Optical Coherence Tomography for Spontaneous Coronary Artery Dissection Assessment: The Flush-Free OCT Technique

Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic cause of acute coronary syndrome that primarily affects young women. Although intravascular imaging, particularly optical coherence tomography (OCT), provides high-resolution visualization of intramural hematoma and dissection planes, its routine use in SCAD is not recommended. This is mainly due to the risk of false lumen propagation from high-pressure injection of a flushing medium, typically viscous contrast medium, to exclude intraluminal blood and enable OCT luminal visualization. We present a case series of 3 patients with SCAD who underwent flush-free OCT image acquisition, allowing for the identification of intramural hematoma without the need for high-pressure contrast injection. In all cases, findings were confirmed through conventional contrast OCT image acquisition. Our novel approach minimizes procedural risks associated with high-pressure contrast injection while preserving the diagnostic benefits of OCT. These findings suggest that the flush-free OCT technique is feasible and can be a safer initial intravascular modality in patients with suspected SCAD.