title: Complete Angiographic Resolution of Cocaine Induced Coronary Artery Dissection within Eight Days without Coronary Stenting--A Case Report.
abstract: BACKGROUND
  Coronary dissection is a rarely reported complication of cocaine use for which there are no specific guidelines on management despite the widespread use of the drug.
  
  
  METHODS
  We report a case of a 26-year-old otherwise fit and healthy Caucasian male smoker who presented to our facility with an infero-lateral ST elevation myocardial infarction (STEMI) following nasal inhalation of 1 gram of cocaine. Coronary angiography showed a mid left anterior descending (LAD) artery dissection with distal occlusive embolism and another dissection of the distal right coronary artery (RCA) with embolism and occlusion of the distal posterolateral branch.
  
  
  RESULTS
  Wiring of both vessels with a High-Torque Floppy wire successfully re-established TIMI 3 flow with relief of pain and resolution of his ST-segment elevation. Given the absence of any flow-limiting lesions, stenting was avoided. He was subsequently put on a combination of therapeutic dose enoxaparin, aspirin, ticagrelor, atorvastatin and metoprolol. A repeat angiogram eight days later showed complete healing of the dissections.
  
  
  CONCLUSIONS
  This case shows that percutaneous management without stenting coupled with aggressive anti-coagulation of cocaine induced coronary dissection may result in an acceptable outcome especially in a young otherwise fit and healthy patient.
authors.affiliation: Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Hospital, Sydney, NSW, Australia.
authors.forename: Chathupa
authors.initials: C
authors.lastname: Wickremaarachchi
authors.affiliation: Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Jude
authors.initials: J
authors.lastname: Olinga
authors.affiliation: Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Sze-Yuan
authors.initials: SY
authors.lastname: Ooi
authors.affiliation: Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia. Electronic address: greg.cranney@ehc.com.au.
authors.forename: Gregory
authors.initials: G
authors.lastname: Cranney
mesh_terms: D000328:Adult; D003042:Cocaine / Q000633:toxicity*; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000139:chemically induced / Q000000981:diagnostic imaging; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000601:surgery; D015607:Stents; D013997:Time Factors; D014652:Vascular Diseases / Q000139:chemically induced / Q000151:congenital* / Q000000981:diagnostic imaging
chemical_list: D003042:Cocaine
keywords: Angioplasty; Cocaine; Dissection; Myocardial infarction