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. 2018 Sep 21;39(36):3353-3368.
doi: 10.1093/eurheartj/ehy080.

European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection

David Adlam  1 , Fernando Alfonso  2 , Angela Maas  3 , Christiaan Vrints  4 ; Writing Committee
Collaborators, Affiliations

European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection

David Adlam et al. Eur Heart J. .
No abstract available

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Figures

Figure 1
Figure 1
Schematic illustration of spontaneous coronary artery dissection. Accumulation and axial propagation of blood forms a false lumen in the outer third of the tunica media leading to external compression of the true lumen (A). Blood may enter through an endothelial-intimal disruption or ‘tear’ (B) or as a result of bleeding from a microvessel within the vessel wall (C) leading to an expanding and compressing false lumen (dotted arrows).
Figure 2
Figure 2
Gross pathology (A) and histopathology (B) showing spontaneous coronary artery dissection with external compression of the true lumen by blood within a false lumen in the outer third of the tunica media.
Figure 3
Figure 3
Extracoronary abnormalities in spontaneous coronary artery dissection including renal (A and D) and femoral (B) fibromuscular dysplasia, carotid and vertebrobasilar aneurysms and tortuosity (C and F) and a localised iliac dissection (E).
Figure 4
Figure 4
Prevalence of extracoronary lesions of fibromuscular dysplasia in contemporary series of spontaneous coronary artery dissection patients.
Figure 5
Figure 5
Angiographic classification of spontaneous coronary artery dissection. Type 1 spontaneous coronary artery dissection (A), Type 2A spontaneous coronary artery dissection (B), Type 2B spontaneous coronary artery dissection (C), Type 3 spontaneous coronary artery dissection (D), Type 4 spontaneous coronary artery dissection (E), and Intermediate Type1/2 spontaneous coronary artery dissection (F).
Figure 6
Figure 6
Multivessel spontaneous coronary artery dissection affecting two branches of the circumflex coronary artery, the left anterior descending coronary artery and its diagonal branch (arrows).
Figure 7
Figure 7
Intracoronary imaging of spontaneous coronary artery dissection by intravascular ultrasound (with outer border of false lumen arrowed, A), and optical coherence tomography showing partial (B) and circumferential (C) false lumens; the site of a fenestration (D) connecting true and false lumens and reduced light penetration through the false lumen (E). Three-dimensional image derived from segmentation of optical coherence tomography image showing how the false lumen tracks around the true lumen and is influenced (and frequently bounded) by side branches (F).
Figure 8
Figure 8
Guidewire passage into the false lumen demonstrated by optical coherence tomography, with both wire (GW) and optical coherence tomography catheter (C) seen in the false lumen outside the compressed true lumen.
Figure 9
Figure 9
Coronary computed tomography findings with parallel angiographic images for a Type 2A dissection of the left anterior descending coronary artery at presentation (A) and following healing after 3-months follow-up (B).
Figure 10
Figure 10
False lumen propagation during stenting. A Type 2A dissection affecting a high obtuse marginal branch of the circumflex but with maintained distal flow (A). Stenting (B) leads to proximal haematoma migration (arrowed C). Two further stents were required in this case to fully exclude the haematoma from luminal restriction.
See this image and copyright information in PMC

References

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