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Revision as of 18:23, 28 November 2017
Spontaneous Coronary Artery Dissection Microchapters |
Differentiating Spontaneous coronary artery dissection from other Diseases |
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Diagnosis |
Treatment |
Case Studies |
Type 1 Type 2A Type 2B Type 3 |
Algorithm for the Angiographic Diagnosis and Confirmation of Spontaneous Coronary Artery Dissection[1]
Presence of features that raise suspicion for SCAD? ❑ Myocardial infarction in young women (especially age ≤50) ❑ Absence of traditional cardiovascular risk factors ❑ Little or no evidence of typical atherosclerotic lesions in coronary arteries ❑ History of fibromuscular dysplasia ❑ History of relevant connective tissue disorder or systemic inflammatory condition ❑ Ehlers-Danlos syndrome Type 4 ❑ Systemic lupus erythematosus | |||||||||||||||||||||||||||||||
Perform early coronary angiography | |||||||||||||||||||||||||||||||
Presence of type 1 SCAD lesion characteristics? ❑ Contrast staining of arterial wall ❑ Multiple radiolucent lumens ❑ ±Dye hang-up or slow contrast clearing from the lumen | |||||||||||||||||||||||||||||||
YES | NO | ||||||||||||||||||||||||||||||
Type 1 SCAD most likely | Presence of type 2 SCAD lesion characteristics? ❑ Diffuse lesion (typically >20–30 mm) ❑ Smooth luminal narrowing with varying severity ❑ Involvement of mid to distal segments | ||||||||||||||||||||||||||||||
YES | NO | ||||||||||||||||||||||||||||||
Stenosis relieved by intracoronary nitroglycerin? | Look for type 3 SCAD lesion characteristics ❑ Focal or tubular stenosis (typically <20 mm) ❑ Mimics atherosclerosis ❑ Additional features ❑ No atherosclerosis in other arteries ❑ Long lesions (11–20 mm) ❑ Hazy stenosis ❑ Linear stenosis | ||||||||||||||||||||||||||||||
YES | NO | Type 3 SCAD most likely ❑ Consider OCT or IVUS for definitive diagnosis ❑ Reassess with angiography in 4 to 6 weeks | |||||||||||||||||||||||||||||
R/O coronary spasm or other conditions | Type 2 SCAD most likely ❑ Consider OCT or IVUS for definitive diagnosis ❑ Reassess with angiography in 4 to 6 weeks | ||||||||||||||||||||||||||||||
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.