Spontaneous coronary artery dissection classification

Spontaneous Coronary Artery Dissection Microchapters
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Overview
Historical Perspective
Classification
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Differentiating Spontaneous coronary artery dissection from other Diseases
Epidemiology and Demographics
Risk Factors
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Natural History, Complications and Prognosis
Diagnosis
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History and Symptoms
Physical Examination
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Treatment
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Medical Therapy
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Primary Prevention
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Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Type 1 Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Case 7 Type 2A Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Type 2B Case 1 Case 2 Case 3 Case 4 Type 3 Case 1 Case 2 Case 3 Case 4 Case 5 Case 6

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

Synonyms and keywords: SCAD

Classification

SCAD may be classified according to its angiographic features:

Type	Characteristic Features
Type 1	Pathognomonic multiple radiolucent lumen Contrast dye staining of arterial wall Presence or absence of dye hang-up or slow contrast clearing from the lumen
Type 2	Diffuse (typically >20–30 mm) Smooth narrowing varying in severity (ranging from 40 to 100% stenosis) No response to intracoronary nitroglycerin No atherosclerotic lesions in other coronary arteries Repeat coronary angiogram showing spontaneous resolution of the dissected segment or previous angiogram showing normal artery Intracoronary imaging with OCT or IVUS proving the presence of intramural hematoma and double-lumen
2A Variant	Normal arterial caliber proximal and distal to dissection
2B Variant	Dissection extends to the distal tip of the artery without discernible normal segment distally
Type 3	Mimics atherosclerosis with focal or tubular stenosis Lack of atherosclerotic changes in other coronary arteries Long lesions (11–20 mm) Hazy stenosis Linear stenosis Note: requires OCT or IVUS to prove the presence of intramural hematoma or double-lumen

Type 1

Projection angle: 14 RAO, 35 CRA. Type 1 SCAD is seen in OM2.

Type 2A

Projection angle: 25 LAO, 20 CRA. Type 2A SCAD is seen in R3, R4.

Projection angle: 23 RAO, 14 CRA. Type 2A SCAD is seen in L3.

Projection angle: 25 RAO, 25 CRA. Type 2A SCAD is seen in L2.

Projection angle: 5 LAO, 34 CRA. Type 2A SCAD is seen in L3.

Projection angle: 13 LAO, 42 CRA. Type 2A SCAD is seen in L2, D2.

Projection angle: 31 LAO, 24 CRA. Type 2A SCAD is seen in L2 and D1.

Type 2B

Projection angle: 41 RAO, 19 CRA. Type 2B SCAD is seen starting in L2 resulting in a total occlusion.

Projection angle: 36 RAO, 11 CAU. Type 2B SCAD is seen in OM1. Note, there is also a type 1 in L1, L2.

Projection angle: 11 RAO, 22 CRA. Type 2B SCAD is seen in OM2.

Projection angle: 30 RAO, 1 CRA. Type 2B SCAD is seen in OM2.

Type 3

Projection angle: 1 LAO, 35 CRA. Type 3 SCAD is seen in D1.

Projection angle: 0 RAO, 38 CRA. Type 3 SCAD is seen in L3.

Projection angle: 0 RAO, 38 CRA. Type 3 SCAD is seen in L3.

Projection angle: 3 RAO, 26 CRA. Type 3 SCAD is seen in L2.

Projection angle: 7 RAO, 39 CRA. Type 3 SCAD is seen in S1.

Projection angle: 10 RAO, 14 CAU. Type 3 SCAD is seen in L3.