Spontaneous coronary artery dissection other imaging findings: Difference between revisions
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* Facilitate diagnosis of potential arteriopathy | * Facilitate diagnosis of potential arteriopathy | ||
Disadvantages of intracoronary imaging for SCAD include: | 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> | ||
* Invasive, requires anticoagulation | * Invasive, requires anticoagulation | ||
* Costly | * Costly | ||
Revision as of 17:16, 27 February 2018
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Spontaneous Coronary Artery Dissection Microchapters |
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Differentiating Spontaneous coronary artery dissection from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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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
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.
Other Imaging Findings
Intracoronary Imaging: 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.
Advantages and Disadvantages of Intracoronary Imaging for SCAD
Advantages of intracoronary imaging for SCAD include:[5]
- Definitive diagnosis of SCAD
- Confirm true lumen entry by coronary wire
- Facilitate stent sizing
- Confirm adequate stent apposition
- Confirm full coverage of dissected segment
- Facilitate diagnosis of potential arteriopathy
Disadvantages of intracoronary imaging for SCAD include:[5]
- Invasive, requires anticoagulation
- Costly
- Not available in all laboratories
- Possible risks of extending dissection by guide catheter, coronary wire, imaging catheter, hydraulic extension (with OCT)
- Vessel occlusion by catheter or embolization
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 | |
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+2 |
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+1 |
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+1 |
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+1 |
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+1 |
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+3 |
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+1 |
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+2 |
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+1 |
| Angiographic Characteristics | |
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+1 |
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+1 |
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+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.
Coronary Computed Tomography Angiography
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.[7][8][9] 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
- ↑ 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) - ↑ 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) - ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.