Angiographic patterns in spontaneous coronary artery dissection: novel diagnostic insights

ABSTRACT

Introduction

Spontaneous coronary artery dissection (SCAD) is a rare but well-recognized cause of acute coronary syndrome, especially important in women. Invasive coronary angiography (ICA) is the fundamental diagnostic technique for the confirmation of SCAD. Knowing the angiographic patterns suggestive of SCAD is essential for the correct identification of patients with this entity.

Areas covered

In this narrative review, the main angiographic characteristics of SCAD lesions as detected by ICA are presented and discussed.

Expert opinion

In addition to the specific angiographic classification of SCAD, several authors have described complementary angiographic patterns suggestive of SCAD. Knowledge and correct identification of these angiographic patterns is essential for the correct diagnosis of patients with clinical suspicion of SCAD.

KEYWORDS:

• Acute coronary syndrome
• intramural hematoma
• coronary angiography
• spontaneous coronary artery dissection
• coronary artery disease

Article highlights

• Knowledge of the classical and other more subtle angiographic presentations of SCAD is required to ensure a correct diagnosis and management of this elusive clinical entity.

• The publication of the SCAD-specific angiographic classification has served to improve the recognition of angiographic patterns without the classical double-lumen.

• Intracoronary imaging techniques have been of major value in gaining further anatomic insights allowing an improved angiographic recognition and superior diagnostic accuracy of SCAD.

• Several additional angiographic findings suggestive of SCAD have been described, which are useful in identifying those lesions that are most likely to correspond to dissection/hematoma.

• A high degree of clinical suspicion together with a careful analysis of the coronary angiogram remains paramount for the correct diagnosis of patients with SCAD.

Abbreviations

ACS	=	Acute coronary syndrome
BKL	=	Broken line angiographic pattern
CAD	=	Coronary artery disease
CCTA	=	Coronary computed tomography angiography
ICA	=	Invasive coronary angiography
ICI	=	Intracoronary imaging
IMH	=	Intramural hematoma
LAD	=	Left anterior descending coronary artery
SCAD	=	Spontaneous coronary artery dissection
OCT	=	Optical coherence tomography
PCI	=	Percutaneous coronary intervention
STEMI	=	ST-segment-elevation myocardial infarction
TIMI	=	Thrombolysis in Myocardial infarction

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.