Peer Review Report For: Case Report: Concomitant spontaneous dissection of the coronary artery and internal carotid artery in a young man [version 2; peer review: 1 approved]

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Introduction Spontaneous coronary artery dissection (SCAD) is a relatively rare cause of acute coronary syndrome (ACS), generally affecting young or middle-aged women and people with few conventional atherosclerosis risk factors. Its association with dissection of the internal carotid artery is exceptional. Through our observation of a concomitant spontaneous coronary and carotid dissection, we discuss its clinical presentation, therapeutic management, pathogenesis and factors favouring its occurrence. Case We report the case of a 34-year-old man admitted to emergency with a segment elevation myocardial infarction (STEMI). The patient developed right hemiplegia and aphasia. Cerebral CT revealed a left ischaemic stroke in the anterior junctional territory, and CT angiography of the supra-aortic arteries revealed a dissection of the left internal carotid artery. However, CT angiography of the aorta revealed no abnormalities. Coronary angiography performed after 48 hours showed a dissection of the anterior inter-ventricular artery. Conclusions Concurrent dissection of the coronary and internal carotid arteries with an uninjured aorta is a rare entity. This association suggests a congenital pathology of the vessels such as Marfan’s disease or Ehlers-Danlos syndrome.

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