scholarly journals TCT-11 Angiographic Appearance of Spontaneous Coronary Artery Dissection with Intramural Hematoma Proven on Intracoronary Imaging

2014 ◽  
Vol 64 (11) ◽  
pp. B3-B4
Author(s):  
Jacqueline Saw ◽  
G. B. John Mancini ◽  
Karin Humphries ◽  
Anthony Fung ◽  
Andrew Starovoytov ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Intramural Hematoma ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Intracoronary Imaging

scholarly journals Spontaneous Coronary Artery Dissection

2015 ◽  
Vol 10 (3) ◽  
pp. 142
Author(s):  
Jacqueline Saw ◽  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Artery Wall ◽  
Coronary Artery Dissection ◽  
Intracoronary Imaging ◽  
Younger Women

Spontaneous coronary artery dissection (SCAD) is a non-traumatic and non-iatrogenic separation of the coronary artery wall that is now recognised as an important cause of myocardial infarction, especially in younger women. SCAD can be elusive on coronary angiography and clinician familiarity with non-pathognomonic angiographic SCAD variants and the use of intracoronary imaging will improve diagnosis. Conservative management and long-term cardiovascular follow-up are typically recommended.

scholarly journals Spontaneous coronary artery dissection: Acute findings on coronary computed tomography angiography

2018 ◽  
Vol 8 (5) ◽  
pp. 467-475 ◽  
Author(s):  
Marysia S Tweet ◽  
Nila J Akhtar ◽  
Sharonne N Hayes ◽  
Patricia JM Best ◽  
Rajiv Gulati ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Intramural Hematoma ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Computed Tomography ◽  
Luminal Stenosis

Background: The coronary computed tomography angiography features of acute spontaneous coronary artery dissection, an important cause of acute coronary syndrome in young women, have not been assessed. Methods: The “Virtual” Multicenter Mayo Clinic Spontaneous Coronary Artery Dissection Registry was established in 2010 and includes retrospective and prospective patient data. Retrospective assessment of acute coronary computed tomography angiography images was performed for 14 patients (16 vessels) who had images performed within two days of invasive coronary angiography diagnosis of acute spontaneous coronary artery dissection. Results: Four pertinent diagnostic coronary features of acute spontaneous coronary artery dissection were observed in order of prevalence: 1) abrupt luminal stenosis (64%); 2) intramural hematoma (50%); 3) tapered luminal stenosis (36%); and 4) dissection (14%). Additional findings include epicardial fat stranding (42%), coronary tortuosity (29%), and coronary bridge (14%). Fifty percent of patients had myocardial hypoperfusion in the myocardial distribution of the dissected coronary artery. Conclusions: We define key coronary computed tomography angiography features of acute spontaneous coronary artery dissection, the most common of which are abrupt luminal stenosis and intramural hematoma. Importantly, intramural hematoma appears similar to noncalcified atherosclerotic plaque, emphasizing the importance of invasive coronary angiography for acute diagnosis of spontaneous coronary artery dissection until the sensitivity and specificity of coronary computed tomography angiography is better understood.

Abstract 14266: Management of Spontaneous Coronary Artery Dissection: Trends Over Time

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Elliot Fitzsimmons ◽  
Elizabeth Thompson ◽  
Robert L Wilensky ◽  
Clare McCarthy ◽  
Jennifer Lewey
Keyword(s):  
Coronary Artery ◽  
Beta Blockers ◽  
Intramural Hematoma ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Clear Trend ◽  
Event Time ◽  
Trends Over Time ◽  
Over Time

Introduction: Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic cause of ACS that preferentially impacts young women. Increasing evidence suggests that patients with SCAD do well with a conservative approach, as intramural hematoma frequently resolves with medical management and complications from PCI are common. Our objective is to describe changes in management of SCAD over time at the University of Pennsylvania Health System (UPHS). Methods: We conducted a retrospective cohort study among patients treated within UPHS from 2005-2019. We identified all patients in the electronic health record with SCAD using ICD-9 (414.12) and ICD-10 (I25.42) codes. Charts were manually reviewed and indexed by date of SCAD event. Time categories were calculated by tertiles of patients. Since the first tertile spanned 21 years, this category was subdivided. The most recent time period represents practice after the AHA Scientific Statement on SCAD was published. Cochran-Armitage trend tests compared trends over time. Results: We identified 140 patients with SCAD. In this cohort, 43% of patients treated from 1993-2005 were managed conservatively, compared to 89% of patients treated in 2018-2019, while 57% of patients treated from 1993-2005 were managed invasively, compared to 11% of patients treated in 2018-2019, p<0.001 for trend over time (Figure). Between 1993-2005 and 2018-2019, the use of DAPT increased from 40% to 80% (p<0.001 for trend) and use of statins increased from 60% to 85% (p=0.021 for trend). Beta blocker use remained stable (80% vs. 89%, p=0.401) and ACEi/ARB use varied considerably without a clear trend over time (p=0.553). Conclusions: The proportion of patients with SCAD managed conservatively has steadily increased since 2015. This trend corresponds to the increased understanding of clinical outcomes of this patient population. Medical treatment has changed over time and most patients are treated with DAPT, statins, and beta blockers.

scholarly journals A tale of two SCADs: Spontaneous coronary artery dissection series

2021 ◽  
Vol 9 (37) ◽  
pp. 70-73
Author(s):  
Sanjana Rao ◽  
Nitish Mittal ◽  
Mohammad M Ansari
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Intramural Hematoma ◽  
Rare Condition ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Shortness Of Breath ◽  
Coronary Artery Dissection ◽  
Coronary Artery Angiography ◽  
Associated Symptoms

Spontaneous coronary artery dissection (SCAD), a relatively rare condition, occurs when a tear is present in the coronary artery walls, slowing the flow of blood due to potential clotting. Most patients show symptoms of chest pain or shortness of breath; however, SCAD is seen mostly in relatively young and healthy women with minimal past medical history. Within this report, we present two female SCAD patients and the etiology of a SCAD case, including a complicated diagnosis and treatment. We describe a 33-year-old woman and a 40-year-old woman both presenting to the emergency department with chest pain and shortness of breath. Electrocardiogram was done and coronary artery angiography was performed on both patients, demonstrating a SCAD. Both patients were treated with aspirin, bet-blockers, and statin to relieve associated symptoms and accordingly discharged.   Key words: Spontaneous coronary artery dissection (SCAD), Female, intramural hematoma

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