Imaging Modalities to Delineate Sequelae of Spontaneous Coronary Artery Dissection Managed with Percutaneous Coronary Intervention

Figures

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  Figure 1. Electrocardiogram showing occasional premature ventricular complexes, Q-waves in leads I, avL, V1, and V2 suggesting a prior antero-lateral infarct, and irregular rhythm suggesting atrial fibrillation (red arrows)

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  Figure 2. Coronary angiography with the corresponding OCT cross-sections (2a) Coronary angiography demonstrating mid-LAD and proximal-LAD areas of extravascular staining (blue arrowheads), area of mid-LAD stenting with diffuse mild in-stent re-stenosis (yellow bracket), and diffuse proximal LAD narrowing consistent with compression from the false lumen (red bracket). (2b) Coronary angiography with white hashes A–D corresponding to OCT cross-sections in 2c–2f. (2c) OCT image corresponding to cross-section A in 2b, showing diffuse concentric mild intimal thickening (blue arrow) within mid-LAD stents. (2d) OCT image corresponding to cross-section B in 2b, showing intimal flap (white asterisk) with initiation of communication of the true and false lumens. (2e) OCT image corresponding to cross-section C in 2b, showing the true lumen (yellow asterisk) with intima devoid of intimal plaque and patent false lumen (red asterisk). (2f) OCT image corresponding to cross-section D in 2b, showing compression of the proximal LAD by the thrombosed false lumen (white arrowhead). OCT, optical coherence tomography; LAD, left anterior descending artery

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  Figure 3. Coronary computed tomography angiography showing proximity of the thrombosed false lumen of dissection to origin of the left main artery (red arrows), proximal left anterior descending artery area of true and false lumen communication (blue arrow), and mid-left anterior descending artery stent (yellow arrows)

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  Figure 4. Coronary angiography at the index presentation showing residual dissection after stenting of the left anterior descending artery (4a) Diffuse left anterior descending artery dissection at index presentation (black arrow). (4b) Diffuse residual proximal left anterior descending artery narrowing suggestive of residual uncovered dissection after stenting at index presentation (black arrow).