Spontaneous coronary artery dissection other imaging findings

Spontaneous Coronary Artery Dissection Microchapters
Home
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Spontaneous coronary artery dissection from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Approach
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Angiography
CT
MRI
Echocardiography
Other Imaging Findings
Other Diagnostic Studies
Treatment
Treatment Approach
Medical Therapy
Percutaneous Coronary Intervention
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Type 1 Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Case 7 Type 2A Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Type 2B Case 1 Case 2 Case 3 Case 4 Type 3 Case 1 Case 2 Case 3 Case 4 Case 5 Case 6

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A. Arzu Kalayci, M.D. [2]

Synonyms and keywords: SCAD

Overview

The gold standard for the diagnosis of SCAD is conventional coronary angiography with intravascular imaging. Although exposure to radiation has always been a concern for especially pregnant or young women, this is the only way to make a definitive diagnosis.

Other Imaging Findings

Intravascular Ultrasound and Optical Coherence Tomogrpahy

In the event that diagnosis of SCAD based on angiography is ambiguous, intravascular ultrasound (IVUS) or optical coherence tomography (OCT) can be used for diagnostic clarification. In fact, a definitive diagnosis of type 3 SCAD requires OCT or IVUS. IVUS/OCT should be considered the gold standard in diagnosing SCAD. OCT may be preferred to IVUS due to superiority in spatial resolution and clarity in identifying intramural hematomas and intimal tears, though IVUS is still quite adequate.

Clinical-Angiographic Score System for SCAD Faster Diagnosis
Clinical Characteristics
Connective tissue disorder (Marfan syndrome, Ehler-Danlos syndrome, cystic medial necrosis) / Fibromuscular Dysplasia	+2
Youth/<50 year	+1
Estroprogestinic therapy	+1
No classical coronary risk factors	+1
Pregnancy (peri-partum, history of multiple pregnancy)/ Female gender	+1
History of coronary artery spasm/ Previous SCAD	+3
Amphetamines/Cocaine/ Vasospastic drug abuse	+1
Systematic inflammation (SLE, Chron disease, sarcoidosis, polyarteritis nodosa, Behcet's syndrome	+2
Emotional/ Physical stress	+1
Angiographic Characteristics
One vessel disease (no typical atherosclerotic lesions in order coronary arteries)	+1
Long/tortuose suspected lesion	+1
Diffuse, typically smooth arterial narrowing	+1
At least 3 points: Indication to perform endovascular imaging (OCT or, if not available, IVUS)
In the presence of a score of at least three points in a patient presenting with chest pain, ECG/Echo abnormalities or troponin rise/fall, perform OCT/IVUS analysis for suspected SCAD.