Spontaneous coronary artery dissection other imaging findings
Spontaneous Coronary Artery Dissection Microchapters |
Differentiating Spontaneous coronary artery dissection from other Diseases |
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Diagnosis |
Treatment |
Case Studies |
Type 1 Type 2A Type 2B 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
The gold standard for the diagnosis of SCAD is conventional coronary angiography with intravascular imaging. Although exposure to radiation has always been a concern for especially pregnant or young women, this is the only way to make a definitive diagnosis.
Other Imaging Findings
Intravascular Ultrasound and Optical Coherence Tomogrpahy
When angiographic diagnosis of SCAD is uncertain, intracoronary imaging such as intravascular ultrasound (IVUS)[1][2][3] or optical coherence tomography (OCT)[4] 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.
A clinical-angiographic scoring system for faster and efficient SCAD diagnosis has been proposed as follows:[5]
Clinical-Angiographic Score System for SCAD Faster Diagnosis | |
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Clinical Characteristics | |
|
+2 |
|
+1 |
|
+1 |
|
+1 |
|
+1 |
|
+3 |
|
+1 |
|
+2 |
|
+1 |
Angiographic Characteristics | |
|
+1 |
|
+1 |
|
+1 |
At least 3 points: Indication to perform endovascular imaging (OCT or, if not available, IVUS) | |
In the presence of a score of at least three points in a patient presenting with chest pain, ECG/Echo abnormalities or troponin rise/fall, perform OCT/IVUS analysis for suspected SCAD. |
References
- ↑ 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
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ignored (help) - ↑ 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) - ↑ 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.
- ↑ 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) - ↑ 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.