Imaging in Patients With Spontaneous Coronary Artery Dissection
Multimodality imaging is integral to studying both coronary anatomy and myocardial perfusion of patients with SCAD. The top left panel demonstrates SCAD coronary intimal disruption and intramural hematoma. The right upper panel shows patterns of SCAD as seen on coronary angiography. The middle left panel demonstrates an example of SCAD as seen on CTA. The middle right panel shows intravascular findings of intramural hematoma on OCT and IVUS as demarcated by the asterisks. The left lower panel demonstrates the use of TTE for regional wall motion assessment, CTA for myocardial perfusion assessment (arrows demonstrate lack of contrast in the LAD territory), and CMR demonstrating late gadolinium enhancement consistent with myocardial infarction, fibrosis or inflammation (arrows demonstrate late gadolinium enhancement in the LAD territory). The left lower panel also shows an example of MPI in a SCAD patient with lack of perfusion in the LAD territory. The right lower panel demonstrates extracoronary vascular abnormalities including fibromuscular dysplasia which are commonly observed in patients with SCAD. CMR = cardiac magnetic resonance; CTA = computed tomography angiography; LAD = left anterior descending; IVUS = intravascular ultrasound; MPI = myocardial perfusion imaging; OCT = optical coherence tomography; SCAD = spontaneous coronary artery dissection; TTE = transthoracic echocardiography.