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Spontaneous coronary artery dissection: where is the tear?

Nature Clinical Practice Cardiovascular Medicine volume 4, pages 636–637 (2007)Cite this article

The Case Study by Satoda and colleagues,1 published in this issue of Nature Clinical Practice Cardiovascular Medicine, reopens the discussion about spontaneous coronary artery dissection (SCAD). Reports of this condition recur frequently in the literature, but SCAD is seldom observed in clinical practice and remains nebulous in its nature. The authors provide cross-sectional images of the coronary arterial wall at two intervals during the evolution of an acute ischemic event. These images were obtained with multidetector CT (MDCT), in combination with traditional coronary angiography, shortly after the onset of the syndrome, and with intravascular ultrasonography (IVUS) at 3-month follow-up evaluation. The aim of this Viewpoint is to discuss the current understanding of SCAD in the light of findings obtained with new imaging techniques.

The patient was a 34-year-old woman recovering from the birth of her first child.1 Initially, MDCT and coronary angiography clearly showed coronary stenosis of the left anterior descending artery, with evidence of an intramural hematoma. At 3-month follow-up evaluation, however, the stenosis had disappeared, and IVUS showed a residual intramural hematoma, without an intimal tear or a connection with the true lumen.

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Acknowledgements

The author would like to thank MJ Mayo for technical assistance in preparing the supplementary online figure.

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  1. Leachman Cardiology Associates PA, Suite 2780, 6624 Fannin, Houston, TX 77030, USA pangelini@leachmancardiology.com

Authors and Affiliations

  1. P Angelini is an Interventional Cardiologist at the Texas Heart Institute, St Luke's Episcopal Hospital and a Professor of Medicine at Baylor College of Medicine, Houston, TX, USA.,

    Paolo Angelini

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Angelini, P. Spontaneous coronary artery dissection: where is the tear?. Nat Rev Cardiol 4, 636–637 (2007). https://doi.org/10.1038/ncpcardio1039

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