SPONTANEOUS CORONARY-ARTERY DISSECTION CAUSING SUDDEN-DEATH - MECHANICAL ARTERIAL FAILURE OR PRIMARY VASCULITIS

A previously healthy 36-year-old woman died suddenly, and autopsy exam ination disclosed dissection of the left anterior descending coronary artery with luminal occlusion. A periadventitial inflammatory infiltra te consisting predominantly of eosinophils and including histiocytic m ultinucleated giant cells was present. The syndrome of spontaneous cor onary artery dissection is a rare but well-described clinicopathologic entity. The pathogenesis and, Specifically, the significance of the p eriarterial inflammation, has been controversial. The findings in our case, as well as in others reported in the literature, suggest a prima rily mechanical process inciting a localized inflammatory reaction, ra ther than a primary vasculitis.