Diagnosis of Spontaneous Coronary Artery Dissection by Optical Coherence Tomography

• Published in: Journal of the American College of Cardiology Vol. 59; no. 12; pp. 1073 - 1079
• Main Authors: Alfonso, Fernando, MD, PhD, Paulo, Manuel, MD, Gonzalo, Nieves, MD, PhD, Dutary, Jaime, MD, Jimenez-Quevedo, Pilar, MD, PhD, Lennie, Vera, MD, Escaned, Javier, MD, PhD, Bañuelos, Camino, MD, Hernandez, Rosana, MD, PhD, Macaya, Carlos, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 20.03.2012; Elsevier Limited
• Subjects: Acute coronary syndromes; Adult; Aneurysm, Dissecting - diagnosis; Aneurysm, Dissecting - pathology; Aneurysm, Dissecting - therapy; Angioplasty, Balloon, Coronary; Blood clots; Cardiology; Cardiovascular; Cardiovascular disease; Coronary Aneurysm - diagnosis; Coronary Aneurysm - pathology; Coronary Aneurysm - therapy; Coronary Angiography; Coronary Thrombosis - diagnosis; Coronary vessels; Coronary Vessels - pathology; Dissection; Female; Heart attacks; Hematoma - diagnosis; Humans; Internal Medicine; Ischemia; Male; Medical imaging; Middle Aged; Myocardial Revascularization - methods; optical coherence tomography; spontaneous coronary artery dissection; Tomography, Optical Coherence - methods; Watchful Waiting; OCT; optical coherence tomography; SCAD; spontaneous coronary artery dissection
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2011.08.082

Objectives This study sought to assess the diagnostic value of optical coherence tomography (OCT) in patients with suspected spontaneous coronary artery dissection (SCAD). Background SCAD is a rare but challenging clinical entity. 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 mm2 ) and false lumen (5.9 ± 2.1 mm2 ), 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.