Invasive imaging modalities in a spontaneous coronary artery dissection: when believing is seeing

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome (ACS) with recent advancements in cardiac imaging facilitating its identification. However, SCAD is still often misdiagnosed due to the absence of angiographic hallmarks in a significant number of cases, highlighting the importance of meticulous interpretation of angiographic findings and, when necessary, additional usage of intravascular imaging to verify changes in arterial wall integrity and identify specific pathoanatomical features associated with SCAD. Accurate diagnosis of SCAD is crucial, as the optimal management strategies for patients with SCAD differ from those with atherosclerotic coronary disease. Current treatment strategies favor a conservative approach, wherein intervention is reserved for cases with persistent ischemia, patients with high-risk coronary anatomy, or patients with hemodynamic instability. In this paper, we provide a preview of invasive imaging modalities and classical angiographic and intravascular imaging hallmarks that may facilitate proper SCAD diagnosis.

Automated summary

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome, and recent advancements in cardiac imaging have improved its diagnosis. However, due to the absence of distinct features, SCAD is often misdiagnosed, emphasizing the importance of careful interpretation of angiographic findings and the use of intravascular imaging. Accurate diagnosis of SCAD is crucial because management strategies differ from atherosclerotic coronary disease.