How and when to suspect spontaneous coronary artery dissection: novel insights from a single-centre series on prevalence and angiographic appearance

Motreff, Pascal; Malclès, Guilhem; Combaret, Nicolas; Barber‐Chamoux, Nicolas; Bouajila, Sara; Pereira, Bruno; Amonchot, Aimé; Citron, Bernard; Lusson, Jean-René; Eschalier, Romain; Souteyrand, Géraud

doi:10.4244/eij-d-16-00187

Cited by 92 publications

(78 citation statements)

References 22 publications

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“…Correlation with ECG or echo changes and the use of OCT in the 25% of NSTE-ACS patients with angiographically normal epicardial coronary arteries [164][165][166] may be helpful for identifying the culprit lesion, or rule out other mechanisms such as dissection or haematomas [MI with non-obstructive coronary arteries (MINOCA)]. [167][168][169] A routine invasive strategy in NSTE-ACS has been shown to improve clinical outcomes, 170 and benefit was mainly confined to biomarker-positive patients 171 and patients with other high-risk features as defined in Figure 4. Of importance, the use of a radial approach, new-generation DES, and more effective P2Y 12 -inhibitors were not available or broadly implemented in these trials, and led to a magnified benefit in frail ACS populations.…”

Section: Early Invasive Vs Conservative Strategymentioning

confidence: 99%

2018 ESC/EACTS Guidelines on myocardial revascularization

Neumann¹,

Ahlsson²,

Alfonso³

et al. 2018

European Heart Journal

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5,223

2,078

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Section: Early Invasive Vs Conservative Strategymentioning

confidence: 99%

2018 ESC/EACTS Guidelines on myocardial revascularization

Neumann¹,

Ahlsson²,

Alfonso³

et al. 2018

European Heart Journal

Self Cite

5,223

2,078

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“…A young female patient with single risk factor of cardiovascular disease with ACS presentation should prompt us to rule out SCAD diagnosis. It accounts for approximately one third of young women (<60 years) and with one or less cardiovascular risk factor presenting with ACS [6]. In this particular setting with morphologic ambiguity, OCT which provides high-resolution images, may help to differentiate SCAD from atherosclerotic plaque disruption.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Infarction Complicating Vasospastic Angina in a Female Patient—Case Report

Ndao¹,

Ka²,

Dia³

et al. 2020

WJCD

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Coronary artery vasospasm is an infrequent cause of acute coronary syndrome (ACS). A 50-year-old female developed persistent chest discomfort related to anterior STEMI. After an unsuccessful thrombolysis attempt, due to delay concern, the patient was then sent to the catheterization laboratory for rescue PCI. The coronary angiogram revealed a TIMI 3 flow proximal LAD significant stenosis with spastic appearance of the coronary arteries which has improved after intracoronary nitrates administration. Optical Coherence Tomography (OCT) excluded coronary artery dissection and haematoma also revealed thrombus on moderate atherosclerotic plaque. The patient was then pain-free; she was managed medically and discharged after few days of monitoring. Three weeks later, she developed transient chest pain with ST segment elevation while cycling during rehabilitation program. Provocation test by Ergonovine was positive with complete occlusion of proximal RCA (right coronary artery) complicated by transient complete heart block and shock. She was stabilized with 7 mg of intracoronary nitrates injection. She was discharged after close monitoring with calcium channel blocker and tobacco cessation. ACS may complicate prolonged coronary artery vasospasm making the diagnosis challenging. OCT may help understand ACS mechanism and exclude spontaneous coronary artery dissection. Provocation test is crucial for confirmation.

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“…In this case, the differentials included an atherosclerotic plaque event resulting in a similar presentation or a Lotus-Root like lesion causing the angiographic findings. Motreff et al, identified 5 angiographic features which could assist clinicians towards the diagnosis of SCAD [16,17]. The patient had 3 out of the 5 criteria fulfilled i.e., absence of atheroma on other arteries, radiolucent flap generating two lumens and ending of angiographic ambiguity on a side branch.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Thromboembolic Stroke - Silent Myocardial Infarction from Spontaneous Coronary Artery Dissection

Gue¹

2017

AVS

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Spontaneous Coronary Artery Dissection (SCAD) is a very rare cause of acute coronary syndromes [1]. The pathogenesis remains unclear. However, several diseases and conditions have been associated with SCAD, such as connective tissue disorders [2,3], increased sheer stress such as after exercise [3,4]. It affects predominantly females, particularly in the peri-partum and post-partum period [1,3,[5][6][7][8]. We present an unusual case of SCAD in a male patient who presented with stroke. Case PresentationA 57-year-old Caucasian male was admitted with right sided weakness. Past medical history includes COPD with a history of 40 pack years. ECG showed inferior Q waves and lateral T-wave inversion (Figure 1). He denied any ischemic symptoms such as chest pain prior to presentation. Diabetes was ruled out with a normal fasting glucose. Admission bloods showed polycythaemia which was subsequently seen by the haematology team who concluded that it is secondary to smoking. CT scan on admission showed an area of low attenuation in the right cerebellum and he was diagnosed clinically as left hemispheric stroke (Figure 2). He was initiated on antiplatelet therapy as per local stroke protocol. An echocardiogram was performed as to rule out embolic cause of stroke.Echocardiogram showed an akinetic apex with thrombus within the apex and evidence of severe left ventricular systolic impairment with ejection fraction of <35% (Figure 3). He was started on apixaban by the stroke team (as an unlicensed indication as patient declined to be started on warfarin) and was referred to cardiology team. AbstractAn incidental finding on a patient who was followed up after presenting to the hospital with a cerebrovascular event. The angiogram performed showed Spontaneous Coronary Artery Dissection (SCAD) of Left Anterior Descending (LAD) artery. This has resulted in thrombus formation within the left ventricle which led to a thromboembolic stroke. The patient did not have any typical associated conditions for SCAD and it is theorized that heavy smoking and secondary polycythaemia might be contributing factors to the findings.

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How and when to suspect spontaneous coronary artery dissection: novel insights from a single-centre series on prevalence and angiographic appearance

Abstract: SCAD accounts for approximately one third of ACS in young women with ≤1 CRF. The combination of specific angiographic signs and OCT imaging facilitates the diagnosis of ambiguous cases without intimal rupture.

Cited by 92 publications

References 22 publications

2018 ESC/EACTS Guidelines on myocardial revascularization

2018 ESC/EACTS Guidelines on myocardial revascularization

Myocardial Infarction Complicating Vasospastic Angina in a Female Patient—Case Report

An Unusual Case of Thromboembolic Stroke - Silent Myocardial Infarction from Spontaneous Coronary Artery Dissection

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