Lim Chris, Banning Adrian, Channon Keith
John Radcliffe Hospital, Department of Cardiology Level 2, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom.
J Invasive Cardiol. 2010 Nov;22(11):559-60.
The diagnosis of spontaneous coronary artery dissection (SCAD) is not always readily apparent on coronary angiography. Even if the diagnosis is suspected, angiography often conveys limited information about the underlying pathology, much of which is crucial for successful percutaneous coronary intervention (PCI). Due to the dissection flap and the resultant double lumen, SCAD poses unique challenges for PCI, specifically in securing wire access to the true lumen without propagation of the dissection. Optical coherence tomography (OCT) is a wire-based intravascular imaging modality with a high resolution of 10-20 µm. We present a case demonstrating the use of OCT in emergency PCI of SCAD, where OCT was integral not only to the diagnosis of SCAD, but also to successful PCI of the condition. It is a valuable aid to PCI in cases where there is uncertainty regarding the precise guidewire location, proving its use in the cardiac catheterization laboratory beyond that of merely a diagnostic tool.
自发性冠状动脉夹层（SCAD）在冠状动脉造影上的诊断并不总是一目了然。即使怀疑有诊断，造影通常传达的关于潜在病理的信息有限，而其中许多信息对于成功的经皮冠状动脉介入治疗（PCI）至关重要。由于夹层瓣和由此产生的双腔，SCAD给PCI带来了独特的挑战，特别是在确保导丝进入真腔而不使夹层扩展方面。光学相干断层扫描（OCT）是一种基于导丝的血管内成像方式，具有10 - 20微米的高分辨率。我们展示了一个病例，该病例证明了OCT在SCAD急诊PCI中的应用，其中OCT不仅对于SCAD的诊断不可或缺，而且对于该病症的成功PCI也至关重要。在精确导丝位置存在不确定性的情况下，它是PCI的一种有价值辅助手段，证明了其在心脏导管实验室中的用途不仅仅是作为一种诊断工具。
