title: Diagnosis of spontaneous coronary artery dissection by optical coherence tomography.
abstract: OBJECTIVE
  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.
authors.affiliation: Interventional Cardiology Unit, Cardiovascular Institute, IdISSC, Complutense University, Clínico San Carlos, University Hospital, Madrid, Spain. falf@hotmail.com
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfonso
authors.forename: Manuel
authors.initials: M
authors.lastname: Paulo
authors.forename: Nieves
authors.initials: N
authors.lastname: Gonzalo
authors.forename: Jaime
authors.initials: J
authors.lastname: Dutary
authors.forename: Pilar
authors.initials: P
authors.lastname: Jimenez-Quevedo
authors.forename: Vera
authors.initials: V
authors.lastname: Lennie
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.forename: Camino
authors.initials: C
authors.lastname: Bañuelos
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernandez
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D003323:Coronary Aneurysm / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000175:diagnosis; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006406:Hematoma / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods; D041623:Tomography, Optical Coherence / Q000379:methods; D057832:Watchful Waiting