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

  • Interventional Cardiology (SR Bailey, Section Editor)
  • Published:
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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.

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Author information

Authors and Affiliations

  1. Interventional Cardiology Unit, Orbassano, and Infermi Hospital, San Luigi Gonzaga University Hospital, Rivoli, Turin, Italy

    Enrico Cerrato, Cristina Rolfo, Giorgio Quadri, Francesco Tomassini, Fabio Ferrari, Fabio Mariani & Ferdinando Varbella

  2. Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical Sciences, University of Turin, Turin, Italy

    Federico Giacobbe, Matteo Anselmino & Davide Belliggiano

  3. Department of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy

    Matteo Bianco & Laura Montagna

  4. Cardiology Division, Infermi Hospital, Rivoli, Turin, Italy

    Luca Lo Savio & Alfonso Franzé

  5. Cardiology Division, Santissima Annunziata Hospital, Savigliano, Italy

    Umberto Barbero

  6. Interventional Cardiology Unit, San Martino Hospital, University of Genoa, Genoa, Italy

    Italo Porto

  7. Hospital Clinico San Carlos IDISCC, Complutense University of Madrid, Madrid, Spain

    Hernán Mejía-Rentería, Fernando Macaya, Nieves Gonzalo & Javier Escaned

  8. Servicio de Cardiologia, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Madrid, Spain

    Pablo Salinas

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  1. Enrico Cerrato
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Correspondence to Enrico Cerrato.

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Electronic Supplementary Material

SUPPLEMENTARY FIGURE A

Advantages and disadvantages of the intracoronary imaging techniques (IVUS/OCT). (PPTX 52.6 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)

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)

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)

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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Cerrato, E., Giacobbe, F., Rolfo, C. et al. Role of Invasive and Non-invasive Imaging Tools in the Diagnosis and Optimal Treatment of Patients with Spontaneous Coronary Artery Dissection. Curr Cardiol Rep 21, 122 (2019). https://doi.org/10.1007/s11886-019-1202-0

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