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Cardiac computed tomography: beyond the screening of coronary artery disease.

Correspondence: *Pablo Esteban Auquilla Clavijo Av. Francisco Goya 21, 5.o dcha. 50006 Zaragoza, España E-mail: pabloauq50hotmail.com Available online: 02-20-2019 Arch Cardiol Mex (Eng). 2019;89(3):242-244 www.archivoscardiologia.com Date of reception: 11-12-2018 Date of acceptance: 17-01-2019 DOI: 10.24875/ACME.M19000048 Today, the main use of cardiac computed tomography (CCT) is for the screening of coronary artery disease; however, its use is increasingly common in the follow-up of patients after percutaneous revascularization and in control studies of different clinical scenarios, such as spontaneous coronary artery dissection (SCAD). SCAD is a major cause of acute coronary syndrome (ACS) in women. According to reports, this entity is the culprit in nearly one-quarter of ACS cases in women younger than 50 years1. Although classically it was thought that it affected mostly young women, today it is recognized that it affects women of postmenopausal age as well2. In most cases, treatment is usually conservative, but in patients who experience an acute myocardial infarction (AMI) with symptoms of recurrent ischemia or hemodynamic compromise, surgical or percutaneous revascularization may be required3. In the case of percutaneous intervention, given the fragility of the vascular wall in these cases, the procedure can have important complications (intramural hematoma and dissection dissemination), secondary to coronary procedures, and/or angioplasty. These complications increase the risk of restenosis or implanted stent late malposition4. For all these reasons, in some cases, it is necessary to carry out control studies to assess implanted stents permeability and/or residual dissection evolution. We present the case of a 64-year-old woman without cardiovascular risk factors, who had been admitted 3 months prior with an AMI secondary to spontaneous dissection of the anterior descending (AD) artery with total occlusion of the vessel at middle level, complicated with retrograde peri-procedural dissection toward the left common trunk (LCT) and circumflex artery (CX). A drug-eluting stent was implanted in LCT-AD up to the origin of the first diagonal (D1); given that, CX had TIMI 3 flow, conservative treatment was decided on this vessel. On echocardiography, the left ventricle global systolic