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Coronary Artery Dissection
Jonathan D. Dodd, MD, MSc, MRCPI, FFR(RCSI); Darragh Brady, MD; Gerard M. Healy, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Separation occurring in outer 1/3 of tunica media and intramural hematoma (IMH) occupying dissection and compressing true lumen, leading to coronary insufficiency

        IMAGING

        • General Features

          • CT Findings

            • MR Findings

              • Echocardiographic Findings

                • Angiographic Findings

                  • Intracoronary Imaging

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    Selected References

                                    1. Hayes SN et al: Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association. Circulation. 137(19):e523-57, 2018
                                    2. Tan NY et al: Usefulness of cardiac magnetic resonance imaging in patients with acute spontaneous coronary artery dissection. Am J Cardiol. 122(10):1624-29, 2018
                                    3. Tweet MS et al: Spontaneous coronary artery dissection: acute findings on coronary computed tomography angiography. Eur Heart J Acute Cardiovasc Care. 2048872617753799, 2018
                                    4. Yeo I et al: Spontaneous coronary artery dissection: diagnosis and management. Curr Treat Options Cardiovasc Med. 20(3):27, 2018
                                    5. Tweet MS et al: Multimodality imaging for spontaneous coronary artery dissection in women. JACC Cardiovasc Imaging. 9(4):436-50, 2016
                                    6. Bashir M et al: Cardiac transplantation for spontaneous coronary artery dissection. Interact Cardiovasc Thorac Surg. 16(1):91-2, 2013
                                    7. Hoshi T et al: Multimodality intracoronary imaging in spontaneous coronary artery dissection: impacts of intravascular ultrasound, optical coherence tomography, and coronary angioscopy. Catheter Cardiovasc Interv. 81(3):E151-4, 2013
                                    8. Nakashima T et al: Detection of intramural hematoma and serial non-contrast T1-weighted magnetic resonance imaging findings in a female patient with spontaneous coronary artery dissection. Circ J. 77(11):2844-5, 2013
                                    9. Sheikh AS et al: Pregnancy-related spontaneous coronary artery dissection: two case reports and a comprehensive review of literature. Heart Views. 13(2):53-65, 2012
                                    10. Ohlmann P et al: Images in cardiovascular medicine. Spontaneous coronary dissection: computed tomography appearance and insights from intravascular ultrasound examination. Circulation. 113(10):e403-5, 2006
                                    11. Tepe SM et al: MRI demonstration of acute myocardial infarction due to posttraumatic coronary artery dissection. Int J Cardiovasc Imaging. 22(1):97-100, 2006
                                    12. van Gaal WJ 3rd et al: Treatment of spontaneous coronary dissection with drug-eluting stents--late clinical, angiographic and IVUS follow up. J Invasive Cardiol. 18(2):E93-4, 2006
                                    13. Chai HT et al: Utilization of a double-wire technique to treat long extended spiral dissection of the right coronary artery. Evaluation of incidence and mechanisms. Int Heart J. 46(1):35-44, 2005
                                    14. Justice LT et al: Left main dissection and thrombosis in a young athlete. Cardiol Rev. 13(5):260-2, 2005
                                    15. Porto I et al: Intravascular ultrasound imaging in the diagnosis and treatment of spontaneous coronary dissection with drug-eluting stents. J Invasive Cardiol. 16(2):78-80, 2004
                                    16. Rogers JH et al: Coronary artery dissection and perforation complicating percutaneous coronary intervention. J Invasive Cardiol. 16(9):493-9, 2004
                                    17. Kwong RY et al: Detecting acute coronary syndrome in the emergency department with cardiac magnetic resonance imaging. Circulation. 107(4):531-7, 2003
                                    18. Badmanaban B et al: Spontaneous coronary artery dissection presenting as cardiac tamponade. Ann Thorac Surg. 73(4):1324-6, 2002
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Definitions

                                            • Separation occurring in outer 1/3 of tunica media and intramural hematoma (IMH) occupying dissection and compressing true lumen, leading to coronary insufficiency

                                          IMAGING

                                          • General Features

                                            • CT Findings

                                              • MR Findings

                                                • Echocardiographic Findings

                                                  • Angiographic Findings

                                                    • Intracoronary Imaging

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Microscopic Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Demographics

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Consider

                                                                      Selected References

                                                                      1. Hayes SN et al: Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association. Circulation. 137(19):e523-57, 2018
                                                                      2. Tan NY et al: Usefulness of cardiac magnetic resonance imaging in patients with acute spontaneous coronary artery dissection. Am J Cardiol. 122(10):1624-29, 2018
                                                                      3. Tweet MS et al: Spontaneous coronary artery dissection: acute findings on coronary computed tomography angiography. Eur Heart J Acute Cardiovasc Care. 2048872617753799, 2018
                                                                      4. Yeo I et al: Spontaneous coronary artery dissection: diagnosis and management. Curr Treat Options Cardiovasc Med. 20(3):27, 2018
                                                                      5. Tweet MS et al: Multimodality imaging for spontaneous coronary artery dissection in women. JACC Cardiovasc Imaging. 9(4):436-50, 2016
                                                                      6. Bashir M et al: Cardiac transplantation for spontaneous coronary artery dissection. Interact Cardiovasc Thorac Surg. 16(1):91-2, 2013
                                                                      7. Hoshi T et al: Multimodality intracoronary imaging in spontaneous coronary artery dissection: impacts of intravascular ultrasound, optical coherence tomography, and coronary angioscopy. Catheter Cardiovasc Interv. 81(3):E151-4, 2013
                                                                      8. Nakashima T et al: Detection of intramural hematoma and serial non-contrast T1-weighted magnetic resonance imaging findings in a female patient with spontaneous coronary artery dissection. Circ J. 77(11):2844-5, 2013
                                                                      9. Sheikh AS et al: Pregnancy-related spontaneous coronary artery dissection: two case reports and a comprehensive review of literature. Heart Views. 13(2):53-65, 2012
                                                                      10. Ohlmann P et al: Images in cardiovascular medicine. Spontaneous coronary dissection: computed tomography appearance and insights from intravascular ultrasound examination. Circulation. 113(10):e403-5, 2006
                                                                      11. Tepe SM et al: MRI demonstration of acute myocardial infarction due to posttraumatic coronary artery dissection. Int J Cardiovasc Imaging. 22(1):97-100, 2006
                                                                      12. van Gaal WJ 3rd et al: Treatment of spontaneous coronary dissection with drug-eluting stents--late clinical, angiographic and IVUS follow up. J Invasive Cardiol. 18(2):E93-4, 2006
                                                                      13. Chai HT et al: Utilization of a double-wire technique to treat long extended spiral dissection of the right coronary artery. Evaluation of incidence and mechanisms. Int Heart J. 46(1):35-44, 2005
                                                                      14. Justice LT et al: Left main dissection and thrombosis in a young athlete. Cardiol Rev. 13(5):260-2, 2005
                                                                      15. Porto I et al: Intravascular ultrasound imaging in the diagnosis and treatment of spontaneous coronary dissection with drug-eluting stents. J Invasive Cardiol. 16(2):78-80, 2004
                                                                      16. Rogers JH et al: Coronary artery dissection and perforation complicating percutaneous coronary intervention. J Invasive Cardiol. 16(9):493-9, 2004
                                                                      17. Kwong RY et al: Detecting acute coronary syndrome in the emergency department with cardiac magnetic resonance imaging. Circulation. 107(4):531-7, 2003
                                                                      18. Badmanaban B et al: Spontaneous coronary artery dissection presenting as cardiac tamponade. Ann Thorac Surg. 73(4):1324-6, 2002