Coronary Artery Tortuosity in Spontaneous Coronary Artery Dissection

Eleid, Mackram F.; Guddeti, Raviteja; Tweet, Marysia S.; Lerman, Amir; Singh, Mandeep; Best, Patricia J.M.; Vrtiska, Terri J.; Prasad, Megha; Rihal, Charanjit S.; Hayes, Sharonne N.; Gulati, Rajiv

doi:10.1161/circinterventions.114.001676

Cited by 270 publications

(235 citation statements)

References 19 publications

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“…On the basis of our prior experience from review of multiple coronary angiograms in patients with FMD in noncoronary vascular beds, a number of coronary angiographic features consistent with FMD changes in other arterial beds were identified and sought in this cohort (Table 1). These CFMD changes consisted of the following: (1) irregular stenosis, that is, stenosis with irregular borders of any severity (mild, <40%; moderate, 40%-69%; severe, ≥70%) and length (band-like; focal-tubular, <20 mm; or diffuse, ≥20 mm), that may or may not have concomitant systolic accentuation (presence of irregular stenosis during diastole that is further exaggerated during ventricular systole); (2) smooth stenosis (similar to focal changes), that is, stenosis with smooth borders of any severity (mild, <40%; moderate, 40%-69%; severe, ≥70%) and length (focal-tubular, <20 mm; diffuse, ≥20 mm); (3) arterial enlargement, that is, dilatation with segmental or diffuse vessel enlargement up to 1.5 times larger than adjacent normal coronary artery or ectasia with segmental or diffuse enlargement >1.5 times larger than adjacent normal coronary artery; and (4) arterial tortuosity, that is, mild tortuosity with the presence of ≥3 consecutive bends ≥45° in an epicardial artery with ≥2-mm diameter at end diastole, 14 moderate tortuosity with ≥3 consecutive bends ≥90° at end diastole, 15 and severe tortuosity with ≥2 consecutive bends ≥180° at any cardiac cycle. 16 These features give a "corkscrew" appearance to the artery.…”

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confidence: 99%

Angiographic and Intracoronary Manifestations of Coronary Fibromuscular Dysplasia

et al. 2016

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Background-We previously described a strong association between fibromuscular dysplasia (FMD) and spontaneous coronary artery dissection. Angiographic manifestations of coronary FMD aside from dissection were considered rare. However, we observed several coronary FMD angiographic abnormalities with corresponding optical coherence tomography abnormalities. Methods and Results-Baseline demographics and imaging of patients with suspected coronary FMD at Vancouver GeneralHospital were reviewed. Presence of multifocal (string-of-beads) extracoronary FMD was confirmed by 2 specialists. In these patients, coronary angiographic findings (excluding dissected segments) were reviewed and classified by 2 experienced angiographers for irregular stenosis, that is, stenosis with irregular borders in a focal or diffuse pattern with/without systolic accentuation; smooth stenosis, diffuse or focal; segmental dilatation/ectasia; and tortuosity. Optical coherence tomography was performed in a subset of patients. Of 32 patients with extracoronary FMD and suspected coronary involvement, 28 were women (88%), and their mean age was 59.4±9.9 years. Nineteen presented with myocardial infarction (13 caused by spontaneous coronary artery dissection), and 13 had stable symptoms. The observed coronary angiographic abnormalities included tortuosity in all cases (91% were moderate to severe), irregular stenosis in 59%, smooth stenosis in 19%, and segmental dilatation/ectasia in 56%. [11][12][13] However, the angiographic manifestation of CFMD is elusive and not well described. A recent attempt to describe CFMD angiographic features mostly reiterated the appearance of overlying SCAD. 7 Because there are many potential causes of SCAD besides CFMD, the presence of SCAD is not synonymous with CFMD.The angiographic appearance of CFMD in nondissected coronary arteries is reported to be rare and had not been previously studied. Because Vancouver General Hospital is a quaternary referral center for SCAD, a relatively large volume of patients with SCAD and FMD are seen at our cardiac catheterization laboratory. We observed several angiographic abnormalities in nondissected portions of the coronary tree in patients with extracoronary FMD, which we believe to represent CFMD because these features are similar to FMD changes observed in extracoronary beds. We sought to describe and classify these abnormal coronary angiographic appearances of CFMD and to provide the underlying optical coherence tomography (OCT) findings. MethodsWe performed a retrospective chart and angiographic review of patients with documented FMD in at least 1 extracoronary vascular bed and angiographic nonatherosclerotic coronary artery abnormalities that were suspected to be attributable to CFMD. This cohort included patients who underwent coronary angiography at Vancouver General Hospital for stable symptoms or acute coronary syndrome. We searched for the term FMD in our cardiac catheterization database and our SCAD registries over a 5-year period. These coronary angiograms were rev...

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Angiographic and Intracoronary Manifestations of Coronary Fibromuscular Dysplasia

et al. 2016

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“…Other reasons for high PCI failure rate are the prevalent involvement of distal coronary segments and the more tortuous pathway of coronary arteries in patients with SCAD, as compared with non-SCAD patients [41,68]. Distal sites and tortuosity are well-known unfavorable factors during PCI because of higher risk of arterial wall damage and the difficulties to reach the target segments with stents or balloons [42].…”

Section: Percutaneous Coronary Interventionmentioning

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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“…Women have been reported in over 90% of cases with many cases also reported on pregnant females. Males who have been reported tend to be younger as well [2][3][4]. Arterial dissection in SCAD can occur within or between any of the three layers of the arterial wall.…”

Section: Case Reportmentioning

confidence: 99%

Incidental Spontaneous Coronary Artery Dissection

Ziffra¹,

Troll²,

Cookman³

2017

J Med Cases

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Spontaneous coronary artery dissection (SCAD) is a rare diagnosis that presents both a diagnostic and therapeutic challenge. This disorder is rare but more often found in young and pregnant females. The diagnosis of SCAD is difficult as the presenting signs and symptoms may be non-specific. The treatment for SCAD may often be conservative if the patient does not have acute coronary syndrome. Patients who experience dissection are at risk for future events. We present a case of a 44-year-old male with a history of smoking and hypertension who presented with chest pain and syncope. He was found on angiogram to have an SCAD.

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Coronary Artery Tortuosity in Spontaneous Coronary Artery Dissection

Cited by 270 publications

References 19 publications

Angiographic and Intracoronary Manifestations of Coronary Fibromuscular Dysplasia

Angiographic and Intracoronary Manifestations of Coronary Fibromuscular Dysplasia

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

Incidental Spontaneous Coronary Artery Dissection

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