Spontaneous coronary artery dissection classification: Difference between revisions

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<span style="font-size:85%">Projection angle: 14 RAO, 35 CRA. Type 1 SCAD is seen in OM2.</span>
<span style="font-size:85%">Projection angle: 14 RAO, 35 CRA. Type 1 SCAD is seen in OM2.</span>
==Spontaneous Coronary Artery Dissection Type 2==
Type 2 SCAD lesion is characterized diffuse (typically >20–30 mm) and usually smooth narrowing that can vary in severity from an inconspicuous mild stenosis to complete occlusion, plus:
: a. no response to intracoronary nitroglycerin and no atherosclerotic lesions in other coronary arteries
: '''OR'''
: b. repeat coronary angiogram showing angiographic resolution of the dissected segment or previous angiogram showing normal artery
: '''OR'''
: c. intracoronary imaging with optical coherence tomography or intravascular ultrasound proving the presence of intramural hematoma and double-lumen


===Type 2A===
===Type 2A===

Revision as of 22:39, 27 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

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:[1][2]

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 contrast dye staining of arterial wall with multiple radiolucent lumens, with or without the presence of dye hang-up or slow contrast clearing from the lumen.

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

Spontaneous Coronary Artery Dissection Type 2

Type 2 SCAD lesion is characterized diffuse (typically >20–30 mm) and usually smooth narrowing that can vary in severity from an inconspicuous mild stenosis to complete occlusion, plus:

a. no response to intracoronary nitroglycerin and no atherosclerotic lesions in other coronary arteries
OR
b. repeat coronary angiogram showing angiographic resolution of the dissected segment or previous angiogram showing normal artery
OR
c. intracoronary imaging with optical coherence tomography or intravascular ultrasound proving the presence of intramural hematoma and double-lumen

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.

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.