Combined Use of OCT and IVUS in Spontaneous Coronary Artery Dissection

Paulo, Manuel; Sandoval, Jorge; Lennie, Vera; Dutary, Jaime; Medina, Miguel Ángel; Gonzalo, Nieves; Jimenez-Quevedo, Pilar; Escaned, Javier; Bañuelos, Camino; Hernández, Rosana; Macaya, Carlos; Alfonso, Fernándo

doi:10.1016/j.jcmg.2013.02.010

Cited by 135 publications

(89 citation statements)

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“…37 We performed a prospective study systematically assessing the value of this combined imaging modality strategy in patients with SCAD (Figure 7). 38, 39 We found that OCT had a higher diagnostic value for detecting the precise location of the intimal tear and also for accurately measuring the thickness of the intima-medial membrane. In our study, OCT provided crisp images of the intimal-lumen interface and allowed more precise measurements of the true lumen.…”

Section: Octmentioning

confidence: 81%

“…Renal artery screening was performed in 94% of patients, iliac artery screening was performed in 64% of patients, and cerebrovasdetected tiny intracoronary thrombi that were not seen with IVUS. 39 Nevertheless, in most cases the outer circumference of the vessel wall was not recognized on OCT because of shadowing/attenuation issues, or as a result of limited field of view. Furthermore, in some cases a complete blood-free lumen was not obtained because of intentional use of careful and gentle flushing sequences in these vulnerable vessels.…”

Section: Octmentioning

confidence: 99%

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Spontaneous Coronary Artery Dissection

Alfonso

Bastante

Rivero

et al. 2014

Circ J

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Section: Octmentioning

confidence: 81%

Section: Octmentioning

confidence: 99%

Spontaneous Coronary Artery Dissection

Alfonso

Bastante

Rivero

et al. 2014

Circ J

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“…As stated above a two-dimensional image of the lumen, supplied by the coronary angiography, is sometimes not exhaustive if SCAD is suspected; new intravascular imaging techniques, such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS), are able to improve the diagnostic accuracy of coronary angiography by providing direct and detailed visualization of the coronary wall [47][48][49].…”

Section: Intravascular Imagingmentioning

confidence: 99%

How to Approach a Spontaneous Coronary Artery Dissection: An Up-To-Date

Pepe¹,

Cecere²,

Napodano³

et al. 2017

Interv Cardiol J

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AbstarctSpontaneous coronary artery dissection (SCAD) is a separation of the coronary wall layers, not related to trauma, medical procedures or atherosclerosis. The dissection causes the blood entry in the vascular wall with the consequent formation of a false lumen and intramural hematoma (IMH). Two pathogenetic mechanisms have been proposed to explain SCAD: a "primary" rupture of coronary endothelium or the rupture of the "vasa vasorum". Clinical presentation and severity of manifestations are variable, ranging from complete absence of symptoms to acute coronary syndrome (ACS), cardiogenic shock, cardiac arrest or sudden cardiac death. Despite coronary angiography is the first-line examination, by supplying two-dimensional images of the lumen, it does not always allow an incontrovertible diagnosis of SCAD. New intravascular imaging techniques, such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS), have been recently introduced and may be extremely helpful in assessing the coronary wall integrity, thus improving coronary angiography diagnostic accuracy.Because of the lack of large randomized trials comparing different strategies, the optimal treatment of SCAD is still controversial. The first-line approach is conservative and based on medical therapy. Nevertheless, in particular situations an invasive approach is necessary. In the last years, several new strategies have improved the way to perform percutaneous coronary interventions (PCI), such as new generation drug eluting stents (DES), bio-resorbable scaffolds (BRS), sirolimus self-expandable stent (SES), drug eluting balloons (DEB), and cutting balloon. Cardiac artery bypass graft (CABG) is an even more invasive method to restore coronary flow and should be considered in urgent/emergent settings when PCI is not feasible or has failed.Cause the therapeutic approach of SCAD can be substantially different from that of atherosclerotic coronary artery disease, an accurate diagnosis is crucial to set up the best treatment strategy.

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“…However, due to limited depth penetration, OCT may not depict the entire depth of the IMH (21,22); IVUS is superior in this regard (23). It is critical to note the potential risks with intracoronary imaging in the setting of SCAD, including the potential to extend the dissection with the guide wire or imaging catheter, guide catheter-induced iatrogenic dissection, hydraulic extension by contrast injection required in OCT, and imaging catheter-induced coronary occlusion (1).…”

Section: Spontaneous Coronary Artery Dissection (Scad) Is Definedmentioning

confidence: 99%