Intravascular photoacoustic and optical coherence tomography imaging dual-mode system for detecting spontaneous coronary artery dissection: A feasibility study

In this work,we present an intravascular dual-mode endoscopic system capable of both intravascular photoacoustic imaging(IVPAI)and intravascular optical coherence tomography(IVOCT)for recognizing spontaneous coronary artery dissection(SCAD)phantoms.IVPAI provides high-resolution and high-penetration images of intramural hematoma(IMH)at different depths,so it is especially useful for imaging deep blood clots associated with imaging phantoms.IVOCT can readily visualize the double-lumen morphology of blood vessel walls to identify intimal tears.We also demonstrate the capability of this dual-mode endoscopic system using mimicking phantoms and biological samples of blood clots in ex vivo porcine arteries.The results of the experiments indicate that the combined IVPAI and IVOCT technique has the potential to provide a more accurate SCAD assessment method for clinical applications.

Spontaneous coronary artery dissection-associated takotsubo syndrome: A systematic review of case reports

BACKGROUND Spontaneous coronary artery dissection(SCAD)is underdiagnosed and requires comprehensive angiographic findings.Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome(TTS)or exist simultaneously,making it challenging for clinicians to treat and manage.Case reports lack consolidated AIM To conduct a systematic review of available case reports on SCAD in order to investigate its potential association with TTS.METHODS SCAD-associated TTS case reports were reviewed after thoroughly screening PubMed,EMBASE,Scopus,and Google Scholar databases till January 2023.Case reports described demographics,comorbidities,imaging,management,and results.RESULTS Twelve articles about 20 female patients were analyzed.30%of patients(n=6,>60 years)were elderly(mean age 56.2±9.07 years,range 36-70 years).Canada has 9 cases,United States 3,Australia 3,Sweden 2,Japan,Denmark,and France 1.Only 5 reports identified emotional stressors in these cases while 4 reports showed physical triggers for TTS.Nine had hypertension,2 had hyperlipidemia,and 1 had prediabetes.5 patients(25%)smoked.10(50%)troponin-positive myocardial infarction patients reported chest discomfort.11(55%)of 20 instances had TTS/SCAD.12(60%)of 20 patients exhibited ST elevation and 3(15%)had T wave inversion on electrocardiogram.19/20 patients had elevated troponin.9(45%)of 20 people had apical akinesis with TTS ballooning on cardiac imaging.All 20 exhibited echocardiographic wall motion abnormalities.19(95%)of 20 coronary angiography cases had SCAD.10 of 19 SCAD patients had left anterior descending,2 diagonal,and 2 left circumflex coronary artery involvement.7 of 20 patients had left ventricular ejection fraction(LVEF)data.LVEF averaged 38.78±7.35%.5(25%)of the 20 cases underwent dual antiplatelet therapy.Three(15%)of 20 cases experienced occasional ectopic ventricular complexes,Mobitz ll AV block,and paroxysmal atrial fibrillation.All 20 cases recovered and survived.CONCLUSION Given the clinical similarities and challenges in detecting TTS and SCAD,this subset needs more research to raise awareness and reduce morbidity.

Spontaneous coronary artery dissection:A review of diagnostic methods and management strategies

Spontaneous coronary artery dissection(SCAD)is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic,non-traumatic separation of the coronary artery wall.The most common profile is a middle-aged woman between 44 and 53 years with few cardiovascular risk factors.SCAD is frequently linked with predisposing factors,such as postpartum,fibromuscular dysplasia or other vasculopathies,connective tissue disease and hormonal therapy,and it is often triggered by intense physical or emotional stress,sympathomimetic drugs,childbirth and activities increasing shear stress of the coronary artery walls.Patients with SCAD usually present at the emergency department with chest discomfort,chest pain,and rapid heartbeat or fluttery.During the last decades,the most common problem of SCAD was the lack of awareness about this condition which has led to significant underdiagnosis and misdiagnosis.However,modern imaging techniques such as optical coherence tomography,intravascular ultrasound,coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of the disease.Treatment of SCAD remains controversial,especially during the last years,where invasive techniques are being used more often and in more emergent cardiac syndromes.Although conservative treatment combining aspirin and betablocker remains the recommended strategy in most cases,revascularization could also be suggested as a method of treatment in specific indications,but with a higher risk of complications.The prognosis of SCAD is usually good and long-term mortality seems to be low in these patients.Follow-up should be performed on a regular basis.

Spontaneous Coronary Artery Dissection with Iliac Artery Dissection: A Case Report and Literature Review

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome or sudden cardiac death.It often occurs in females with no conventional cardiovascular risk factors.Bilateral iliac artery dissection is also a rare disease.This case report describes a patient with spontaneous coronary artery dissection and iliac artery dissection.The authors believe that a conservative approach could be used as an effective therapy for a clinically stable patient.

Spontaneous Coronary Artery Dissection as a Cause of Acute Myocardial Infarction in Young Female Population： A Single-center Study

Background： Spontaneous coronary artery dissection （SCAD） is a nonatherosclerotic but a rare and extremely dangerous clinical entity, it has a high prevalence in young female population with acute myocardial infarction （AMI）. The previous reports were restricted to other countries＇ population, but rare in China. Hence, this study aimed to focus on the characteristics of SCAD as a cause of young female AMI population in Jiangsu, China. Methods： This study enrolled young female AMI patients aged ≤50 years who underwent coronary angiography （CAG） and intracoronary imaging in our center between January 2013 and December 2016. Their clinical presentations, risk factors, and CAG characteristics were analyzed. Results： A total of 60 young l＇emale AMI （〈7 days） patients were enrolled. From their CAG and intracoronary imaging results, the prevalence of SCAD in young female AMI population was 35% （21/60）, the prevalence of coronary atherosclerostic heart disease was 65% （39/60）. In the SCAD group, 43% （9/21） presented with non-ST-elevation myocardial infarction （NSTEM1） and the remainder presenting as STEMI. SCAD usually occurred in a single vessel （20/21, 95%）, especially in left anterior descending artery （14/21, 67%）. Eighteen patients （18/21, 86%） underwent conservative treatment, whereas the remaining three patients （3/21, 14%） underwent percutaneous coronary intervention. Regarding the angiographic results of SCAD lesions, intramural hematoma was discriminated in 95% （20/21）, and Type I imaging was observed in 5% （1/21）, Type l I was observed in 67% （14/21）, and Type Ⅲ was 29% （6/21）. The average stenosis in the group was 76.9% - 20.6%, and the mean lesion length was 36.6 ± 8.6 ±m. Conclusions： SCAD has a high prevalence in young female AMI population in Jiangsu, China. Discriminating the cause of AMI in young female population is very important.

Syncope with spontaneous coronary artery dissection in an elderly woman

Diagnosis of spontaneous coronary artery dissection （SCAD） is challenging because of its rarity and uncertain etiology. It frequently occurs in young women during pregnancy and in the postpartum period, and rarely found in elder women with no history of cardiovascular disease or coronary risk factors. In this article we report a case of SCAD in a 75-year-old woman without traditional cardiovascular risk factors who presented with syncope and mild chest discomfort. There were no abnormal electrocardiographic changes and no elevated cardiac enzymes were detected. Computed tomography of brain revealed nothing abnormal. Coronary artery disease was suspected. Coronary angiogram revealed dissection in the middle left circumflex artery. The patient underwent percutaneous transluminal coronary angioplasty and was free of symptoms at 6-month follow-up. Our report suggests that emergency coronary angiography is indicated if syncope caused by coronary artery disease is suspected.

Spontaneous dissection of proximal left main coronary artery in a healthy adolescent presenting with syncope:A case report

BACKGROUND Spontaneous coronary artery dissection(SCAD)is a frequent cause of acute coronary syndrome in young to middle-aged women with few or no traditional cardiovascular risk factors.Chest pain is the most frequently described presenting symptom,but syncope is extremely rare.Herein,we report on a 16-year-old girl who presented with an episode of syncope occurring during a race.Despite significantly elevated troponin level,the diagnosis of the left main coronary artery SCAD with cardiogenic shock was delayed.CASE SUMMARY A 16-year-old girl presented with an episode of syncope.Myocardial injury markers were positive.Echocardiography showed a mildly reduced left ventricular ejection fraction(50%).Although initially stable,she later experienced recurrent chest pain accompanying precordial ST segment elevation with dynamic changes and developed cardiogenic shock,necessitating emergent revascularization.Coronary angiography demonstrated almost total occlusion at the ostium and proximal segment of the left main trunk coronary artery(LMT).Intravascular ultrasound confirmed a false lumen with prominent dissection in the LMT.Percutaneous coronary intervention assisted by intra-aortic balloon pump was conducted in the LMT.A 3.5 mm×24 mm everolimus-eluting stent was deployed to the focal lesions of the LMT.A postprocedural electrocardiogram showed alleviation of the precordial ST-segment elevation.The diagnosis of SCAD was confirmed.Transthoracic echocardiography showed an improved left ventricular ejection fraction(57%).The patient was asymptomatic during the 24-mo.follow-up period.CONCLUSION SCAD should always be considered in the differential diagnosis of acute coronary syndrome presentations in low-risk patients,regardless of age.

Spontaneous coronary dissection should not be ignored in patients with chest pain in autosomal dominant polycystic kidney disease:A case report

BACKGROUND When autosomal dominant polycystic kidney disease(ADPKD)presents with acute coronary syndrome(ACS),the possibility of spontaneous coronary artery dissection(SCAD)should be highly considered.In some cases,SCAD is considered an extrarenal manifestation of ADPKD depending on the pathological characteristics of the unstable arterial wall in ADPKD.CASE SUMMARY Here,we report a 46-year-old female patient with ADPKD who presented with ACS.Coronary angiography revealed no definite signs of dissection,while intravascular ultrasound revealed a proximal to distal dissection of the left circumflex.After a careful conservative medication treatment,the patient exhibited favorable prognosis.CONCLUSION In cases of ADPKD co-existing with ACS,differential diagnosis of SCAD should be considered.Moreover,when no clear dissection is found on coronary angiography,IVUS should be performed to prevent missed diagnosis.

Acute myocardial infarction in twin pregnancy after assisted reproduction:A case report

BACKGROUND Acute myocardial infarction(AMI)during pregnancy is rare,especially in twin pregnancy,and it can endanger the lives of the mother and children.Except for conventional cardiovascular risk factors,pregnancy and assisted reproduction can increase the risk of AMI during pregnancy.AMI develops secondary to different etiologies,such as coronary spasm and spontaneous coronary artery dissection.CASE SUMMARY A 33-year-old woman,with twin pregnancy in the 31st week of gestation,presented to the hospital with intermittent chest tightness for 12 wk,aggravation for 1 wk,and chest pain for 4 h.Combined with the electrocardiogram and hypersensitive troponin results,she was diagnosed with acute ST-elevation myocardial infarction.Although the patient had no related medical history,she presented several risk factors,such as age greater than 30 years,assisted reproduction,and hyperlipidemia.After diagnosis,the patient received antiplatelet and anticoagulant treatment.Cesarean section and coronary angiography performed 7 d later showed stenosis and thrombus shadow of the right coronary artery.After receiving medication,the patient was in good condition.CONCLUSION This case suggests that,with the widespread use of assisted reproductive technology,more attention should be paid to perinatal healthcare,especially when chest pain occurs,to facilitate early diagnosis and intervention of AMI,and the etiology of AMI in pregnancy needs to be differentiated,especially between coronary spasm and spontaneous coronary artery dissection.