Left Main Spontaneous Coronary Artery Dissection in a Young Woman With Migraine and Triptan Use

Figures

• 

  Figure 1. ECG of the Patient Demonstrating ST-Segment Elevation in Leads I and aVL With Diffuse ST-Segment Depressions in the Inferior and Anterior Leads ECG = electrocardiogram.

• 

  Figure 2. Coronary Angiogram Coronary angiography revealed 100% stenosis from the mid-to-distal left main artery involving the proximal LAD and circumflex artery with absence of antegrade contrast flow (arrow) through the left coronary system. Please refer to (Video 1) for further details. LAD = left anterior descending artery.

• 

  Figure 3. Optical Coherence Tomography Cross-Sectional Image of the Left Main Coronary Artery OCT demonstrates a spontaneous coronary artery dissection with a visible intimal flap (arrow) separating the true lumen from the false lumen (asterisk). Please refer to (Video 2) below for further details. OCT = optical coherence tomography.

• 

  Figure 4. Brain MRI (Left) Axial T2-FLAIR image demonstrating evolving infarction involving the right frontal, parietal, and temporal lobes, as well as the right basal ganglia and insular cortex. (Right) Corresponding AWI image confirming restricted diffusion consistent with acute ischemic infarction. Small bilateral extra-axial collections, greater on the left, are also present and are consistent with subdural hematomas, measuring up to 5 mm in thickness on the left.

• 

  Figure 5. Elongated Signal Abnormality Within the Cord From T11 Through L1 Likely spinal cord infarction given history vs inflammatory etiology including transverse myelitis, demyelinating etiology or infectious etiology.