Spontaneous coronary artery dissection angiography

	Spontaneous Coronary Artery Dissection Microchapters
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Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Spontaneous coronary artery dissection from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Approach
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Angiography
CT
MRI
Echocardiography
Other Imaging Findings
Other Diagnostic Studies
Treatment
Treatment Approach
Medical Therapy
Percutaneous Coronary Intervention
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Type 1 Case 1; Case 2; Case 3; Case 4; Case 5; Case 6; Case 7; Type 2A Case 1; Case 2; Case 3; Case 4; Case 5; Case 6; Type 2B Case 1; Case 2; Case 3; Case 4; Type 3 Case 1; Case 2; Case 3; Case 4; Case 5; Case 6;

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A.; Arzu Kalayci, M.D. [2]

Synonyms and keywords: SCAD

Overview

The current gold standard for diagnosing spontaneous coronary artery dissection (SCAD) is coronary angiography, as it is widely available and the first-line imaging modality for patients presenting with the acute coronary syndrome. The predominant angiographic feature of SCAD consists of diffuse smooth narrowing of varying severity involving mid-to-distal coronary segments, secondary to compression of the true lumen and/or expansion of the false lumen by the development of an intramural hematoma. The typical appearance of extraluminal contrast staining, multiple radiolucent lumens, spiral dissection, or intraluminal filling defects is less commonly observed. Other angiographic findings associated with SCAD include coronary tortuosity, myocardial bridging, and coronary fibromuscular dysplasia.

Angiographic findings include:^[1]

Type 1: appearance on an angiography involves the presence of two intraluminal streams/lumens separated by a radiolucent flap of the intima.
Type 2: when the dissection plane is deeper in the vessel wall between the media and adventitial layers, the formation of a hematoma can result in luminal narrowing which is seen as stenosis on angiography.
Type 3: appearance mimics atherosclerosis. The dissection is typically shorter than that of type 2 (< 20 mm) and may have a hazy appearance. To confirm this type, intracoronary imaging is required. The angiographic findings include linear and long lesion or coronary tortuosity. Another important distinguishing factor from atherosclerosis is the absence of atherosclerosis in the reminder of coronary vessels.
Type 4: angiographic finding of this type include an occluded artery. The repeat angiography is required to visualize the healed coronary artery and confirm the diagnosis.

↑ Kim, Esther S.H.; Longo, Dan L. (2020). "Spontaneous Coronary-Artery Dissection". New England Journal of Medicine. 383 (24): 2358–2370. doi:10.1056/NEJMra2001524. ISSN 0028-4793.