CONGRESS ABSTRACT

Background: spontaneous dissections (D) in multiple arteries are a rare condition. We describe the case of a patient who, over a period of 19 years presented multiple arterial dissections, Case description: A 52-years-old man was admitted to our CCU for a NSTEMI.At 33 y  he underwent PTCA of the left renal artery for renal infarction from artery D,  At 41 y complained a STEMI from a coronary dissection (CD) of a posterolateral branch of the circumflex artery. At 49 y,  D of the right internal carotid. At the entrance in CCU  minimal troponin increase, no ischemic changes on the ECG  and no alterations at the echocardiogram.  A coronary angiography was performed: reduction in caliber of the distal segment of a collateral of the posterolateral branch (Fig. 1,2), due to type 2b CD (Yip-Saw classification). On the seventh day of hospitalization due to hypertensive crisis he complained of a recurrence of chest pain, a troponin HS peak of 853 ng/L and a medio-distal infero and lateral hypokinesia at the echocardiogram.   Ranolazine and nitrates were added to  β-blocker therapy , the seconds  suspended for side effects.  Hypotensive therapy  was conducted with a target of ≤ 120 mmHg  of SBP.  Due to the absence of “high-risk features”  to coronary angiography  was treated  only with aspirin. The dyslipidemia was dealt with statin. The CRP was normal (mg/dl <0.06).  After one month, the patient was admitted to outpatient cardiac rehabilitation (CR) maintaining SBP during training ≤135 mmHg,  increasing  functional capacity at the end of the program.  The patient is currently asymptomatic and free from recurrence. Conclusion: to our knowledge, a combination of a multisite arterial D has not been reported previously. Ongoing genetic testing may help to understand the pathophysiology.  Some considerations can be made. The multifocal presentation suggests a relationship with fibrodysplasia rather than hemorrhage of the vasa vasorum; the  normal CRP  exclude an inflammatory cause. β -blockers are a mainstay of treatment for reducing wall shear stress and limiting CD propagation. It is important to combine strict BP control.  Statin use has been associated with CD recurrence. In our case ranolazine was beneficial to treat ischemia without affecting hemodynamic parameters.