Spontaneous coronary artery dissection other imaging findings: Difference between revisions

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==Overview==
==Overview==


When the diagnosis of spontaneous coronary artery dissection (SCAD) cannot be ascertained by the standard coronary angiography, intracoronary imaging such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT) may provide complementary information for establishing a definitive diagnosis.  Coronary computed tomography angiography (CCTA) may be useful for non-invasive follow-up of SCAD involving proximal or large-caliber coronary arteries.
When the [[diagnosis]] of spontaneous coronary artery dissection ([[SCAD]]) cannot be ascertained by the standard [[coronary angiography]], intracoronary [[imaging]] such as [[intravascular ultrasound]] ([[IVUS]]) or [[optical coherence tomography]] ([[OCT]]) may provide complementary information for establishing a definitive diagnosis.  [[Coronary]] [[computed tomography angiography]] (CCTA) may be useful for non-invasive follow-up of [[SCAD]] involving proximal or large-caliber [[coronary]] [[arteries]]. [[OCT]] findings suggestive of [[SCAD]] may include the presence of two [[lumen]]s and intramural [[hematoma]].


==Other Imaging Findings==
==Other Imaging Findings==


=== Intracoronary Imaging: Intravascular Ultrasound and Optical Coherence Tomogrpahy ===
===Intracoronary Imaging: [[Intravascular Ultrasound]] and [[Optical Coherence Tomography]===


When angiographic diagnosis of SCAD is uncertain, intracoronary imaging such as [[intravascular ultrasound]] ([[IVUS]])<ref name="pmid11835932">{{cite journal |author=Maehara A, Mintz GS, Castagna MT, ''et al.'' |title=Intravascular ultrasound assessment of spontaneous coronary artery dissection |journal=[[The American Journal of Cardiology]] |volume=89 |issue=4 |pages=466–8 |year=2002 |month=February |pmid=11835932 |doi= |url=}}</ref><ref name="pmid14760197">{{cite journal |author=Porto I, Banning AP |title=Intravascular ultrasound imaging in the diagnosis and treatment of spontaneous coronary dissection with drug-eluting stents |journal=[[The Journal of Invasive Cardiology]] |volume=16 |issue=2 |pages=78–80 |year=2004 |month=February |pmid=14760197 |doi= |url=}}</ref><ref name="pmid18513437">{{cite journal |author=Arnold JR, West NE, van Gaal WJ, Karamitsos TD, Banning AP |title=The role of intravascular ultrasound in the management of spontaneous coronary artery dissection |journal=[[Cardiovascular Ultrasound]] |volume=6 |issue= |pages=24 |year=2008 |pmid=18513437 |pmc=2429898 |doi=10.1186/1476-7120-6-24 |url=}}</ref> or [[optical coherence tomography]] ([[OCT]])<ref name="pmid19401282">{{cite journal |author=Ishibashi K, Kitabata H, Akasaka T |title=Intracoronary optical coherence tomography assessment of spontaneous coronary artery dissection |journal=[[Heart (British Cardiac Society)]] |volume=95 |issue=10 |pages=818 |year=2009 |month=May |pmid=19401282 |doi=10.1136/hrt.2008.158485 |url=}}</ref> may provide adjunctive information for establishing the diagnosis. OCT may be superior to IVUS with respect to delineating the lumen-intimal interface and visualizing intimal tears, false lumen, intramural hematoma, and intraluminal thrombosis. However, these advanced imaging modalities may not be readily available and have potential risks, including extending the coronary dissection with guidewire or imaging catheter, catheter-induced occlusion of true lumen, and hydraulic extension with contrast injection for OCT.  Intracoronary imaging should be pursued only when angiographic diagnosis cannot be determined and when the lesion can be crossed with the imaging catheter.
*When [[angiographic]] diagnosis of [[SCAD]] is uncertain, [[intracoronary]] imaging such as [[intravascular ultrasound]] ([[IVUS]])<ref name="pmid11835932">{{cite journal |author=Maehara A, Mintz GS, Castagna MT, ''et al.'' |title=Intravascular ultrasound assessment of spontaneous coronary artery dissection |journal=[[The American Journal of Cardiology]] |volume=89 |issue=4 |pages=466–8 |year=2002 |month=February |pmid=11835932 |doi= |url=}}</ref><ref name="pmid14760197">{{cite journal |author=Porto I, Banning AP |title=Intravascular ultrasound imaging in the diagnosis and treatment of spontaneous coronary dissection with drug-eluting stents |journal=[[The Journal of Invasive Cardiology]] |volume=16 |issue=2 |pages=78–80 |year=2004 |month=February |pmid=14760197 |doi= |url=}}</ref><ref name="pmid18513437">{{cite journal |author=Arnold JR, West NE, van Gaal WJ, Karamitsos TD, Banning AP |title=The role of intravascular ultrasound in the management of spontaneous coronary artery dissection |journal=[[Cardiovascular Ultrasound]] |volume=6 |issue= |pages=24 |year=2008 |pmid=18513437 |pmc=2429898 |doi=10.1186/1476-7120-6-24 |url=}}</ref> or [[optical coherence tomography]] ([[OCT]])<ref name="pmid19401282">{{cite journal |author=Ishibashi K, Kitabata H, Akasaka T |title=Intracoronary optical coherence tomography assessment of spontaneous coronary artery dissection |journal=[[Heart (British Cardiac Society)]] |volume=95 |issue=10 |pages=818 |year=2009 |month=May |pmid=19401282 |doi=10.1136/hrt.2008.158485 |url=}}</ref> may provide adjunctive information for establishing the diagnosis.  
* [[OCT]] may be superior to [[IVUS]] with respect to delineating the [[lumen]]-intimal interface and visualizing [[intimal]] tears, false [[lumen]], [[intramural hematoma]], and intraluminal [[thrombosis]].  
*These advanced imaging modalities may not be readily available and have potential risks, including extending the [[coronary dissection]] with [[guidewire]] or [[imaging]] [[catheter]], [[catheter-induced occlusion]] of the true [[lumen]], hydraulic extension with contrast injection for [[OCT]].   
*[[Intracoronary imaging]] should be pursued only when the angiographic diagnosis cannot be determined and when the [[lesion]] can be crossed with the imaging [[catheter]].


====Advantages and Disadvantages of Intracoronary Imaging for SCAD====
====Advantages and Disadvantages of Intracoronary Imaging for [[SCAD]]====


Advantages of intracoronary imaging for SCAD include:<ref name="SawMancini2016">{{cite journal|last1=Saw|first1=Jacqueline|last2=Mancini|first2=G.B. John|last3=Humphries|first3=Karin H.|title=Contemporary Review on Spontaneous Coronary Artery Dissection|journal=Journal of the American College of Cardiology|volume=68|issue=3|year=2016|pages=297–312|issn=07351097|doi=10.1016/j.jacc.2016.05.034}}</ref>
*Advantages of [[intracoronary imaging]] for [[SCAD]] include:<ref name="SawMancini2016">{{cite journal|last1=Saw|first1=Jacqueline|last2=Mancini|first2=G.B. John|last3=Humphries|first3=Karin H.|title=Contemporary Review on Spontaneous Coronary Artery Dissection|journal=Journal of the American College of Cardiology|volume=68|issue=3|year=2016|pages=297–312|issn=07351097|doi=10.1016/j.jacc.2016.05.034}}</ref>
* Definitive diagnosis of SCAD
:*Definitive diagnosis of [[SCAD]]
* Confirm true lumen entry by coronary wire
:*Confirm true lumen entry by coronary wire
* Facilitate stent sizing
:*Facilitate [[stent]] sizing
* Confirm adequate stent apposition
:*Confirm adequate stent apposition
* Confirm full coverage of dissected segment
:*Confirm full coverage of the [[dissected]] segment
* Facilitate diagnosis of potential arteriopathy
:*Facilitate diagnosis of potential [[arteriopathy]]
*Disadvantages of intracoronary imaging for [[SCAD]] include:<ref name="SawMancini2016">{{cite journal|last1=Saw|first1=Jacqueline|last2=Mancini|first2=G.B. John|last3=Humphries|first3=Karin H.|title=Contemporary Review on Spontaneous Coronary Artery Dissection|journal=Journal of the American College of Cardiology|volume=68|issue=3|year=2016|pages=297–312|issn=07351097|doi=10.1016/j.jacc.2016.05.034}}</ref>


Disadvantages of intracoronary imaging for SCAD include:
:*Invasive requires [[anticoagulation]]
* Invasive, requires anticoagulation
:*Costly
* Costly
:*Not available in all laboratories
* Not available in all laboratories
:*Possible risks of extending dissection by [[guide catheter]], [[coronary]] wire, imaging [[catheter]], hydraulic extension (with [[OCT]])
* Possible risks of extending dissection by guide catheter, coronary wire, imaging catheter, hydraulic extension (with OCT)
:*[[Vessel]] occlusion by [[catheter]] or [[embolization]]
* Vessel occlusion by catheter or embolization


====Indications for Intracoronary Imaging in the Setting of SCAD====
====Indications for Intracoronary Imaging in the Setting of [[SCAD]]====
 
*A clinical-angiographic scoring system for faster and efficient [[SCAD]] diagnosis has been proposed as follows:<ref name="pmid28149642">{{cite journal| author=Buccheri D, Zambelli G| title=Focusing on spontaneous coronary artery dissection: actuality and future perspectives. | journal=J Thorac Dis | year= 2016 | volume= 8 | issue= 12 | pages= E1784-E1786 | pmid=28149642 | doi=10.21037/jtd.2016.12.79 | pmc=5227193 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28149642  }} </ref>
A clinical-angiographic scoring system for faster and efficient SCAD diagnosis has been proposed as follows:<ref name="pmid28149642">{{cite journal| author=Buccheri D, Zambelli G| title=Focusing on spontaneous coronary artery dissection: actuality and future perspectives. | journal=J Thorac Dis | year= 2016 | volume= 8 | issue= 12 | pages= E1784-E1786 | pmid=28149642 | doi=10.21037/jtd.2016.12.79 | pmc=5227193 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28149642  }} </ref>


{| class="wikitable" style="width: 80%; text-align: justify;"
{| class="wikitable" style="width: 80%; text-align: justify;"
! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Clinical-Angiographic Score System for SCAD Faster Diagnosis}}
! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Clinical-Angiographic Score System for SCAD Faster Diagnosis}}
|-
|-
! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Clinical Characteristics}}
! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Clinical Characteristics}}
|-
|-
|
|
* Connective tissue disorder (Marfan syndrome, Ehlers-Danlos syndrome, cystic medial necrosis) / Fibromuscular Dysplasia
*[[Connective tissue disorder]] ([[Marfan syndrome]], [[ Ehlers-Danlos syndrome]], [[cystic medial necrosis]]) / [[Fibromuscular Dysplasia]]
| +2
| +2
|-
|-
|
|
* Youth / <50 year
*Youth / <50 year
| +1
| +1
|-
|-
|
|
* Estroprogestinic therapy
*[[Estroprogestinic]] therapy
| +1
| +1
|-
|-
|
|
* No classical coronary risk factors
*No classical coronary risk factors
| +1
| +1
|-
|-
|
|
* Pregnancy (peri-partum, history of multiple pregnancy) / Female gender
*[[Pregnancy]] ([[peripartum]], history of multiple [[pregnancies]]) / [[Female]] gender
| +1
| +1
|-
|-
|
|
* History of coronary artery spasm / Previous SCAD
*History of [[coronary artery spasm]] / Previous [[SCAD]]
| +3
| +3
|-
|-
|
|
* Amphetamines / Cocaine / Vasospastic drug abuse
*[[Amphetamines]] / [[Cocaine]] / [[Vasospastic drug abuse]]
| +1
| +1
|-
|-
|
|
* Systemic inflammation (SLE, Crohn disease, sarcoidosis, polyarteritis nodosa, Behcet's syndrome)
*[[Systemic inflammation]] ([[SLE]], [[Crohn disease]], [[sarcoidosis]], [[polyarteritis nodosa]], [[ Behcet's syndrome]])
| +2
| +2
|-
|-
|
|
* Emotional / Physical stress
*[[Emotional]] / [[Physical stress]]
| +1
| +1
|-
|-
! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Angiographic Characteristics}}
! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Angiographic Characteristics}}
|-
|-
|
|
* One vessel disease (no typical atherosclerotic lesions in other coronary arteries)
*One [[vessel]] disease (no typical [[atherosclerotic]] [[lesions]] in other [[coronary arteries]])
| +1
| +1
|-
|-
|
|
* Long/tortuous suspected lesion
*Long/tortuous suspected [[lesion]]
| +1
| +1
|-
|-
|
|
* Diffuse, typically smooth arterial narrowing
*Diffuse, typically smooth [[arterial]] narrowing
| +1
| +1
|-
|-
| colspan="2" |'''At least 3 points:''' Indication to perform endovascular imaging (OCT or, if not available, IVUS)
| colspan="2" |'''At least 3 points:''' Indication to perform endovascular imaging ([[OCT]] or, if not available, [[IVUS]])
|-
|-
|}
|}


OCT/IVUS for suspected SCAD may be indicated in a patient with chest pain, ECG/Echo abnormalities, troponin rise/fall, and a score of ≥3 points.
[[OCT]]/[[IVUS]] for suspected [[SCAD]] may be indicated in a patient with [[chest pain]], [[ECG]]/[[Echo]] abnormalities, [[troponin]] rise/fall, and a score of ≥3 points.


===Coronary Computed Tomography Angiography===
=== Optical Coherence Tomography ===
Table below describes the [[imaging]] findings of various types of [[SCAD]] in [[optical coherence tomography]] ([[OCT]]) [[imaging]] study:<ref name="KimLongo2020">{{cite journal|last1=Kim|first1=Esther S.H.|last2=Longo|first2=Dan L.|title=Spontaneous Coronary-Artery Dissection|journal=New England Journal of Medicine|volume=383|issue=24|year=2020|pages=2358–2370|issn=0028-4793|doi=10.1056/NEJMra2001524}}</ref>


Thus far, no studies have comprehensively evaluated the usefulness of coronary computed tomography angiography (CCTA) in the setting of spontaneous coronary artery dissection (SCAD).  CCTA is not recommended as the first-line investigation for suspected SCAD as CCTA is generally contraindicated in patients presenting with high-risk acute coronary syndrome.<ref name="RybickiUdelson2016">{{cite journal|last1=Rybicki|first1=Frank J.|last2=Udelson|first2=James E.|last3=Peacock|first3=W. Frank|last4=Goldhaber|first4=Samuel Z.|last5=Isselbacher|first5=Eric M.|last6=Kazerooni|first6=Ella|last7=Kontos|first7=Michael C.|last8=Litt|first8=Harold|last9=Woodard|first9=Pamela K.|last10=Alpert|first10=Joseph S.|last11=Andrews|first11=George A.|last12=Chen|first12=Edward P.|last13=Cooke|first13=David T.|last14=Cury|first14=Ricardo C.|last15=Edmundowicz|first15=Daniel|last16=Ferrari|first16=Victor|last17=Graff|first17=Louis G.|last18=Hollander|first18=Judd E.|last19=Klein|first19=Lloyd W.|last20=Leipsic|first20=Jonathan|last21=Levy|first21=Phillip D.|last22=Mahmarian|first22=John J.|last23=Rosenberg|first23=Craig|last24=Rubin|first24=Geoffrey|last25=Ward|first25=R. Parker|last26=White|first26=Charles|last27=Yucel|first27=E. Kent|last28=Carr|first28=J. Jeffrey|last29=Rybicki|first29=Frank J.|last30=White|first30=Richard D.|last31=Woodard|first31=Pamela K.|last32=Patel|first32=Manesh|last33=Douglas|first33=Pamela|last34=Hendel|first34=Robert C.|last35=Kramer|first35=Christopher|last36=Doherty|first36=John|title=2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain|journal=Journal of the American College of Radiology|volume=13|issue=2|year=2016|pages=e1–e29|issn=15461440|doi=10.1016/j.jacr.2015.07.007}}</ref><ref name="MarkBerman2010">{{cite journal|last1=Mark|first1=D. B.|last2=Berman|first2=D. S.|last3=Budoff|first3=M. J.|last4=Carr|first4=J. J.|last5=Gerber|first5=T. C.|last6=Hecht|first6=H. S.|last7=Hlatky|first7=M. A.|last8=Hodgson|first8=J. M.|last9=Lauer|first9=M. S.|last10=Miller|first10=J. M.|last11=Morin|first11=R. L.|last12=Mukherjee|first12=D.|last13=Poon|first13=M.|last14=Rubin|first14=G. D.|last15=Schwartz|first15=R. S.|title=ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents|journal=Circulation|volume=121|issue=22|year=2010|pages=2509–2543|issn=0009-7322|doi=10.1161/CIR.0b013e3181d4b618}}</ref><ref name="HammBassand2011">{{cite journal|last1=Hamm|first1=C. W.|last2=Bassand|first2=J.-P.|last3=Agewall|first3=S.|last4=Bax|first4=J.|last5=Boersma|first5=E.|last6=Bueno|first6=H.|last7=Caso|first7=P.|last8=Dudek|first8=D.|last9=Gielen|first9=S.|last10=Huber|first10=K.|last11=Ohman|first11=M.|last12=Petrie|first12=M. C.|last13=Sonntag|first13=F.|last14=Uva|first14=M. S.|last15=Storey|first15=R. F.|last16=Wijns|first16=W.|last17=Zahger|first17=D.|last18=Bax|first18=J. J.|last19=Auricchio|first19=A.|last20=Baumgartner|first20=H.|last21=Ceconi|first21=C.|last22=Dean|first22=V.|last23=Deaton|first23=C.|last24=Fagard|first24=R.|last25=Funck-Brentano|first25=C.|last26=Hasdai|first26=D.|last27=Hoes|first27=A.|last28=Knuuti|first28=J.|last29=Kolh|first29=P.|last30=McDonagh|first30=T.|last31=Moulin|first31=C.|last32=Poldermans|first32=D.|last33=Popescu|first33=B. A.|last34=Reiner|first34=Z.|last35=Sechtem|first35=U.|last36=Sirnes|first36=P. A.|last37=Torbicki|first37=A.|last38=Vahanian|first38=A.|last39=Windecker|first39=S.|last40=Windecker|first40=S.|last41=Achenbach|first41=S.|last42=Badimon|first42=L.|last43=Bertrand|first43=M.|last44=Botker|first44=H. E.|last45=Collet|first45=J.-P.|last46=Crea|first46=F.|last47=Danchin|first47=N.|last48=Falk|first48=E.|last49=Goudevenos|first49=J.|last50=Gulba|first50=D.|last51=Hambrecht|first51=R.|last52=Herrmann|first52=J.|last53=Kastrati|first53=A.|last54=Kjeldsen|first54=K.|last55=Kristensen|first55=S. D.|last56=Lancellotti|first56=P.|last57=Mehilli|first57=J.|last58=Merkely|first58=B.|last59=Montalescot|first59=G.|last60=Neumann|first60=F.-J.|last61=Neyses|first61=L.|last62=Perk|first62=J.|last63=Roffi|first63=M.|last64=Romeo|first64=F.|last65=Ruda|first65=M.|last66=Swahn|first66=E.|last67=Valgimigli|first67=M.|last68=Vrints|first68=C. J.|last69=Widimsky|first69=P.|title=ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)|journal=European Heart Journal|volume=32|issue=23|year=2011|pages=2999–3054|issn=0195-668X|doi=10.1093/eurheartj/ehr236}}</ref> CCTA may have a lower spatial and temporal resolution than coronary angiography in the diagnosis of SCAD, and normal results on CCTA do not completely exclude SCAD.  Nevertheless, CCTA may be useful for non-invasive follow-up of SCAD involving proximal or large-caliber coronary arteries.
{| class="wikitable"
|+
! colspan="2" style="background: #4479BA; text-align: center;" colspan=2 | {{fontcolor|#FFF|[[SCAD]] Subtype}}
! style="background: #4479BA; text-align: center;" colspan=2 | {{fontcolor|#FFF|[[OCT]] Finding}}
|-
| colspan="2" |Type 1
|
* Intramural [[hematoma]]
* Two lumens divided by an [[intimal]] tear
|-
| rowspan="2" |Type 2
|Type 2A
| rowspan="3" |
* Presence of a compressive intramural [[hematoma]]
|-
|Type 2B
|-
| colspan="2" |Type 3
|-
| colspan="2" |Type 4
|
* No specific finding
|}
<br />
=== Computed Tomography Angiography ===
*A small percentage of [[patients]] with SCAD usually demonstrate signs of [[connective tissue disorders]] or [[vascular]] [[disorders]] including but not limited to [[fibromascular dysplasia]].
*[[ Computed tomography angiography]] ([[CTA]]) of the body may reveal other [[angiographic]] abnormalities of these subgroup of [[patients]]. Findings may include: <ref name="KimLongo2020">{{cite journal|last1=Kim|first1=Esther S.H.|last2=Longo|first2=Dan L.|title=Spontaneous Coronary-Artery Dissection|journal=New England Journal of Medicine|volume=383|issue=24|year=2020|pages=2358–2370|issn=0028-4793|doi=10.1056/NEJMra2001524}}</ref>
:* [[Dissection]] of [[arteries]]
:* Aneurysmal changes or beadings of the [[arteries]]
:* Multifocal fibromuscular dysplasia of the [[arteries]]
*[[Arteries]] that can be affected include:
:* [[Celiac]]
:* [[Cerebral]]
:* [[Cervical]]
:* [[External iliac]]
:* [[Internal carotid]]
:* [[Vertebral]]
:* [[Renal]]
===[[Coronary Computed Tomography Angiography]]===
* [[CCTA]] is not recommended as the first-line investigation for suspected [[SCAD]] as [[CCTA]] is generally contraindicated in patients presenting with high-risk [[acute coronary syndrome]].<ref name="RybickiUdelson2016">{{cite journal|last1=Rybicki|first1=Frank J.|last2=Udelson|first2=James E.|last3=Peacock|first3=W. Frank|last4=Goldhaber|first4=Samuel Z.|last5=Isselbacher|first5=Eric M.|last6=Kazerooni|first6=Ella|last7=Kontos|first7=Michael C.|last8=Litt|first8=Harold|last9=Woodard|first9=Pamela K.|last10=Alpert|first10=Joseph S.|last11=Andrews|first11=George A.|last12=Chen|first12=Edward P.|last13=Cooke|first13=David T.|last14=Cury|first14=Ricardo C.|last15=Edmundowicz|first15=Daniel|last16=Ferrari|first16=Victor|last17=Graff|first17=Louis G.|last18=Hollander|first18=Judd E.|last19=Klein|first19=Lloyd W.|last20=Leipsic|first20=Jonathan|last21=Levy|first21=Phillip D.|last22=Mahmarian|first22=John J.|last23=Rosenberg|first23=Craig|last24=Rubin|first24=Geoffrey|last25=Ward|first25=R. Parker|last26=White|first26=Charles|last27=Yucel|first27=E. Kent|last28=Carr|first28=J. Jeffrey|last29=Rybicki|first29=Frank J.|last30=White|first30=Richard D.|last31=Woodard|first31=Pamela K.|last32=Patel|first32=Manesh|last33=Douglas|first33=Pamela|last34=Hendel|first34=Robert C.|last35=Kramer|first35=Christopher|last36=Doherty|first36=John|title=2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain|journal=Journal of the American College of Radiology|volume=13|issue=2|year=2016|pages=e1–e29|issn=15461440|doi=10.1016/j.jacr.2015.07.007}}</ref><ref name="MarkBerman2010">{{cite journal|last1=Mark|first1=D. B.|last2=Berman|first2=D. S.|last3=Budoff|first3=M. J.|last4=Carr|first4=J. J.|last5=Gerber|first5=T. C.|last6=Hecht|first6=H. S.|last7=Hlatky|first7=M. A.|last8=Hodgson|first8=J. M.|last9=Lauer|first9=M. S.|last10=Miller|first10=J. M.|last11=Morin|first11=R. L.|last12=Mukherjee|first12=D.|last13=Poon|first13=M.|last14=Rubin|first14=G. D.|last15=Schwartz|first15=R. S.|title=ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents|journal=Circulation|volume=121|issue=22|year=2010|pages=2509–2543|issn=0009-7322|doi=10.1161/CIR.0b013e3181d4b618}}</ref><ref name="HammBassand2011">{{cite journal|last1=Hamm|first1=C. W.|last2=Bassand|first2=J.-P.|last3=Agewall|first3=S.|last4=Bax|first4=J.|last5=Boersma|first5=E.|last6=Bueno|first6=H.|last7=Caso|first7=P.|last8=Dudek|first8=D.|last9=Gielen|first9=S.|last10=Huber|first10=K.|last11=Ohman|first11=M.|last12=Petrie|first12=M. C.|last13=Sonntag|first13=F.|last14=Uva|first14=M. S.|last15=Storey|first15=R. F.|last16=Wijns|first16=W.|last17=Zahger|first17=D.|last18=Bax|first18=J. J.|last19=Auricchio|first19=A.|last20=Baumgartner|first20=H.|last21=Ceconi|first21=C.|last22=Dean|first22=V.|last23=Deaton|first23=C.|last24=Fagard|first24=R.|last25=Funck-Brentano|first25=C.|last26=Hasdai|first26=D.|last27=Hoes|first27=A.|last28=Knuuti|first28=J.|last29=Kolh|first29=P.|last30=McDonagh|first30=T.|last31=Moulin|first31=C.|last32=Poldermans|first32=D.|last33=Popescu|first33=B. A.|last34=Reiner|first34=Z.|last35=Sechtem|first35=U.|last36=Sirnes|first36=P. A.|last37=Torbicki|first37=A.|last38=Vahanian|first38=A.|last39=Windecker|first39=S.|last40=Windecker|first40=S.|last41=Achenbach|first41=S.|last42=Badimon|first42=L.|last43=Bertrand|first43=M.|last44=Botker|first44=H. E.|last45=Collet|first45=J.-P.|last46=Crea|first46=F.|last47=Danchin|first47=N.|last48=Falk|first48=E.|last49=Goudevenos|first49=J.|last50=Gulba|first50=D.|last51=Hambrecht|first51=R.|last52=Herrmann|first52=J.|last53=Kastrati|first53=A.|last54=Kjeldsen|first54=K.|last55=Kristensen|first55=S. D.|last56=Lancellotti|first56=P.|last57=Mehilli|first57=J.|last58=Merkely|first58=B.|last59=Montalescot|first59=G.|last60=Neumann|first60=F.-J.|last61=Neyses|first61=L.|last62=Perk|first62=J.|last63=Roffi|first63=M.|last64=Romeo|first64=F.|last65=Ruda|first65=M.|last66=Swahn|first66=E.|last67=Valgimigli|first67=M.|last68=Vrints|first68=C. J.|last69=Widimsky|first69=P.|title=ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)|journal=European Heart Journal|volume=32|issue=23|year=2011|pages=2999–3054|issn=0195-668X|doi=10.1093/eurheartj/ehr236}}</ref>
*[[CCTA]] may have a lower spatial and temporal resolution than [[coronary angiography]] in the diagnosis of [[SCAD]], and normal results on [[CCTA]] do not completely exclude [[SCAD]].  Nevertheless, [[CCTA]] may be useful for non-invasive follow-up of [[SCAD]] involving proximal or large-caliber [[coronary arteries]].


==References==
==References==

Latest revision as of 10:20, 4 March 2021

Spontaneous Coronary Artery Dissection Microchapters

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Differentiating Spontaneous coronary artery dissection from other Diseases

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Type 1

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Type 3

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

When the diagnosis of spontaneous coronary artery dissection (SCAD) cannot be ascertained by the standard coronary angiography, intracoronary imaging such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT) may provide complementary information for establishing a definitive diagnosis. Coronary computed tomography angiography (CCTA) may be useful for non-invasive follow-up of SCAD involving proximal or large-caliber coronary arteries. OCT findings suggestive of SCAD may include the presence of two lumens and intramural hematoma.

Other Imaging Findings

Intracoronary Imaging: Intravascular Ultrasound and [[Optical Coherence Tomography]

Advantages and Disadvantages of Intracoronary Imaging for SCAD

  • Definitive diagnosis of SCAD
  • Confirm true lumen entry by coronary wire
  • Facilitate stent sizing
  • Confirm adequate stent apposition
  • Confirm full coverage of the dissected segment
  • Facilitate diagnosis of potential arteriopathy
  • Disadvantages of intracoronary imaging for SCAD include:[5]

Indications for Intracoronary Imaging in the Setting of SCAD

  • A clinical-angiographic scoring system for faster and efficient SCAD diagnosis has been proposed as follows:[6]
Clinical-Angiographic Score System for SCAD Faster Diagnosis
Clinical Characteristics
+2
  • Youth / <50 year
 +1
+1
  • No classical coronary risk factors
 +1
+1
+3
+1
+2
+1
Angiographic Characteristics
+1
  • Long/tortuous suspected lesion
 +1
  • Diffuse, typically smooth arterial narrowing
 +1
At least 3 points: Indication to perform endovascular imaging (OCT or, if not available, IVUS)

OCT/IVUS for suspected SCAD may be indicated in a patient with chest pain, ECG/Echo abnormalities, troponin rise/fall, and a score of ≥3 points.

Optical Coherence Tomography

Table below describes the imaging findings of various types of SCAD in optical coherence tomography (OCT) imaging study:[7]

SCAD Subtype OCT Finding
Type 1
Type 2 Type 2A
  • Presence of a compressive intramural hematoma
Type 2B
Type 3
Type 4
  • No specific finding


Computed Tomography Angiography

Coronary Computed Tomography Angiography

References

  1. ↑ Maehara A, Mintz GS, Castagna MT; et al. (2002). "Intravascular ultrasound assessment of spontaneous coronary artery dissection". The American Journal of Cardiology. 89 (4): 466–8. PMID 11835932. Unknown parameter |month= ignored (help)
  2. ↑ Porto I, Banning AP (2004). "Intravascular ultrasound imaging in the diagnosis and treatment of spontaneous coronary dissection with drug-eluting stents". The Journal of Invasive Cardiology. 16 (2): 78–80. PMID 14760197. Unknown parameter |month= ignored (help)
  3. ↑ Arnold JR, West NE, van Gaal WJ, Karamitsos TD, Banning AP (2008). "The role of intravascular ultrasound in the management of spontaneous coronary artery dissection". Cardiovascular Ultrasound. 6: 24. doi:10.1186/1476-7120-6-24. PMC 2429898. PMID 18513437.
  4. ↑ Ishibashi K, Kitabata H, Akasaka T (2009). "Intracoronary optical coherence tomography assessment of spontaneous coronary artery dissection". Heart (British Cardiac Society). 95 (10): 818. doi:10.1136/hrt.2008.158485. PMID 19401282. Unknown parameter |month= ignored (help)
  5. ↑ 5.0 5.1 Saw, Jacqueline; Mancini, G.B. John; Humphries, Karin H. (2016). "Contemporary Review on Spontaneous Coronary Artery Dissection". Journal of the American College of Cardiology. 68 (3): 297–312. doi:10.1016/j.jacc.2016.05.034. ISSN 0735-1097.
  6. ↑ Buccheri D, Zambelli G (2016). "Focusing on spontaneous coronary artery dissection: actuality and future perspectives". J Thorac Dis. 8 (12): E1784–E1786. doi:10.21037/jtd.2016.12.79. PMC 5227193. PMID 28149642.
  7. ↑ 7.0 7.1 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.
  8. ↑ Rybicki, Frank J.; Udelson, James E.; Peacock, W. Frank; Goldhaber, Samuel Z.; Isselbacher, Eric M.; Kazerooni, Ella; Kontos, Michael C.; Litt, Harold; Woodard, Pamela K.; Alpert, Joseph S.; Andrews, George A.; Chen, Edward P.; Cooke, David T.; Cury, Ricardo C.; Edmundowicz, Daniel; Ferrari, Victor; Graff, Louis G.; Hollander, Judd E.; Klein, Lloyd W.; Leipsic, Jonathan; Levy, Phillip D.; Mahmarian, John J.; Rosenberg, Craig; Rubin, Geoffrey; Ward, R. Parker; White, Charles; Yucel, E. Kent; Carr, J. Jeffrey; Rybicki, Frank J.; White, Richard D.; Woodard, Pamela K.; Patel, Manesh; Douglas, Pamela; Hendel, Robert C.; Kramer, Christopher; Doherty, John (2016). "2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain". Journal of the American College of Radiology. 13 (2): e1–e29. doi:10.1016/j.jacr.2015.07.007. ISSN 1546-1440.
  9. ↑ Mark, D. B.; Berman, D. S.; Budoff, M. J.; Carr, J. J.; Gerber, T. C.; Hecht, H. S.; Hlatky, M. A.; Hodgson, J. M.; Lauer, M. S.; Miller, J. M.; Morin, R. L.; Mukherjee, D.; Poon, M.; Rubin, G. D.; Schwartz, R. S. (2010). "ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents". Circulation. 121 (22): 2509–2543. doi:10.1161/CIR.0b013e3181d4b618. ISSN 0009-7322.
  10. ↑ Hamm, C. W.; Bassand, J.-P.; Agewall, S.; Bax, J.; Boersma, E.; Bueno, H.; Caso, P.; Dudek, D.; Gielen, S.; Huber, K.; Ohman, M.; Petrie, M. C.; Sonntag, F.; Uva, M. S.; Storey, R. F.; Wijns, W.; Zahger, D.; Bax, J. J.; Auricchio, A.; Baumgartner, H.; Ceconi, C.; Dean, V.; Deaton, C.; Fagard, R.; Funck-Brentano, C.; Hasdai, D.; Hoes, A.; Knuuti, J.; Kolh, P.; McDonagh, T.; Moulin, C.; Poldermans, D.; Popescu, B. A.; Reiner, Z.; Sechtem, U.; Sirnes, P. A.; Torbicki, A.; Vahanian, A.; Windecker, S.; Windecker, S.; Achenbach, S.; Badimon, L.; Bertrand, M.; Botker, H. E.; Collet, J.-P.; Crea, F.; Danchin, N.; Falk, E.; Goudevenos, J.; Gulba, D.; Hambrecht, R.; Herrmann, J.; Kastrati, A.; Kjeldsen, K.; Kristensen, S. D.; Lancellotti, P.; Mehilli, J.; Merkely, B.; Montalescot, G.; Neumann, F.-J.; Neyses, L.; Perk, J.; Roffi, M.; Romeo, F.; Ruda, M.; Swahn, E.; Valgimigli, M.; Vrints, C. J.; Widimsky, P. (2011). "ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)". European Heart Journal. 32 (23): 2999–3054. doi:10.1093/eurheartj/ehr236. ISSN 0195-668X.
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