The Role Of Intravascular Imaging In The Diagnosis And Management Of Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection(SCAD)is known to be a rare but increasingly recognized cause of acute myocardial ischemia and sudden cardiac death.During SCAD,myocardial injury is caused by coronary obstruction due to the formation of intramural hematoma and/or intimal disruption.It can occur in single or multiple coronary vessels.The clinical presentation depends on the location and extent of progression of the SCAD.It can present as asymptom,angina,acute myocardial infarction,ventricular arrhythmias or sudden cardiac death.It is more frequent in younger patients without conventional risk factors for coronary artery disease,It occurs more commonly in women than in men.The underlying etiology of SCAD appears to be multifactorial.Unlike atherosclerotic disease,the optimal management of SCAD remains undetermined because no randomized trials have compared medical therapies or revascularization strategies.Coronary angiography is the gold standard for diagnosing SCAD.While SCAD can readily be recognized in coronary angiography due to contrast staining into the false lumen,coronary angiography is only a 2-dimensional luminogram.It is excellent to assess luminal narrowing;however,it is poor in assessing the arterial wall,where the key abnormalities occur with SCAD.Hence,the SCAD diagnosis may be overlooked,require intravascular imaging to be confirmed diagnosing.We present six cases of SCAD to illustrate specific aspects of the presentation and management of this condition,we used intravascular diagnostic techniques,intravascular ultrasound(IVUS)and optical coherence tomography(OCT),in 6 patients with SCAD.Our findings suggest that the use of OCT and IVUS provides valuable,unique,and complementary diagnostic insights on the pathophysiological substrate of SCAD.IVUS is used in to guide percutaneous coronary intervention(PCI)and to confirm sealing of the dissection and adequate stent expansion.