD in the patient.
Initial stenting was ineffective, necessitating surgical intervention with CABG.
Postoperative management included beta-blockers to reduce the risk of recurrence.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A 39-year-old woman who developed recurrent spontaneous coronary artery dissection and cardiogenic shock following the delivery of twins.

Intervention

Emergency coronary artery bypass grafting (CABG) using bilateral internal mammary arteries and autologous saphenous vein, performed after failure of initial percutaneous coronary intervention (PCI).

Outcome

Clinical recovery and left ventricular function at 1-year follow-up

CABG can be a lifesaving and definitive treatment option for recurrent spontaneous coronary artery dissection with hemodynamic instability when percutaneous interventions fail.

Abstract

ABSTRACT This case report details a rare instance of recurrent spontaneous coronary artery dissection (SCAD) in a 39‐year‐old woman following the delivery of twins, leading to cardiogenic shock. SCAD, although occurring most commonly in middle‐aged women (45–52 years), can also occur in young, otherwise healthy women, in association with pregnancy. In this situation, it poses significant diagnostic and therapeutic challenges, particularly during pregnancy or postpartum periods. This patient's emergency coronary angiography revealed double‐vessel SCAD, and initial treatment with a drug‐eluting stent failed. Surgical intervention with coronary artery bypass grafting (CABG) was ultimately necessary due to recurrent dissection and hemodynamic instability. The case underscores the utility of CABG as a definitive treatment for SCAD, particularly when percutaneous interventions are insufficient. Additionally, the report discusses the importance of early diagnosis using advanced imaging techniques and highlights postoperative management, including beta‐blockers to reduce recurrence risk. This case provides insights into SCAD's complex pathophysiology and the critical role of tailored intervention strategies for young women postpartum.

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