[13] Chest, 1988 32 yo F Motor vehicle collision at 15 mph 3 days prior to admission LAD & LCx dissection Surgical revascularization Discharge Selleckchem Z-DEVD-FMK home Vogiatzis,

et al. [16] Hellenic J Cardiol, 2010 31 yo F (pregnant) Spontaneous LCx dissection Conservative treatment without revascularization Discharge home Greenberg, et al. [4] Chest, 1998 35 yo F Water-skiing 2 days prior to arrival Circumflex artery dissection with moderate occlusion Angiogram without intervention Death due to brain death secondary to Vfib arrest prior to emergency department arrival De Macedo, et al. [17] J Invasive Cardiol, 2009 34 yo M Spontaneous RCA dissection Stent, heparin, clopidogrel, tirofiban, aspirin Discharge home Hobelmann[6] Emerg Med J, 2006 32 yo M Elbow to chest in basketball RCA dissection Eptifibitide and heparin, stent X2 Discharge home Table 2 Abbreviations: LAD: left anterior descending artery; LCx: left circumflex artery; RCA: right Temsirolimus cell line coronary artery; LMCA: left main coronary artery; OM: obtuse marginal artery; Vfib: ventricular fibrillation Other causes of dissection unrelated to trauma include spontaneous lesions and iatrogenic injuries from coronary angiography. Spontaneous dissections have a 4:1 predilection for women with 25-33% occurring during pregnancy or the peripartum period [14]. Spontaneous lesions

are associated with three mTOR activation Exoribonuclease conditions: 1) pre-existing coronary artery disease; 2) hormonal factors, such as pregnancy or oral contraceptive use, as stated above [14–16]; and 3) patients with tissue

fragility disorders (e.g., Marfan’s or Ehler-Danlos syndromes) [17]. Mortality with spontaneous dissection can be up to 70%, based on post-mortem studies after sudden cardiac death [17]. Iatrogenic injuries are rare, occurring in 3-6/10,000 angiograms. They are most commonly seen as RCA injuries, and can be due wire passage or balloon inflation [18]. Treatment of Coronary Artery Dissection The approach to treatment of coronary artery lesions is variable and depends upon the mechanism, the co-morbidities of the patient, and degree of hemodynamic stability. Conservative management includes anticoagulation and observation if they are hemodynamically stable with minimal injuries. Thrombolytics can be administered to dissolve clot associated with an intimal injury, but are contraindicated in multiply injured patients. Revascularization can be achieved with percutaneous techniques or coronary bypass, and timing is dependent upon the clinical scenario. Advancements in percutaneous interventions have prompted some to attempt revascularization using this method. Lesions in the LAD and RCA are highly amenable to stent placement [23].