The radiographic appearance of coronary artery dissection: A decision-making dilemma

Abstract

The appearance of acute iatrogenic dissection of the coronary arteries during coronary angiography is described in five patients. Specific signs of dissection include: 1) initimal flap, 2) delayed flow, 3) loss of side branches, 4) periostial contrast "puddling," and 5) unusually small size coronary artery with atypical smooth walls. Recognition of the radiographic patterns of this complication should permit distinction from coronary spasm, thrombosis, and embolization. Recent advent of alternate forms of therapy (streptokinase infusion, angioplasty) makes it imperative to precisely diagnose the dissection to avoid possible catastrophic results.

Coronary artery stenting for spontaneous coronary artery dissection: A case report and review of the literature

“…As demonstrated by our case, features of dissection at angiography include contrast media seen in two lumina (true and false), separated by a radiolucent intimal flap. The lumen of the vessel is enlarged at the site of dissection, caused by the presence of dye inside the coronary wall (seen as a persistence of contrast after washout from the remainder of the vessel) [2,6,16,37,56]. A simulated stenosis from compression of the true lumen by the false lumen has also been described [5].…”

Postpartum dissection of the left main coronary artery

“…On angiography, dissection is indicated by the presence of extraluminal radiolucent contrast after washout of dye from the remainder of the vessel, although the dissection may be obscured by significant narrowing of the true lumen. 23,24 A radiolucent intimal flap may rarely be seen.…”

Spontaneous coronary artery dissection

“…1). 8,9,19,[66][67][68] An intimal tear may or may not be present, and the dissection may be obscured by significant narrowing of the true lumen. 69,70 It is important to rule out catheter-induced trauma to the vessel as the possible etiology of the dissection.…”