A Case of Spontaneous Coronary Artery Dissection Healed by Medical Treatment: Serial Findings of Coronary Angiography, Intravascular Ultrasound and Multi-Detector Computed Tomography

Background: There is limited understanding of the role of cardiac computed tomography angiography (CCTA) for assessment of patients with spontaneous coronary artery dissection (SCAD). Methods: In this report we describe the diagnostic utility of CCTA in three young women presenting with signs and symptoms of myocardial ischemia who were eventually diagnosed with SCAD. Results: None of the women had traditional atherosclerotic risk factors. SCAD was not initially identified on CCTA in any of the three women, but was visualized during retrospective analysis in two patients after invasive coronary angiography. In two patients follow-up CCTA imaging was used successfully for subsequent management. Conclusions: In patients presenting with signs or symptoms of acute coronary syndrome, SCAD may be missed or not detectable on CCTA. A negative CCTA should not exclude a diagnosis of SCAD, and invasive coronary angiography should be considered for further evaluation.

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Late results of bioabsorbable scaffolds implanted in spontaneous coronary artery dissection evaluated with computed tomography coronary angiography

European Heart Journal ◽

10.1093/ehjci/ehaa946.1738 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

E Pozo Osinalde ◽

F Macaya ◽

S.J Camacho-Freire ◽

M Massot ◽

J Moreu ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Coronary Angiography ◽

Computed Tomography Coronary Angiography ◽

Plaque Burden ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Coronary Wall ◽

Luminal Area

Abstract Background Percutaneous coronary intervention (PCI) in spontaneous coronary artery dissection (SCAD) should be reserved for cases presenting with ongoing extensive ischaemia. Bioresorbable scaffolds (BVS) have emerged as an alternative to avoid permanent stenting, an especially attractive concept for this clinical scenario. However, data of late angiographic outcome of this device in SCAD is lacking. Purpose To evaluate the long-term angiographic outcome of BVS in the setting of SCAD using computed tomography coronary angiography (CTCA) Methods In this multicentre prospective study, high-risk SCAD patients treated with BVS were scheduled for a follow-up CTCA at least 2 years from implantation date. Acquisition was performed according to the current recommendations. All the studies were analysed in a central core laboratory by an independent level 3 expert in CTCA blinded to the clinical and angiographic results. For this purpose, a dedicated software for coronary analysis was used to quantify coronary stenosis and evaluate coronary wall. Results Thirty-four BVS were implanted in 15 SCAD patients (51±12 years-old; 87% female) from 7 different centres in Spain and United Kingdom. The most common presentation was STEMI (n=9, 60%). Target vessels included 11 left anterior descending arteries (73.3%), 3 right coronary arteries (20%) and 1 left circumflex coronary artery (6.7%). One patient received target lesion revascularisation due to scaffold shrinkage in a proximal right coronary artery at 13 months. CTCA was performed 2.4±0.7 years after BVS implantation. No scaffold thrombosis or significant stenosis were detected. Patency of all scaffolds was confirmed with a median luminal area of 5.52 mm2 (IQR: 3.74–6.95) and median stenosis of 11% (IQR: 4–15%). Regarding coronary wall tissue characterization of segments with BVS, there was 32±9.3% of plaque burden and a median plaque volume of 45.3 mm3 (IQR: 26.6–61.9). The most common component of the plaque was fibrous (85±9.4%). Compared to the proximal reference segments, BVS showed more plaque burden (32.2% vs 25.3%; p=0.017) and fibrous percentage (84.7% vs 75.1%; p=0.004) whereas less fibrofatty (6 vs 4.8 mm3; p=0.007) and necrotic volume (0.4 vs 1.2 mm3; p=0.029). BVS segments showed lower absolute minimal luminal area (5.5 vs 8.9 mm2; p=0.004) and diameter (2.7 vs 3.4 mm; p=0.004) compared to the reference segment; however, non-significant differences were seen in percentage stenosis, in keeping with normal vessel tapering. Conclusions In this series of SCAD treated with BVS, scaffolds showed a satisfactory late angiographic outcome, with no significant restenosis and an excellent minimal luminal area and optimal coronary wall healing observed. Funding Acknowledgement Type of funding source: None

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Characterization of single vs. recurrent spontaneous coronary artery dissection

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492318757041 ◽

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.

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