Figure 6.

A 54-year-old woman had inferolateral STEMI due to SCAD involving the OM3 of the left circumflex artery. (A) Left coronary artery angiography in right anterior oblique-cranial projection showing (white arrow) subtotal occlusion of the upper subbranch of the OM3 due to intramural hematoma. Note other coronary vessels are smooth and normal-appearing with severe tortuosity (sinusoidal waves). (B) Repeat left coronary angiogram in cranial projection, performed 8 weeks after SCAD, shows vessel healing with OM3 recanalization (white asterisk) after resorption of intramural hematoma. (C) During repeat coronary angiography (B) via the right common femoral artery, femoral angiography was performed by injecting a 10-cc contrast bolus through the vascular access sheath. Standing waves are shown in the right external iliac artery (regular corrugated luminal contour, between the white asterisks). Standing waves represent vascular artifact, and are possibly due to transient vasospasm induced by the arterial injection of a rapid bolus of contrast. (D) CTA of the abdomen and pelvis with 3-D reconstruction performed 7 years after myocardial infarction to investigate abdominal discomfort. The previously noted luminal irregularity in the right external iliac artery is resolved (arterial segment between white arrows) and a small known saccular splenic artery aneurysm (white asterisk) has a stable appearance. CTA, computed tomography angiography; OM3, third obtuse marginal branch; SCAD, spontaneous coronary artery dissection; STEMI, ST-elevation myocardial infarction.