Spontaneous coronary artery dissection angiography: Difference between revisions

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__NOTOC__
__NOTOC__
{{Spontaneous coronary artery dissection}}
{{Spontaneous coronary artery dissection}}
{{CMG}}; {{AE}}{{NRM}} {{AKK}}
{{CMG}}; {{AE}} {{NRM}}; {{AKK}}


{{SK}} SCAD
{{SK}} SCAD
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==Overview==
==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 [[fibromuscular dysplasia|coronary fibromuscular dysplasia]].


==Angiography==
==Angiography==


In the past, this disorder was often diagnosed only at the time of [[autopsy]].<ref>{{cite journal|author=Narasimhan, S |title=Spontaneous coronary artery dissection (SCAD)|journal=IJTCVS |volume=20 |issue=4 |pages=189-91 |year=2004 |pmid= |doi= 10.1007/s12055-004-0084-x|url=http://medind.nic.in/ibq/t04/i4/ibqt04i4p189.pdf}}</ref> At present, however, [[angiography]] is most often used to diagnose SCAD.<ref name="pmid18830003">{{cite journal |author=Kamran M, Guptan A, Bogal M|title=Spontaneous coronary artery dissection: case series and review |journal=J Invasive Cardiol |volume=20 |issue=10 |pages=553–9 |year=2008 |month=October |pmid=18830003|doi= |url=http://jic.epubxpress.com/link/jic/2008/oct/90?s=0}}</ref> Angiographic findings include:
[[Angiographic]] findings 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>
* '''Type 1:''' appearance on an angiography involves the presence of two intraluminal streams/lumens separated by a radioluscent flap of intima.
* '''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, formation of a [[hematoma]] can result in luminal narrowing which is seen as a stenosis on an angiography.
* '''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.
* '''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]].
 
===Image===
[[Image:SCAD_çizim.png|800 px|thumb|center|'''Angiographic Classification of SCAD''']]
[[Image:SCAD_çizim.png|800 px|thumb|center|'''Angiographic Classification of SCAD''']]
{{See also|Spontaneous coronary artery dissection classification}}


==References==
==References==

Latest revision as of 09:49, 4 March 2021

Spontaneous Coronary Artery Dissection Microchapters

Home

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

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 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.

Angiography

Angiographic findings include:[1]

Image

Angiographic Classification of SCAD

References

  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.