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Diagnosis of spontaneous coronary artery dissection by optical coherence tomography.

Abstract：

OBJECTIVES:This study sought to assess the diagnostic value of optical coherence tomography (OCT) in patients with suspected spontaneous coronary artery dissection (SCAD). BACKGROUND:SCAD is a rare but challenging clinical entity. METHODS:Following a prospective protocol, OCT was performed in 17 consecutive patients with a clinical and angiographic suspicion of SCD from a total of 5,002 patients undergoing coronary angiography. A conservative management strategy was followed. RESULTS:OCT ruled out the diagnosis of SCAD in 6 patients with coronary artery disease (atherosclerotic plaques and/or intracoronary thrombus). In 11 patients (age 48 ± 9 years, 9 female), OCT confirmed the presence of SCAD. A double-lumen or intramural hematoma image was visualized in all cases. However, only 3 patients presented an intimal "flap" on angiography. OCT readily identified the intimal rupture site (n = 7), the thickness (348 ± 84 μm) and length (31 ± 9 mm) of the intimomedial membrane, the area of the true (1.1 ± 0.5 mm(2)) and false lumen (5.9 ± 2.1 mm(2)), the associated intramural hematoma (n = 9), and thrombi in the true or false lumens (n = 11). Most of these findings were angiographically silent. After stenting (n = 4), OCT disclosed adequate stent coverage, expansion, and apposition, but also residual intramural hematoma at the stented site (abluminal) and at the distal vessel. CONCLUSIONS:OCT provides unique insights in patients with SCAD that allow an early diagnosis and adequate management. Most of these findings are undetectable by angiography.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Alfonso F,Paulo M,Gonzalo N,Dutary J,Jimenez-Quevedo P,Lennie V,Escaned J,Bañuelos C,Hernandez R,Macaya C

doi

10.1016/j.jacc.2011.08.082

subject

Has Abstract

pub_date

2012-03-20 00:00:00

pages

1073-9

issue

12

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(12)00096-4

journal_volume

59

pub_type

杂志文章

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