Diagnosis of Spontaneous Coronary Artery Dissection by Optical Coherence Tomography

Alfonso F, Paulo M, Gonzalo N, Dutary J, Jimenez-Quevedo P, Lennie V, Escaned J, Bañuelos C, Hernandez R, Macaya C.

J Am Coll Cardiol. 2012; 60(9):1073-1079.

OBJECTIVES: This study sought to assess the diagnostic value of optical coherence tomography (OCT) in patients with suspected spontaneous coronary artery dissection (SCAD).

METHODS: Following a prospective protocol, OCT was performed in 17 consecutive patients with a clinical and angiographic suspicion of SCD from a total of 5,002 patients undergoing coronary angiography. A conservative management strategy was followed.

RESULTS: OCT ruled out the diagnosis of SCAD in 6 patients with coronary artery disease (atherosclerotic plaques and/or intracoronary thrombus). In 11 patients (age 48 ± 9 years, 9 female), OCT confirmed the presence of SCAD. A double-lumen or intramural hematoma image was visualized in all cases. However, only 3 patients presented an intimal “flap” on angiography. OCT readily identified the intimal rupture site (n = 7), the thickness (348 ± 84 μm) and length (31 ± 9 mm) of the intimomedial membrane, the area of the true (1.1 ± 0.5 mm(2)) and false lumen (5.9 ± 2.1 mm(2)), the associated intramural hematoma (n = 9), and thrombi in the true or false lumens (n = 11). Most of these findings were angiographically silent. After stenting (n = 4), OCT disclosed adequate stent coverage, expansion, and apposition, but also residual intramural hematoma at the stented site (abluminal) and at the distal vessel.

CONCLUSIONS: OCT provides unique insights in patients with SCAD that allow an early diagnosis and adequate management. Most of these findings are undetectable by angiography.

PMID: 22421300

3 Comments to “Diagnosis of Spontaneous Coronary Artery Dissection by Optical Coherence Tomography”

  1. Qianqian Liu 27 August 2012 at 10:03 am #

    See also:

    Spontaneous Coronary Artery Dissection: New Insights From the Tip of the Iceberg?
    Fernando Alfonso.
    Circulation. 2012; 126: 667-670.
    http://circ.ahajournals.org/content/126/6/667.extract

  2. Qianqian Liu 27 August 2012 at 10:30 am #

    See also:

    The role of intravascular ultrasound in the management of spontaneous coronary artery dissection.
    Arnold JR, West NE, van Gaal WJ, Karamitsos TD, Banning AP.
    Cardiovasc Ultrasound. 2008 May 31;6:24.
    PMID:18513437. http://www.ncbi.nlm.nih.gov/pubmed/18513437

  3. Qianqian Liu 27 August 2012 at 10:46 am #

    See also:

    Syncope with spontaneous coronary artery dissection in an elderly woman.
    Chen YF, Chang MH, Chang TC, Lai CH, Jong GP.
    Chin Med J (Engl). 2011 Dec;124(23):4102-4.
    PMID:22340351. http://www.ncbi.nlm.nih.gov/pubmed/22340351


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