Spontaneous coronary artery dissection classification

Spontaneous Coronary Artery Dissection Microchapters
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Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Spontaneous coronary artery dissection from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Approach
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
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CT
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Echocardiography
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Other Diagnostic Studies
Treatment
Treatment Approach
Medical Therapy
Percutaneous Coronary Intervention
Surgery
Primary Prevention
Secondary Prevention
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

The National Heart, Lung, and Blood Institute (NHLBI) classification scheme for coronary dissection was devised in the pre-stent era for classifying the dissection following balloon angioplasty (i.e., iatrogenic dissection). In light of the distinctive angiographic features of spontaneous coronary artery dissection (SCAD), Saw et al. proposed a classification system to better characterize the lesions:

Type	Feature		Example
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	The unnamed parameter 2= is no longer supported. Please see the documentation for {{columns-list}}. 2
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	The unnamed parameter 2= is no longer supported. Please see the documentation for {{columns-list}}. 2
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	The unnamed parameter 2= is no longer supported. Please see the documentation for {{columns-list}}. 2

Spontaneous Coronary Artery Dissection Type 1

Type 1 SCAD lesion is characterized by the pathognomonic appearance of arterial wall contrast staining with multiple radiolucent lumens.

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.

Type 2B

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

Type 3

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