Spontaneous coronary artery dissection angiography

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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

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 acute coronary syndrome. The predominant angiographic feature of SCAD consists of smooth narrowing of varying severity and length involving mid-to-distal coronary segments, secondary to compression of the true lumen and/or expansion of the false lumen by the development of 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

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Angiographic findings include:

  • Type 1: appearance on an angiography involves the presence of two intraluminal streams/lumens separated by a radioluscent flap of 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 3: appearance mimics atherosclerosis. The dissection is typically shorter than that of type 2 (< 20 mm) and may have a hazy appearance.


Angiographic Classification of SCAD

References