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Current Cardiology Reports

, 21:122 | Cite as

Role of Invasive and Non-invasive Imaging Tools in the Diagnosis and Optimal Treatment of Patients with Spontaneous Coronary Artery Dissection

  • Enrico CerratoEmail author
  • Federico Giacobbe
  • Cristina Rolfo
  • Giorgio Quadri
  • Francesco Tomassini
  • Fabio Ferrari
  • Fabio Mariani
  • Matteo Anselmino
  • Matteo Bianco
  • Davide Belliggiano
  • Luca Lo Savio
  • Alfonso Franzé
  • Umberto Barbero
  • Italo Porto
  • Hernán Mejía-Rentería
  • Fernando Macaya
  • Pablo Salinas
  • Nieves Gonzalo
  • Javier Escaned
  • Laura Montagna
  • Ferdinando Varbella
Interventional Cardiology (SR Bailey, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Interventional Cardiology

Abstract

Purpose of Review

Spontaneous coronary artery dissection (SCAD) is a serious non-atherosclerotic disease, most frequently presenting as an acute coronary syndrome and affecting female patients. Considering that diagnosis of SCAD is often elusive, and its interventional treatment is associated to a higher rate of complications than obstructive atherosclerotic disease, we aim to review all the imaging tools currently available for the optimal diagnosis and treatment of this condition.

Recent Findings

The developments in both invasive and non-invasive imaging alternatives to coronary angiography, such as intravascular ultrasound, optical coherence tomography, and computed coronary angiography, have largely contributed to appraise the epidemiology of SCAD, understand its causative pathophysiological mechanisms, and improve our ability to confirm doubtful cases of SCAD. Intracoronary imaging is also a valuable in deciding the best therapeutic approach and in guiding interventions in those patients requiring percutaneous treatment. Furthermore, non-invasive imaging is a key tool in ruling out significant extracoronary vascular abnormalities which frequently occur in patients with underlying conditions like fibromuscular dysplasia who develop SCAD.

Summary

Main imaging tools employed in SCAD cases could have advantages and drawbacks. Focusing on different types of SCAD, operators should be able to choose the best imaging technique for diagnosis, management, and follow-up.

Keywords

Spontaneous coronary artery dissection Acute coronary syndrome Coronary angiography Optical coherence tomography Intravascular ultrasound Invasive imaging tools 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Supplementary material

11886_2019_1202_MOESM1_ESM.pptx (53 kb)
SUPPLEMENTARY FIGURE A Advantages and disadvantages of the intracoronary imaging techniques (IVUS/OCT). (PPTX 52.6 kb)
11886_2019_1202_MOESM2_ESM.pptx (43 kb)
SUPPLEMENTARY FIGURE B Proposed diagnostic algorithm on the role of coronary angiography and the use of intracoronary imaging in SCAD diagnosis. (PPTX 42.9 kb)
11886_2019_1202_MOESM3_ESM.pptx (3.2 mb)
SUPPLEMENTARY FIGURE C In some cases, imaging IVUS or OCT could not be performed due to the distal location of the dissection. In such cases, probably as suggested in the current diagnostic flow chart, an angiographic follow-up should be performed in order to access the healing of the vessel and confirm the diagnosis. Red circle in left panel highlights a diagonal branch involved in the dissection. At 2 months follow-up the same segment appears completely healed (right panel) and it was surprisingly bigger in size as expected from the first angiogram. (PPTX 3236 kb)
11886_2019_1202_MOESM4_ESM.pptx (3.9 mb)
SUPPLEMENTARY FIGURE D Panel 1: 51-year-old woman, presenting with ACS/STEMI. Angiographic appearance seemed to indicate an atheromasic disease. Surprisingly, IVUS imaging interrogation showed an intramural hematoma in the distal part of LAD. Combining together clinical information and IVUS imaging interrogation, operator concluded for a SCAD. Panel 2: PCI was performed using Bioresorbable Magnesium Scaffold 3x20mm in mid LAD. Notably, a squeezing of the hematoma was noted by IVUS interrogation at the level of the bifurcation strengthening the diagnosis of SCAD. Panel 3: Final angiographic and IVUS result after an additional implantation of a 3.0x25mm Magmaris in overlap with the previous one. (PPTX 3967 kb)
11886_2019_1202_MOESM5_ESM.pptx (236 kb)
SUPPLEMENTARY FIGURE E Example of fibromuscular dysplasia with the typical “string-of-beads” feature shown in carotid (Panel A, RM) and renal arteries (Panel B, CT). (PPTX 236 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Enrico Cerrato
    • 1
    Email author
  • Federico Giacobbe
    • 2
  • Cristina Rolfo
    • 1
  • Giorgio Quadri
    • 1
  • Francesco Tomassini
    • 1
  • Fabio Ferrari
    • 1
  • Fabio Mariani
    • 1
  • Matteo Anselmino
    • 2
  • Matteo Bianco
    • 3
  • Davide Belliggiano
    • 2
  • Luca Lo Savio
    • 4
  • Alfonso Franzé
    • 4
  • Umberto Barbero
    • 5
  • Italo Porto
    • 6
  • Hernán Mejía-Rentería
    • 7
  • Fernando Macaya
    • 7
  • Pablo Salinas
    • 8
  • Nieves Gonzalo
    • 7
  • Javier Escaned
    • 7
  • Laura Montagna
    • 3
  • Ferdinando Varbella
    • 1
  1. 1.Interventional Cardiology Unit, Orbassano, and Infermi HospitalSan Luigi Gonzaga University HospitalTurinItaly
  2. 2.Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinTurinItaly
  3. 3.Department of CardiologySan Luigi Gonzaga University HospitalTurinItaly
  4. 4.Cardiology DivisionInfermi HospitalTurinItaly
  5. 5.Cardiology DivisionSantissima Annunziata HospitalSaviglianoItaly
  6. 6.Interventional Cardiology Unit, San Martino HospitalUniversity of GenoaGenoaItaly
  7. 7.Hospital Clinico San Carlos IDISCCComplutense University of MadridMadridSpain
  8. 8.Servicio de Cardiologia, Hospital Clinico San CarlosInstituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC)MadridSpain

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