Angiographic appearance of spontaneous coronary artery dissection with intramural hematoma proven on intracoronary imaging

Saw, Jacqueline; Mancini, G.B. John; Humphries, Karin H.; Fung, Anthony; Boone, Robert; Starovoytov, Andrew; Aymong, Eve

doi:10.1002/ccd.26022

Cited by 176 publications

(139 citation statements)

References 10 publications

(19 reference statements)

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“…Forandringene kan bli mistolket som aterosklerose på angiografisk undersøkelse, spesielt hvis klassisk dobbeltlumenkontrastavfarging i arterieveggen mangler (3,7,8). Er man da i tvil om diagnosen hos en klassisk pasient, for eksempel en yngre kvinne uten risikofaktorer, kan man supplere med intrakoronar diagnostikk, som optisk koherens-tomografi (optical coherence tomography, OCT) og/eller intravaskulaer ultralyd (IVUS) i tillegg til konvensjonell koronarangiografi (8).…”

Section: Etiologi Og Diagnoseunclassified

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Spontan koronar arteriedisseksjon

2017

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Section: Etiologi Og Diagnoseunclassified

“…Er man da i tvil om diagnosen hos en klassisk pasient, for eksempel en yngre kvinne uten risikofaktorer, kan man supplere med intrakoronar diagnostikk, som optisk koherens-tomografi (optical coherence tomography, OCT) og/eller intravaskulaer ultralyd (IVUS) i tillegg til konvensjonell koronarangiografi (8).…”

Section: Etiologi Og Diagnoseunclassified

Spontan koronar arteriedisseksjon

2017

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“…SCAD resulting from either mechanism results in blood accumulation within the newly formed false lumen, which may compress the true lumen to varying degrees (1), thus presenting as myocardial ischemia, ACS, cardiogenic shock or sudden cardiac death (4,8,9). SCAD may extensively propagate in anterograde and/or retrograde fashion, with the mean length of dissection typically >45 mm on quantitative coronary angiography (10).…”

Section: Spontaneous Coronary Artery Dissection (Scad) Is Definedmentioning

confidence: 99%

“…The most common associated arteriopathy is fibromuscular dysplasia (FMD) (3,4), which is characterized by dysplasia, disorganization, and loss of smooth muscle cells, fibroblasts and connective tissue that may affect any of the three arterial layers and elastic laminae (11)(12)(13), therefore predisposing the affected arteries to dissection and aneurysm formation. FMD may manifest as coronary tortuosity, dilatation or ectasia (10), and as a "string of beads" appearance (stenosis alternating with dilatation) in non-coronary vasculature (3). Pregnancy is another associated predisposing factor, likely due to effects of high progesterone levels in weakening the arterial media through alterations in the elastic fiber and mucopolysaccharide content as well as decreasing collagen synthesis (14).…”

Section: Spontaneous Coronary Artery Dissection (Scad) Is Definedmentioning

confidence: 99%

“The scaffolding must be removed once the house is built”—spontaneous coronary artery dissection and the potential of bioresorbable scaffolds

et al. 2016

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“…Nevertheless, these findings are still today sorely underestimated due to the absence of angiographic hallmarks in more than 70% of cases (4). According to the Literature, in several cases, an intravascular imaging, namely optical coherence tomography analysis (OCT) and intravascular ultrasound images (IVUS), is mandatory for recognize a dissection (3)(4)(5)(6)(7).…”

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A lesson from intravascular imaging: insights for recognizing a spontaneous coronary artery dissection

et al. 2017

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Spontaneous coronary artery dissection (SCAD) is still today an underdiagnosed disease that occurs in 0.1-1.1% of the major angiographic series and represents 0.1-4% of all acute coronary syndrome (1-3). Nevertheless, these findings are still today sorely underestimated due to the absence of angiographic hallmarks in more than 70% of cases (4). According to the Literature, in several cases, an intravascular imaging, namely optical coherence tomography analysis (OCT) and intravascular ultrasound images (IVUS), is mandatory for recognize a dissection (3-7).Recently the spotlights were turned on for this entity thanks to the initiatives of European and American societies of cardiology through proper study groups. In this light, we have launched an Experts' survey whose results should be published very soon (8).With this in mind, we have greatly appreciated the effort of this Journal to pay attention to this underdiagnosed entity (9), in this light we recently published an intriguing score system for a faster and efficient SCAD diagnosis (10).Here we present an emblematic case of a 58-year old, smoker, male admitted at our department for unstable angina (UA). ECG and echo did not show abnormalities. Coronary angiography (CA) not showed stenosis of right coronary artery (RCA) but a retrograde flow to middle left anterior descending artery (LAD) ( Figure 1A). Left coronary selective angiography showed a small haziness image at the ostium of the LAD, mimicking a coronary calcification (11), and a significative stenosis, a little further down, at the middle tract ( Figure 1B).With these premises we performed an intravascular ultrasound analysis (IVUS) that showed a 30% stenosis at proximal tract without a clear image of dissection ( Figure 1C), so we decided to position a drug-eluting stent (DES) at mid-LAD with a good final result ( Figure 1D). The patient was discharged after 2 days in optimized medical therapy.After 5 days the patient came back to hospital with angina pectoris and pain radiating up to the neck due to a newer non-ST-elevation myocardial infarction (NSTEMI). Thus we performed a new CA that showed an image mimicking a "vasospasm" suspected for SCAD at distal RCA (Figure 2A,B), moreover, an inexplicable coronary collateral circulation to distal RCA from distal LAD was highlighted ( Figure 2C).After administration of intracoronaric the image of SCAD was strongly suspected through the pathognomonic morphology of parallel double-lumen with contrast dye separated by a radiolucent flap ( Figure 2B) but, according to our score (10), we decided to perform an OCT. The Abstract: Spontaneous coronary artery dissection (SCAD) is still today an underdiagnosed disease due to the absence of angiographic hallmarks in more than 70% of cases. In several cases, an intravascular imaging is a sole tool for recognizing a dissection. Particularly, optical coherence tomography analysis (OCT) could represent the gold standard technique of easy interpretation and prompt diagnosis. Here we present a rare case of multivessel spont...

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Angiographic appearance of spontaneous coronary artery dissection with intramural hematoma proven on intracoronary imaging

Abstract: Intracoronary imaging confirms that SCAD may appear angiographically without multiple radiolucent lumen. Angiographers should be familiar with angiographic SCAD variants to improve SCAD diagnosis, and utilize intracoronary imaging when the diagnosis is uncertain.

Cited by 176 publications

References 10 publications

Spontan koronar arteriedisseksjon

Spontan koronar arteriedisseksjon

“The scaffolding must be removed once the house is built”—spontaneous coronary artery dissection and the potential of bioresorbable scaffolds

A lesson from intravascular imaging: insights for recognizing a spontaneous coronary artery dissection

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