Spontaneous coronary artery dissection other imaging findings
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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
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
In the event that diagnosis of SCAD based on angiography is ambiguous, intravascular ultrasound (IVUS)[1][2][3] or optical coherence tomography (OCT)[4] can be used for diagnostic clarification. In fact, a definitive diagnosis of type 3 SCAD requires OCT or IVUS.[5] IVUS/OCT should be considered the gold standard in diagnosing SCAD. OCT may be preferred to IVUS due to superiority in spatial resolution and clarity in identifying intramural hematomas and intimal tears, though IVUS is still quite adequate.[6]
| Clinical-Angiographic Score System for SCAD Faster Diagnosis | |
|---|---|
| Clinical Characteristics | |
| Connective tissue disorder (Marfan syndrome, Ehler-Danlos syndrome, cystic medial necrosis) / Fibromuscular Dysplasia | +2 |
| Youth/<50 year | +1 |
| Estroprogestinic therapy | +1 |
| No classical coronary risk factors | +1 |
| Pregnancy (peri-partum, history of multiple pregnancy)/ Female gender | +1 |
| History of coronary artery spasm/ Previous SCAD | +3 |
| Amphetamines/Cocaine/ Vasospastic drug abuse | +1 |
| Systematic inflammation (SLE, Chron disease, sarcoidosis, polyarteritis nodosa, Behcet's syndrome | +2 |
| Emotional/ Physical stress | +1 |
| Angiographic Characteristics | |
| One vessel disease (no typical atherosclerotic lesions in order coronary arteries) | +1 |
| Long/tortuose suspected lesion | +1 |
| Diffuse, typically smooth arterial narrowing | +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. [7] | |
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) - ↑
- ↑
- ↑ 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.