Role of Invasive and Non-invasive Imaging Tools in the Diagnosis and Optimal Treatment of Patients with Spontaneous Coronary Artery Dissection

Cerrato, Enrico; Giacobbe, Federico; Rolfo, Cristina; Quadri, Giorgio; Tomassini, Francesco; Ferrari, Fabio; Mariani, Fábio; Anselmino, Matteo; Bianco, Matteo; Belliggiano, Davide; Savio, Luca Lo; Franzé, Alfonso; Barbero, Umberto; Porto, Italo; Mejía‐Rentería, Hernán; Macaya, Fernando; Salinas, Pablo; Gonzalo, Nieves; Escaned, Javier; Montagna, Laura; Varbella, Ferdinando

doi:10.1007/s11886-019-1202-0

Cited by 4 publications

(3 citation statements)

References 40 publications

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“…La utilización de la imagenología intracoronaria ha permitido diferenciar los diferentes patrones angiográficos, permitiendo elevar el índice de sospecha. Si bien el IVUS tiene menor resolución espacial que la OCT (con menor sensibilidad para detectar disrupciones pequeñas de la íntima arterial), presenta mayor penetrancia en el tejido (4 a 8 mm), lo que permite visualizar completamente la pared del vaso y evaluar la extensión del hematoma intramural (4) . Se requirió utilizar imagenología intracoronaria en nueve casos, siendo determinante en el diagnóstico.…”

Section: Discussionunclassified

“…Cuando esto ocurre, típi-camente el vaso incrementa su tortuosidad y se generan ángulos rectos en su trayecto que le dan el aspecto de imagen "en sacacorcho" o "tirabuzón". Otras formas que llevan al subdiagnóstico son la existencia de estrechez leve, así como el involucramiento de ramas distales y pequeñas arterias (4) . La fisiopatología no se encuentra completamente aclarada.…”

Section: Introductionunclassified

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Disección coronaria espontánea. Primer reporte a nivel nacional

2020

Rev.Urug.Cardiol.

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ResumenLa disección coronaria espontánea (DCE) es una causa infrecuente de síndrome coronario agudo (SCA), de presentación principalmente en mujeres de mediana edad. Se realizó una revisión de la base de datos institucional, desde la incorporación en nuestro centro de tecnología para adquisición de imagen intracoronaria hasta la actualidad (julio de 2013 a diciembre de 2019). Se encontró DCE en 13 de 4.706 coronariografías diagnósticas (0,3%). Presentamos angiografía y ultrasonografía intracoronaria (IVUS) representativa de lo observado en la serie. La edad media de presentación fue 52 ± 14 años, 11 de los 13 casos eran mujeres. El tiempo medio de seguimiento fue 39 ±27 meses. La forma clínica de presentación más frecuente fue SCA sin elevación del ST (6/13). El vaso más frecuentemente afectado fue la arteria descendente anterior (n=8). En todos los casos se registró elevación significativa de troponinas (> percentil 99). Se realizó tratamiento conservador en 11 casos y angioplastia exitosa en dos. Un paciente que recibió tratamiento conservador falleció durante la internación. Se requirió de imagenología intracoronaria en nueve de los 13 casos. Se presenta el primer reporte nacional de DCE, describiendo sus características clínicas, imagenológicas, tratamiento y evolución. SummarySpontaneous coronary dissection is an infrequent cause of acute coronary syndrome, particularly in middle-aged women. We made review of the database of our center since the date of acquisition of intracoronary imaging techniques in our laboratory (July 2013 -December 2019). Coronary spontaneous dissection was found in 13 patients of 4706 diagnostic coronary angiograms (0.3%). We present angiography and coronary ultrasonography studies representative of this case series. The mean age of presentation was 52 ± 14 years, 11 of 13 of the cases were women. The mean follow-up time was 39 ± 27 months. The most frequent clinical presentation was acute coronary syndrome without ST elevation 6/13. The most frequently affected vessel was the anterior descending artery (n = 8). In all cases, troponins above the 99 percent were found. Conservative treatment was performed in 11 cases and successful angioplasty in the other two cases. One patient under conservative treatment died during hospitalization. The use of intracoronary imaging was required in 9 of the 13 cases. In conclusion, we present for the first time, a national registry of spontaneous coronary dissection describing its clinical, image, treatment and evolution characteristics.

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Section: Introductionunclassified

Disección coronaria espontánea. Primer reporte a nivel nacional

2020

Rev.Urug.Cardiol.

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“…7 Intracoronary imaging techniques, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), have increasingly assumed an important role in the diagnosis of SCAD. [8][9][10] Spontaneous coronary artery dissection physiology is primarily distinguished by the presence or absence of intimal disruption and can be further classified based on angiographic criteria. 11,12 In our study, SCAD was categorized according to the Saw classification.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous coronary artery dissection, a multifactorial disease: insights from a center experience

Oliveira¹,

Vasconcelos²,

Abreu³

et al. 2023

J Transcat Intervent

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Background: Although it is a poorly known disease, spontaneous coronary artery dissection is an important and frequently underdiagnosed cause of non-atherosclerotic acute coronary syndrome, particularly in women. The objective of this study was to characterize a consecutive sample of patients diagnosed with spontaneous coronary artery dissection with respect to predisposing and precipitating factors; clinical and angiographic presentation; management; occurrence of adverse cardiac events; recurrence; and de novo spontaneous coronary artery dissection. Methods: Longitudinal, observational, retrospective, single-centre study, including patients diagnosed with spontaneous coronary artery dissection (n=60) admitted between January 2010 and December 2020. Results: Median age was 55 years, and 83% were women. Most patients (60%) presented without any or just one cardiovascular risk factor. Non-ST-segment elevation acute myocardial infarction accounted for 67% of clinical presentations. The most frequently affected coronary artery was the left anterior descending (47%). Most lesions (77%) appeared on angiography as type 2 spontaneous coronary artery dissection. Conservative management was chosen as the initial approach in most patients (72%). The overall incidence of de novo spontaneous coronary artery dissection was not significantly different among patients initially managed with revascularization as compared to conservative treatment (p=0.953). However, spontaneous coronary artery dissection recurrence occurred in the originally involved vessel in 3 of 15 patients initially managed with revascularization, as compared to only one among 43 patients treated conservatively (p<0.05). Conclusion: Spontaneous coronary artery dissection occurs more often in young women. Non- ST-segment elevation acute myocardial infarction was the most frequent clinical presentation involving mainly the left anterior descending artery. Revascularization did not protect from recurrence.

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MINOCA biomarkers: Non-atherosclerotic aspects

Xu,

Zhang,

et al. 2023

Clinica Chimica Acta

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Role of Invasive and Non-invasive Imaging Tools in the Diagnosis and Optimal Treatment of Patients with Spontaneous Coronary Artery Dissection

Cited by 4 publications

References 40 publications

Disección coronaria espontánea. Primer reporte a nivel nacional

Disección coronaria espontánea. Primer reporte a nivel nacional

Spontaneous coronary artery dissection, a multifactorial disease: insights from a center experience

MINOCA biomarkers: Non-atherosclerotic aspects

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