Spontaneous coronary artery dissection other imaging findings

Jump to navigation Jump to search

Spontaneous Coronary Artery Dissection Microchapters



Historical Perspective




Differentiating Spontaneous coronary artery dissection from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


Diagnostic Approach

History and Symptoms

Physical Examination

Laboratory Findings






Other Imaging Findings

Other Diagnostic Studies


Treatment Approach

Medical Therapy

Percutaneous Coronary Intervention


Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Type 1

Type 2A

Type 2B

Type 3

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A.; Arzu Kalayci, M.D. [2]

Synonyms and keywords: SCAD


When the diagnosis of spontaneous coronary artery dissection (SCAD) cannot be ascertained by the standard coronary angiography, intracoronary imaging such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT) may provide complementary information for establishing a definitive diagnosis. Coronary computed tomography angiography (CCTA) may be useful for non-invasive follow-up of SCAD involving proximal or large-caliber coronary arteries. OCT findings suggestive of SCAD may include the presence of two lumens and intramural hematoma.

Other Imaging Findings

Intracoronary Imaging: Intravascular Ultrasound and [[Optical Coherence Tomography]

Advantages and Disadvantages of Intracoronary Imaging for SCAD

  • Definitive diagnosis of SCAD
  • Confirm true lumen entry by coronary wire
  • Facilitate stent sizing
  • Confirm adequate stent apposition
  • Confirm full coverage of the dissected segment
  • Facilitate diagnosis of potential arteriopathy
  • Disadvantages of intracoronary imaging for SCAD include:[5]

Indications for Intracoronary Imaging in the Setting of SCAD

  • A clinical-angiographic scoring system for faster and efficient SCAD diagnosis has been proposed as follows:[6]
Clinical-Angiographic Score System for SCAD Faster Diagnosis
Clinical Characteristics
  • Youth / <50 year
  • No classical coronary risk factors
Angiographic Characteristics
  • Long/tortuous suspected lesion
  • Diffuse, typically smooth arterial narrowing
At least 3 points: Indication to perform endovascular imaging (OCT or, if not available, IVUS)

OCT/IVUS for suspected SCAD may be indicated in a patient with chest pain, ECG/Echo abnormalities, troponin rise/fall, and a score of ≥3 points.

Optical Coherence Tomography

Table below describes the imaging findings of various types of SCAD in optical coherence tomography (OCT) imaging study:[7]

SCAD Subtype OCT Finding
Type 1
Type 2 Type 2A
  • Presence of a compressive intramural hematoma
Type 2B
Type 3
Type 4
  • No specific finding

Computed Tomography Angiography

Coronary Computed Tomography Angiography


  1. Maehara A, Mintz GS, Castagna MT; et al. (2002). "Intravascular ultrasound assessment of spontaneous coronary artery dissection". The American Journal of Cardiology. 89 (4): 466–8. PMID 11835932. Unknown parameter |month= ignored (help)
  2. Porto I, Banning AP (2004). "Intravascular ultrasound imaging in the diagnosis and treatment of spontaneous coronary dissection with drug-eluting stents". The Journal of Invasive Cardiology. 16 (2): 78–80. PMID 14760197. Unknown parameter |month= ignored (help)
  3. Arnold JR, West NE, van Gaal WJ, Karamitsos TD, Banning AP (2008). "The role of intravascular ultrasound in the management of spontaneous coronary artery dissection". Cardiovascular Ultrasound. 6: 24. doi:10.1186/1476-7120-6-24. PMC 2429898. PMID 18513437.
  4. Ishibashi K, Kitabata H, Akasaka T (2009). "Intracoronary optical coherence tomography assessment of spontaneous coronary artery dissection". Heart (British Cardiac Society). 95 (10): 818. doi:10.1136/hrt.2008.158485. PMID 19401282. Unknown parameter |month= ignored (help)
  5. 5.0 5.1 Saw, Jacqueline; Mancini, G.B. John; Humphries, Karin H. (2016). "Contemporary Review on Spontaneous Coronary Artery Dissection". Journal of the American College of Cardiology. 68 (3): 297–312. doi:10.1016/j.jacc.2016.05.034. ISSN 0735-1097.
  6. Buccheri D, Zambelli G (2016). "Focusing on spontaneous coronary artery dissection: actuality and future perspectives". J Thorac Dis. 8 (12): E1784–E1786. doi:10.21037/jtd.2016.12.79. PMC 5227193. PMID 28149642.
  7. 7.0 7.1 Kim, Esther S.H.; Longo, Dan L. (2020). "Spontaneous Coronary-Artery Dissection". New England Journal of Medicine. 383 (24): 2358–2370. doi:10.1056/NEJMra2001524. ISSN 0028-4793.
  8. Rybicki, Frank J.; Udelson, James E.; Peacock, W. Frank; Goldhaber, Samuel Z.; Isselbacher, Eric M.; Kazerooni, Ella; Kontos, Michael C.; Litt, Harold; Woodard, Pamela K.; Alpert, Joseph S.; Andrews, George A.; Chen, Edward P.; Cooke, David T.; Cury, Ricardo C.; Edmundowicz, Daniel; Ferrari, Victor; Graff, Louis G.; Hollander, Judd E.; Klein, Lloyd W.; Leipsic, Jonathan; Levy, Phillip D.; Mahmarian, John J.; Rosenberg, Craig; Rubin, Geoffrey; Ward, R. Parker; White, Charles; Yucel, E. Kent; Carr, J. Jeffrey; Rybicki, Frank J.; White, Richard D.; Woodard, Pamela K.; Patel, Manesh; Douglas, Pamela; Hendel, Robert C.; Kramer, Christopher; Doherty, John (2016). "2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain". Journal of the American College of Radiology. 13 (2): e1–e29. doi:10.1016/j.jacr.2015.07.007. ISSN 1546-1440.
  9. Mark, D. B.; Berman, D. S.; Budoff, M. J.; Carr, J. J.; Gerber, T. C.; Hecht, H. S.; Hlatky, M. A.; Hodgson, J. M.; Lauer, M. S.; Miller, J. M.; Morin, R. L.; Mukherjee, D.; Poon, M.; Rubin, G. D.; Schwartz, R. S. (2010). "ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents". Circulation. 121 (22): 2509–2543. doi:10.1161/CIR.0b013e3181d4b618. ISSN 0009-7322.
  10. Hamm, C. W.; Bassand, J.-P.; Agewall, S.; Bax, J.; Boersma, E.; Bueno, H.; Caso, P.; Dudek, D.; Gielen, S.; Huber, K.; Ohman, M.; Petrie, M. C.; Sonntag, F.; Uva, M. S.; Storey, R. F.; Wijns, W.; Zahger, D.; Bax, J. J.; Auricchio, A.; Baumgartner, H.; Ceconi, C.; Dean, V.; Deaton, C.; Fagard, R.; Funck-Brentano, C.; Hasdai, D.; Hoes, A.; Knuuti, J.; Kolh, P.; McDonagh, T.; Moulin, C.; Poldermans, D.; Popescu, B. A.; Reiner, Z.; Sechtem, U.; Sirnes, P. A.; Torbicki, A.; Vahanian, A.; Windecker, S.; Windecker, S.; Achenbach, S.; Badimon, L.; Bertrand, M.; Botker, H. E.; Collet, J.-P.; Crea, F.; Danchin, N.; Falk, E.; Goudevenos, J.; Gulba, D.; Hambrecht, R.; Herrmann, J.; Kastrati, A.; Kjeldsen, K.; Kristensen, S. D.; Lancellotti, P.; Mehilli, J.; Merkely, B.; Montalescot, G.; Neumann, F.-J.; Neyses, L.; Perk, J.; Roffi, M.; Romeo, F.; Ruda, M.; Swahn, E.; Valgimigli, M.; Vrints, C. J.; Widimsky, P. (2011). "ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)". European Heart Journal. 32 (23): 2999–3054. doi:10.1093/eurheartj/ehr236. ISSN 0195-668X.