Isolated dissection of the coronary artery: A postmortem study of seven cases

We present the clinical and postmortem findings in seven adults (four femal es and three males), who died with dissection of the coronary arteries. The median age was 56 years. Five of the coronary artery dissections (CADs) we re spontaneous and two followed trauma: one a motor vehicle accident, the o ther occurred during angiography. Four cases died suddenly or within 30 min utes, Three had symptoms of at least 24 hours duration and, not unexpectedl y, had histological evidence of myocardial infarction. Four dissections inv olved the left anterior descending coronary artery, two the right coronary artery and one a dominant circumflex artery. Histological examination of th e dissected arteries in four cases demonstrated necrosis of the medial smoo th muscle which was intimately related to intimal tears and/or an inflammat ory reaction. From a review of the literature and this study of seven cases , we conclude that CAD is multifactorial in causation and has a wide spectr um of clinical presentations. Presently the role of coronary vasospasm and prior trauma appears underestimated, and in many cases of CAD the nature of the primary initiating event remains open to speculation.