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Spontaneous coronary artery dissection: challenges of coronary computed tomography angiography
Mackram F Eleid1, Marysia S Tweet1, Phillip M Young2
11 Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, USA.
Insights
Cardiac computed tomography angiography (CCTA) may miss spontaneous coronary artery dissection (SCAD) in patients with myocardial ischemia. A negative CCTA does not rule out SCAD, and invasive angiography may be needed.
Area of Science:
- Cardiology
- Radiology
Background:
- Limited understanding of cardiac computed tomography angiography (CCTA) utility in spontaneous coronary artery dissection (SCAD).
- SCAD is a critical diagnosis in young women presenting with acute coronary syndrome symptoms.
Observation:
- Three young women with myocardial ischemia symptoms and SCAD were studied.
- Initial CCTA did not detect SCAD in any patient; retrospective analysis revealed it in two.
- No traditional atherosclerotic risk factors were present in these patients.
Findings:
- SCAD can be missed on initial CCTA interpretation.
- Invasive coronary angiography aided SCAD diagnosis after negative CCTA.
- Follow-up CCTA imaging was useful for managing SCAD in two patients.
Implications:
- A negative CCTA should not exclude SCAD diagnosis in suspected cases.
- Invasive coronary angiography is crucial for definitive SCAD diagnosis when CCTA is equivocal.
- Further research is needed to optimize CCTA protocols for SCAD detection.
Background:
There is limited understanding of the role of cardiac computed tomography angiography (CCTA) for assessment of patients with spontaneous coronary artery dissection (SCAD).
Methods:
In this report we describe the diagnostic utility of CCTA in three young women presenting with signs and symptoms of myocardial ischemia who were eventually diagnosed with SCAD.
Results:
None of the women had traditional atherosclerotic risk factors. SCAD was not initially identified on CCTA in any of the three women, but was visualized during retrospective analysis in two patients after invasive coronary angiography. In two patients follow-up CCTA imaging was used successfully for subsequent management.
Conclusions:
In patients presenting with signs or symptoms of acute coronary syndrome, SCAD may be missed or not detectable on CCTA. A negative CCTA should not exclude a diagnosis of SCAD, and invasive coronary angiography should be considered for further evaluation.
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