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Review

Angiographic patterns in spontaneous coronary artery dissection: novel diagnostic insights

, , , , , , & show all
Pages 167-175 | Received 15 Feb 2024, Accepted 25 Apr 2024, Published online: 02 May 2024
 

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.

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.

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