Recurrent spontaneous coronary artery dissection, diagnostic issues, and management: a case report.

Background: Spontaneous coronary artery dissection (SCAD) is a severe and under-diagnosed pathology that generates diagnostic and therapeutic difficulties. Case summary: This case is about a 45-year-old female with a history of coronary spasm in 2012 without ergonovine provocation confirmation. She was admitted in 2014 for an acute coronary syndrome (ACS) revealing an aspect of thrombus of the left anterior descending (LAD) coronary artery. GPIIb/IIIa antagonists, unfractionated heparin, and antiplatelet therapy were introduced. Angiographic control 10 days later showed that the lesion was not thrombotic but a SCAD which spread on the left main coronary artery and LAD proximal part. Angiographic control at 1 month showed a partial healing but persistent focal dissection of the mid-LAD treated by two bioresorbable vascular scaffolds. In 2018, she presented with a new case of SCAD treated at another hospital, where she had been misdiagnosed with myocarditis. A review of the angiograms revealed findings typical of distal SCAD of the circumflex artery. In June 2022, a new ACS was related to a right coronary artery SCAD. The distal part was occluded by an extensive haematoma. This was turned into a dissection by using a cutting balloon. No stent was implanted. Discussion: SCAD is a complex condition that presents diagnostic challenges, as this case illustrates. Such diagnostic errors can lead to the prescription of inappropriate medication, such as anticoagulant therapy, which may exacerbate the condition by increasing the size of the haematoma. It is also a condition that can recur, and clinicians must bear this in mind.