Abstract
Spontaneous coronary artery dissection (SCAD) was diagnosed when there was a radiolucent flap or an artery with double lumens detected by coronary angiography (CAG). We identified these findings by using optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in two young females with acute coronary syndrome. Case 1 A 50-year-old female without cardiovascular risk factors (non-ST elevation acute coronary syndrome). CAG demonstrated diffuse, sub-occlusive and flow-limiting stenosis in the right coronary artery. No angiographic images suggesting arterial dissections were recognized. IVUS showed an intramural hematoma, but could not clearly delineate a dissected-intimal interface. The additional resolution obtained by OCT provided a more complete vessel visualization and showed the distribution of the intimomedial dissection flap in the culprit lesion. A bare-metal stent was implanted into the culprit lesion. Case 2 A 42-year-old female with a smoking habit (ST elevation acute coronary syndrome). A coronary angiogram showed diffuse and smooth stenosis (middle portion) and focal stenosis (apical portion) in the left anterior descending artery. OCT demonstrated an intramural hematoma and an intimal tear in the culprit lesion. A drug-eluting stent was deployed in the mid-portion of the left anterior descending artery. The distal lesion was managed conservatively. Conclusion When only coronary angiograms were evaluated, the intimal flap and intramural hematoma in our cases could not be confirmed, and SCAD might have been misinterpreted. Intracoronary imaging tools, such as OCT and IVUS, could provide high-resolution images of the vessel wall and improve the diagnosis of SCAD.
