Spontaneous coronary artery dissection classification: Difference between revisions

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==Classification==
==Classification==
SCAD may be classified according to its angiographic features:<ref name="pmid24227590">{{cite journal| author=Saw J| title=Coronary angiogram classification of spontaneous coronary artery dissection. | journal=Catheter Cardiovasc Interv | year= 2014 | volume= 84 | issue= 7 | pages= 1115-22 | pmid=24227590 | doi=10.1002/ccd.25293 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24227590  }} </ref><ref name="pmid26198289">{{cite journal| author=Saw J, Mancini GB, Humphries K, Fung A, Boone R, Starovoytov A et al.| title=Angiographic appearance of spontaneous coronary artery dissection with intramural hematoma proven on intracoronary imaging. | journal=Catheter Cardiovasc Interv | year= 2016 | volume= 87 | issue= 2 | pages= E54-61 | pmid=26198289 | doi=10.1002/ccd.26022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26198289  }} </ref>
{| style="font-size: 85%;"
! style="width: 100px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Type}}
! style="background: #4479BA; text-align: center;" colspan="2;"| {{fontcolor|#FFF|Characteristic Features}}
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | '''Type 1'''
| style="background: #F5F5F5; padding: 5px;" colspan="2;"|
*Pathognomonic multiple radiolucent lumen
*Contrast dye staining of arterial wall
*Presence or absence of dye hang-up or slow contrast clearing from the lumen
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" rowspan="3;" | '''Type 2'''
| style="background: #F5F5F5; padding: 5px;" colspan="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
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''2A Variant'''
| style="background: #F5F5F5; padding: 5px;" |Normal arterial caliber proximal and distal to dissection
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''2B Variant'''
| style="background: #F5F5F5; padding: 5px;" |Dissection extends to the distal tip of the artery without discernible normal segment distally
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | '''Type 3'''
| style="background: #F5F5F5; padding: 5px;" colspan="2;"|
*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===
===Type 1===

Revision as of 16:49, 21 November 2017

Spontaneous Coronary Artery Dissection Microchapters

Home

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

Angiography

CT

MRI

Echocardiography

Other Imaging Findings

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

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.

Synonyms and keywords: SCAD

Overview

Classification

SCAD may be classified according to its angiographic features:[1][2]

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.

Projection angle: 28 RAO, 23 CRA. Type 1 SCAD is seen in L3.

Projection angle: 30 RAO, 30 CAU. Type 1 SCAD is seen in L2.

Projection angle: 33 LAO, 2 CRA. Two independent type 1 SCAD lesions are seen in R2 and R3.

Projection angle: 26 RAO, 24 CAU. Type 1 SCAD is seen in OM1/OT. Note, there is also a type 2A in C1.

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

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.

References

  1. Saw J (2014). "Coronary angiogram classification of spontaneous coronary artery dissection". Catheter Cardiovasc Interv. 84 (7): 1115–22. doi:10.1002/ccd.25293. PMID 24227590.
  2. Saw J, Mancini GB, Humphries K, Fung A, Boone R, Starovoytov A; et al. (2016). "Angiographic appearance of spontaneous coronary artery dissection with intramural hematoma proven on intracoronary imaging". Catheter Cardiovasc Interv. 87 (2): E54–61. doi:10.1002/ccd.26022. PMID 26198289.