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<span style="font-size: 1.5em; font-weight: bold;">Algorithm for the Angiographic Diagnosis and Confirmation of Spontaneous Coronary Artery Dissection</span><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> | <span style="font-size: 1.5em; font-weight: bold;">Algorithm for the Angiographic Diagnosis and Confirmation of Spontaneous Coronary Artery Dissection</span><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><BR><BR> | ||
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E01=<div style="text-align: center; font-weight: bold; padding: 5px;">Type 1 SCAD</div>| | E01=<div style="text-align: center; font-weight: bold; padding: 5px;">Type 1 SCAD most likely</div>| | ||
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❑ Involvement of mid to distal segments | ❑ Involvement of mid to distal segments | ||
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❑ Additional features | ❑ Additional features | ||
❑ | ❑ No atherosclerosis in other arteries | ||
❑ Long lesions (11–20 mm) | ❑ Long lesions (11–20 mm) | ||
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H01=<div style="text-align: center; font-weight: bold; padding: 5px;">YES</div>| | |||
H02=<div style="text-align: center; font-weight: bold; padding: 5px;">NO</div>| | |||
H03=<div style="text-align: left; font-weight: bold; padding: 5px;"> | |||
Type 3 SCAD most likely | |||
❑ Consider OCT or IVUS for definitive diagnosis | |||
❑ Reassess with angiography in 4 to 6 weeks | |||
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I01=<div style="text-align: center; font-weight: bold; padding: 5px;">R/O coronary spasm or other conditions</div>| | |||
I02=<div style="text-align: left; font-weight: bold; padding: 5px;"> | |||
Type 2 SCAD most likely | |||
❑ Consider OCT or IVUS for definitive diagnosis | |||
❑ Reassess with angiography in 4 to 6 weeks | |||
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Revision as of 18:22, 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? ❑ Pathognomonic appearance of contrast dye 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.