TY - JOUR
T1 - Spontaneous Coronary Artery Dissection
T2 - Pitfalls of Angiographic Diagnosis and an Approach to Ambiguous Cases
AU - Adlam, David
AU - Tweet, Marysia S.
AU - Gulati, Rajiv
AU - Kotecha, Deevia
AU - Rao, Praveen
AU - Moss, Alistair J.
AU - Hayes, Sharonne N.
N1 - Publisher Copyright:
© 2021 The Authors
PY - 2021/8/23
Y1 - 2021/8/23
N2 - Spontaneous coronary artery dissection (SCAD) is a pathophysiologically distinct cause of acute coronary syndromes (ACS). It is increasingly recognized that optimal management is different from that for atherosclerotic ACS and that a SCAD diagnosis has specific long-term prognostic and therapeutic implications. Accurate diagnosis is therefore essential to ensure the best treatment of patients. At present this relies on the recognition of typical features of SCAD identified on invasive coronary angiography. Although most SCAD can be readily distinguished angiographically from alternative causes of ACS, false positive and false negative diagnoses remain common. In particular, sometimes non-SCAD presentations, including atherothrombosis, takotsubo cardiomyopathy, coronary embolism, coronary vasospasm, contrast streaming, and myocardial infarction with nonobstructive coronary arteries, can mimic angiographic features usually associated with SCAD. The authors present the combined experience from European and US SCAD referral centers reviewing the classical angiographic appearances of SCAD, presenting potential diagnostic pitfalls and exemplars of SCAD mimickers. The authors further review the benefits and limitations of intracoronary imaging in the context of SCAD. Finally, the authors discuss the investigation of ambiguous cases and an approach to minimize misdiagnosis in difficult cases.
AB - Spontaneous coronary artery dissection (SCAD) is a pathophysiologically distinct cause of acute coronary syndromes (ACS). It is increasingly recognized that optimal management is different from that for atherosclerotic ACS and that a SCAD diagnosis has specific long-term prognostic and therapeutic implications. Accurate diagnosis is therefore essential to ensure the best treatment of patients. At present this relies on the recognition of typical features of SCAD identified on invasive coronary angiography. Although most SCAD can be readily distinguished angiographically from alternative causes of ACS, false positive and false negative diagnoses remain common. In particular, sometimes non-SCAD presentations, including atherothrombosis, takotsubo cardiomyopathy, coronary embolism, coronary vasospasm, contrast streaming, and myocardial infarction with nonobstructive coronary arteries, can mimic angiographic features usually associated with SCAD. The authors present the combined experience from European and US SCAD referral centers reviewing the classical angiographic appearances of SCAD, presenting potential diagnostic pitfalls and exemplars of SCAD mimickers. The authors further review the benefits and limitations of intracoronary imaging in the context of SCAD. Finally, the authors discuss the investigation of ambiguous cases and an approach to minimize misdiagnosis in difficult cases.
KW - angiography
KW - computed tomography
KW - differential diagnosis
KW - intravascular ultrasound
KW - optical coherence tomography
KW - spontaneous coronary artery dissection
KW - women
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UR - http://www.scopus.com/inward/citedby.url?scp=85111988786&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2021.06.027
DO - 10.1016/j.jcin.2021.06.027
M3 - Review article
C2 - 34412792
AN - SCOPUS:85111988786
SN - 1936-8798
VL - 14
SP - 1743
EP - 1756
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 16
ER -