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Usefulness of Repeat Angiography to Establish Spontaneous Coronary Artery Dissection in Small Vessels
Naoki Kubota1, Kazuyuki Ozaki1, Yasuhiko Tanabe2
1Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences Niigata Japan.
Insights
Spontaneous coronary artery dissection (SCAD) in small vessels is often missed. Repeat coronary angiography can reveal SCAD by showing vessel enlargement over time, aiding diagnosis in challenging cases.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Spontaneous coronary artery dissection (SCAD) is a rare condition often misdiagnosed.
- Diagnosis can be challenging, especially in small coronary vessels where standard imaging may be insufficient.
- Current diagnostic tools like coronary angiography (CAG) and computed tomography angiography (CCTA) may not always detect SCAD.
Purpose of the Study:
- To investigate the utility of repeat coronary angiography in diagnosing small vessel SCAD.
- To describe the clinical characteristics and diagnostic challenges in patients with acute coronary syndrome due to small vessel SCAD.
Main Methods:
- Retrospective case series of 7 patients with acute coronary syndrome attributed to small vessel SCAD.
- Initial diagnosis attempted with CAG and/or CCTA.
- Follow-up diagnosis established through repeat CAG in the chronic stage.
Main Results:
- SCAD was diagnosed in 7 patients (predominantly female, mean age 50) with few risk factors.
- Initial CAG/CCTA failed to definitively diagnose SCAD in all patients.
- Repeat CAG in the chronic phase revealed vessel enlargement, suggesting SCAD healing.
Conclusions:
- Repeat coronary angiography may be a valuable tool for diagnosing spontaneous coronary artery dissection in small vessels.
- This approach can help identify SCAD when initial diagnostic methods are inconclusive.
- Conservative management was successful in this cohort due to small infarct size.
Abstract:
Spontaneous coronary artery dissection (SCAD) is a rare disease that is often misdiagnosed, except in typical cases. Although intracoronary imaging and multislice coronary computed tomography angiography (CCTA) are useful in establishing dissection, they may not be feasible in all instances, especially in small vessels. We describe a series of 7 patients with acute coronary syndrome secondary to small vessel SCAD that was detected only upon repeat coronary angiography (CAG). This cohort had a mean (±SD) age of 50±6 years, was predominantly female (n=6; 86%), and had few coronary risk factors. Three patients (43%) had dissection of the distal segment of the right coronary artery, 3 (43%) had distal left circumflex artery dissection, and 1 patient (14%) had a diagonal branch dissection. None of the patients required percutaneous coronary intervention, and received conservative therapy only, because the infarct area was sufficiently small. No definitive diagnosis of SCAD could be established in any of the patients at first admission because CAG alone or CCTA did not reveal the presence of a flap or intraluminal hemorrhage. However, in such patients without a definitive diagnosis, repeat CAG in the chronic stage showed enlargement of vessels, suggesting the healing of an SCAD. Repeat CAG may be useful for suggesting the occurrence of SCAD.
