Intravascular imaging for spontaneous coronary artery dissection: A clinical-angiographic score may help the choice

2016 ◽  
Vol 89 (3) ◽  
pp. 505-506
Author(s):  
Dario Buccheri ◽  
Davide Piraino ◽  
Giuseppe Andolina ◽  
Bernardo Cortese
Keyword(s):  
Coronary Artery ◽  
Artery Dissection ◽  
Intravascular Imaging ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Angiographic Score

scholarly journals 499 What light through yonder window breaks? Benefits of optical coherence tomography (OCT) in a case of spontaneous coronary artery dissection

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Alessandro Maino ◽  
Rocco Vergallo ◽  
Alfredo Ricchiuto ◽  
Marco Lombardi ◽  
Angela Buonpane ◽  
...  
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Intravascular Imaging ◽  
Spontaneous Coronary Artery Dissection ◽  
Intramural Haematoma ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
St Segment ◽  
Cardiovascular Evaluation

Abstract Aims Spontaneous coronary artery dissection (SCAD) is a non-traumatic and non-iatrogenic separation of the coronary arterial walls, creating a false lumen. SCAD is an infrequent and often missed diagnosis especially in women presenting with acute coronary syndrome and in the majority of cases angiography alone could be insufficient for identification. Methods and results A 43-year-old woman presented to the Emergency Department of Fondazione Policlinico Universitario A. Gemelli IRCCS (Rome, Italy) for oppressive acute chest pain radiated to the right jaw, resolved spontaneously within a few minutes. Physical examination, including cardiovascular evaluation, was normal. High-sensitivity troponin was 152 ng/l and 250 ng/l in two serial determination (reference range, 0.0–37 ng/l). EKG showed sinus rhythm with no significant ST-segment alterations. Echocardiography revealed preserved biventricular systolic function with mild hypokinesia of the apical segments of the left ventricle. A diagnosis of NSTEMI was made based on clinical and laboratory parameters. Thus, urgent coronary angiography was performed, which demonstrated a single vessel disease with an eccentric, and angiographically complex stenosis of the proximal left anterior descending (LAD) artery with an image of plus compatible with a plaque ulceration. In order to define the extension of the disease and ostium involvement for a better procedural planning, OCT imaging was performed. Surprisingly, OCT showed a intramural haematoma extending from the ADA ostium to the proximal tract (approximately 22 mm) with ulceration in the body, minimal lumen area (MLA) 2.0 mm2 and evidence of normal trilaminar structure of the vessel both on downstream and upstream of the lesion. The angiographic features were compatible with type 2A SCAD. The therapeutic management was conservative with continuation of the double antiplatelet therapy and remote CT monitoring. Three days later, because of a new onset of chest pain and slight elevation of the ST segment on EKG, was performed a coronarographic control: the angiographic appearance of the lesion was substantially unchanged; OCT showed unmodified longitudinal extension of the lesion (about 22 mm) and relative increase in the endoluminal caliber compared to the previous examination (MLA 4.0 mm2).After 2 weeks, coronary CTA control was carried out, which documented the stability of the intramural hematoma in the proximal LAD, extended for 22 mm and with a maximum thickness of 2 mm, determining lumen narrowing of 40–45% The patient was discharged on medical therapy and no events occurred during the follow-up. Six month later, repeat CTA showed a complete resorption of the intramural haematoma. Conclusions In this case we highlight the utility of intravascular imaging, in particular OCT, in the evaluation of angiographic lesions of non-univocal interpretation and how its use can change the management and prognosis of ACS patients. Furthermore, the spontaneous resolution of the clinical and anatomical scenario through conservative treatment additionally confirms spontaneous healing as the natural history of SCAD and foreground the role of precise diagnosis (and intravascular imaging showed to improve it) for therapy shift and calibration.

A ‘parachute effect’ mockingly sealing a spontaneous coronary artery dissection: what we have learnt from intravascular imaging

2021 ◽  
Vol 17 (1) ◽  
pp. 95-99
Author(s):  
Dario Buccheri ◽  
Renzo M Lombardo ◽  
Daniele Vinci ◽  
Arian Frasheri
Keyword(s):  
Coronary Artery ◽  
Acute Coronary Syndromes ◽  
Artery Dissection ◽  
Intravascular Imaging ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Coronary Syndromes

Spontaneous coronary artery dissection is often underdiagnosed. It accounts for a certain amount of acute coronary syndromes. Intravascular imaging, either intravascular ultrasound or optical coherence tomography, represents a relevant ally for interventional cardiologist. Here we report an intriguing case of spontaneous coronary artery dissection not immediately diagnosed due to the explained parachute effect, managed invasively according to an algorithm previously published, with a good long-term outcome.

The fate of spontaneous coronary artery dissection: insight from intravascular imaging at a late follow-up

2019 ◽  
Vol 14 (13) ◽  
pp. 1406-1407
Author(s):  
Nicolas Amabile ◽  
Geraud Souteyrand ◽  
Pascal Motreff ◽  
Christophe Caussin
Keyword(s):  
Coronary Artery ◽  
Artery Dissection ◽  
Intravascular Imaging ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection

Characterization of single vs. recurrent spontaneous coronary artery dissection

2018 ◽  
Vol 26 (2) ◽  
pp. 89-93
Author(s):  
Gianluca Rigatelli ◽  
Fabio Dell’Avvocata ◽  
Claudio Picariello ◽  
Marco Zuin ◽  
Massimo Giordan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Intravascular Ultrasound ◽  
Ultrasound Imaging ◽  
Artery Dissection ◽  
Intravascular Imaging ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Intravascular Ultrasound Imaging ◽  
String Sign

Background Spontaneous coronary artery dissection is a rare non-atherosclerotic cause of acute coronary syndromes, often underdiagnosed based on standard coronary angiography. Moreover, features, presentation, and intravascular imaging of recurrent spontaneous dissections have not been assessed. Methods Patients with recurrent spontaneous coronary artery dissection, who were admitted to our catheterization laboratory over a 10-year period, were identified. Demographic, clinical, angiographic, and intravascular imaging data were reviewed and analyzed, comparing patients with a single event with those who had a recurrence. Results Over the study period, 31 (0.2%, mean age 48.1 ± 8.8 years, 24 females) of 10,954 patients who underwent coronary angiography experienced a single spontaneous coronary artery dissection, and 6 (0.05%, mean age 49.3 ± 10.1 years, 4 females) experienced recurrent spontaneous coronary artery dissection. No patient suffered more than 2 dissections. Arterial hypertension ( p = 0.004), a string sign measuring >15 mm on angiography, and hematoma on intravascular ultrasound imaging were more frequently observed in patients with recurrent spontaneous coronary artery dissection. Conclusions Hypertension, length of the string sign on angiography, and hematoma on intravascular ultrasound imaging might identify patients at higher risk of recurrent spontaneous coronary artery dissection despite a lifelong dual antiplatelet regimen.

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

2017 ◽  
Vol 9 (12) ◽  
pp. 5363-5367 ◽  
Author(s):  
Dario Buccheri ◽  
Diego Milazzo ◽  
Salvatore Geraci ◽  
Giovanni Vaccaro ◽  
Giuseppe Caramanno
Keyword(s):  
Coronary Artery ◽  
Artery Dissection ◽  
Intravascular Imaging ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection

scholarly journals Spontaneous coronary artery dissection as a cause of acute myocardial infarction with ST elevation

2021 ◽  
pp. 35-35
Author(s):  
Vladimir Ivanovic ◽  
Dragana Dabovic ◽  
Milovan Petrovic ◽  
Igor Ivanov ◽  
Marija Bjelobrk
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Intramural Hematoma ◽  
Artery Dissection ◽  
Intravascular Imaging ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Diagonal Branch ◽  
St Elevation

Introduction. Spontaneous coronary artery dissection (SCAD) is defined as a dissection that hasn?t occurred with atherosclerosis, trauma, or hasn?t developed iatrogenically. Case outline. A 53-year-old man admitted to the hospital due to chest pain and ischemic electrocardiographically changes (ECG). Coronarography was performed and 85% of the stenosis of the first diagonal branch (D1) was registered. During the percutaneous coronary intervention (PCI), one drug-eluting was directly implanted into the D1. About 3 hours after the intervention, the patient developed an acute myocardial infarction with ST elevation (STEMI) and recoronarography was performed. The previously implanted stent in D1 was patent without thrombi. The subocclusive stenosis of the LAD was registered and PCI was performed. After implantation of the stents into the LAD, propagation of dissection towards LCx was creating significant stenosis. Following the registration of the stenosis, PCI was performed on this branch. In order to determine the cause of acute STEMI, intravascular imaging was performed, seven days after last PCI. Optical coherence tomography showed an excellent stent apposition and expansion. In the area under the stents, in the proximal segment of LAD and LCX, showed duplication in the blood vessel wall. This duplication represents an unresorbed intramural hematoma as a consequence of SCAD. Conclusion. When performing coronarography on younger patients, women in the peripartum and patients with connective tissue disorders should think on SCAD. Usage of the intravascular imaging could reduce the number of unrecognized SCAD.

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