Spontaneous coronary artery dissection classification: Difference between revisions
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==Classification== | ==Classification== | ||
SCAD may be classified according to its angiographic features:<ref name="pmid24227590">{{cite journal| author=Saw J| title=Coronary angiogram classification of spontaneous coronary artery dissection. | journal=Catheter Cardiovasc Interv | year= 2014 | volume= 84 | issue= 7 | pages= 1115-22 | pmid=24227590 | doi=10.1002/ccd.25293 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24227590 }} </ref><ref name="pmid26198289">{{cite journal| author=Saw J, Mancini GB, Humphries K, Fung A, Boone R, Starovoytov A et al.| title=Angiographic appearance of spontaneous coronary artery dissection with intramural hematoma proven on intracoronary imaging. | journal=Catheter Cardiovasc Interv | year= 2016 | volume= 87 | issue= 2 | pages= E54-61 | pmid=26198289 | doi=10.1002/ccd.26022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26198289 }} </ref> | |||
{| style="font-size: 85%;" | |||
! style="width: 100px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Type}} | |||
! style="background: #4479BA; text-align: center;" colspan="2;"| {{fontcolor|#FFF|Characteristic Features}} | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | '''Type 1''' | |||
| style="background: #F5F5F5; padding: 5px;" colspan="2;"| | |||
*Pathognomonic multiple radiolucent lumen | |||
*Contrast dye staining of arterial wall | |||
*Presence or absence of dye hang-up or slow contrast clearing from the lumen | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" rowspan="3;" | '''Type 2''' | |||
| style="background: #F5F5F5; padding: 5px;" colspan="2;"| | |||
*Diffuse (typically >20–30 mm) | |||
*Smooth narrowing varying in severity (ranging from 40 to 100% stenosis) | |||
*No response to intracoronary nitroglycerin | |||
*No atherosclerotic lesions in other coronary arteries | |||
*Repeat coronary angiogram showing spontaneous resolution of the dissected segment or previous angiogram showing normal artery | |||
*Intracoronary imaging with OCT or IVUS proving the presence of intramural hematoma and double-lumen | |||
|- | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''2A Variant''' | |||
| style="background: #F5F5F5; padding: 5px;" |Normal arterial caliber proximal and distal to dissection | |||
|- | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''2B Variant''' | |||
| style="background: #F5F5F5; padding: 5px;" |Dissection extends to the distal tip of the artery without discernible normal segment distally | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | '''Type 3''' | |||
| style="background: #F5F5F5; padding: 5px;" colspan="2;"| | |||
*Mimics atherosclerosis with focal or tubular stenosis | |||
*Lack of atherosclerotic changes in other coronary arteries | |||
*Long lesions (11–20 mm) | |||
*Hazy stenosis | |||
*Linear stenosis | |||
*Note: requires OCT or IVUS to prove the presence of intramural hematoma or double-lumen | |||
|} | |||
===Type 1=== | ===Type 1=== | ||
Revision as of 16:49, 21 November 2017
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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.
Synonyms and keywords: SCAD
Overview
Classification
SCAD may be classified according to its angiographic features:[1][2]
| Type | Characteristic Features |
|---|---|
| Type 1 |
|
| Type 2 |
|
| 2A Variant | Normal arterial caliber proximal and distal to dissection |
| 2B Variant | Dissection extends to the distal tip of the artery without discernible normal segment distally |
| Type 3 |
|
Type 1
Projection angle: 14 RAO, 35 CRA. Type 1 SCAD is seen in OM2.
Projection angle: 28 RAO, 23 CRA. Type 1 SCAD is seen in L3.
Projection angle: 30 RAO, 30 CAU. Type 1 SCAD is seen in L2.
Projection angle: 33 LAO, 2 CRA. Two independent type 1 SCAD lesions are seen in R2 and R3.
Projection angle: 26 RAO, 24 CAU. Type 1 SCAD is seen in OM1/OT. Note, there is also a type 2A in C1.
Projection angle: 36 RAO, 11 CAU. Type 1 SCAD is seen in L1, L2. Note, there is also a type 2B in OM1.
Type 2A
Projection angle: 25 LAO, 20 CRA. Type 2A SCAD is seen in R3, R4.
Projection angle: 23 RAO, 14 CRA. Type 2A SCAD is seen in L3.
Projection angle: 25 RAO, 25 CRA. Type 2A SCAD is seen in L2.
Projection angle: 5 LAO, 34 CRA. Type 2A SCAD is seen in L3.
Projection angle: 13 LAO, 42 CRA. Type 2A SCAD is seen in L2, D2.
Projection angle: 31 LAO, 24 CRA. Type 2A SCAD is seen in L2 and D1.
Type 2B
Projection angle: 41 RAO, 19 CRA. Type 2B SCAD is seen starting in L2 resulting in a total occlusion.
Projection angle: 36 RAO, 11 CAU. Type 2B SCAD is seen in OM1. Note, there is also a type 1 in L1, L2.
Projection angle: 11 RAO, 22 CRA. Type 2B SCAD is seen in OM2.
Projection angle: 30 RAO, 1 CRA. Type 2B SCAD is seen in OM2.
Type 3
Projection angle: 1 LAO, 35 CRA. Type 3 SCAD is seen in D1.
Projection angle: 0 RAO, 38 CRA. Type 3 SCAD is seen in L3.
Projection angle: 0 RAO, 38 CRA. Type 3 SCAD is seen in L3.
Projection angle: 3 RAO, 26 CRA. Type 3 SCAD is seen in L2.
Projection angle: 7 RAO, 39 CRA. Type 3 SCAD is seen in S1.
Projection angle: 10 RAO, 14 CAU. Type 3 SCAD is seen in L3.
References
- ↑ Saw J (2014). "Coronary angiogram classification of spontaneous coronary artery dissection". Catheter Cardiovasc Interv. 84 (7): 1115–22. doi:10.1002/ccd.25293. PMID 24227590.
- ↑ Saw J, Mancini GB, Humphries K, Fung A, Boone R, Starovoytov A; et al. (2016). "Angiographic appearance of spontaneous coronary artery dissection with intramural hematoma proven on intracoronary imaging". Catheter Cardiovasc Interv. 87 (2): E54–61. doi:10.1002/ccd.26022. PMID 26198289.