Plaque Rupture
Responsible for only a small portion of SCAD pathogenesis
Atherosclerosis results in increased density of the vasa vasorum
May lead to rupture of vasa vasorum providing a dissection plane
Often found in atherosclerosis
mediated SCAD
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De Maio et al. Am J Cardiol 1989;64:
Clinical Presentation
Up to 50% present as sudden cardiac death
Most who survive present as acute coronary syndrome (90%)
2/3 NSTEMI, 1/3 STEMI
Rare presentations:
Stable angina
Tamponade
Ischemic Cardiomyopathy/CHF
Asymptomatic
a picture.
Vanzetto et al. Eur J CT Surgery 2009;35:
Diagnosis
And
Treatment
Diagnosis and Treatment
General Population
Pregnancy associated SCAD
Alvarez et al. Aust N Z J
Diagnosis in the General
Population
Coronary angiography
IVUS
Multidetector CT angiogram
Coronary Angiography
Angiographic findings:
Coronary occlusion
Thrombus formation
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Intimal flap
Persistence of contrast dye in the false lumen
Variability of coronary lumen during the cardiac cycle:
Systole: true lumen > false lumen
Diastole: false lumen > true lumen
Angiogram
IVUS
Limited data
Confirms the dissection
Defines anatomy (site and extension)
Distinguishes atherosclerosis from
subintimal hematoma
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Arnold et al. Cardiovascular Ultrasound
IVUS
Can detect dissection in angiographically normal vessels
Identifies the false lumen
Ensures correct wire placement
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Useful for future follow-up
Arnold et al. Cardiovascular Ultrasound
