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OCT Imaging of SCAD and Differential Diagnosis

  • Ashkan Parsa
  • Jacqueline SawEmail author
Chapter

Abstract

Majority of acute myocardial infarctions (MI) are caused by rupture of a fixed atherosclerotic plaque with subsequent thrombus formation, with coronary angiography showing significant coronary artery obstruction [1]. While the absence of angiographic evidence of significant coronary stenosis may challenge the diagnosis of MI, significant coronary pathology may be present despite subtle or mild lesions seen on angiography. MI with non-obstructive coronary arteries (MINOCA) is a syndrome with different causes characterized by evidence of MI with non-obstructive coronary arteries on angiography. Moreover, spontaneous coronary artery dissection (SCAD) is an important cause of non-atherosclerotic MI among patients presenting with acute coronary syndrome (ACS). The management of patients with MINOCA is specific to the underlying cause and therefore routine evaluation for underlying causes is strongly encouraged. Optical coherence tomography (OCT) is a powerful intracoronary imaging modality that can be used to delineate the underlying pathophysiologic cause of MI. In this chapter, we will review the differential diagnosis of MINOCA and utility of OCT in differentiating between these causes. The main focus of this chapter is to discuss spontaneous coronary artery dissection (SCAD) and the appropriate use of OCT in the diagnosis and management of this clinically important entity.

Keywords

Optical coherence tomography (OCT) Myocardial infarction with non-obstructive coronary arteries (MINOCA) Spontaneous coronary artery dissection (SCAD) 

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Authors and Affiliations

  1. 1.Division of Cardiology, Vancouver General HospitalUniversity of British ColumbiaVancouverCanada

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