1 Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, USA.
2 Department of Radiology, Mayo Clinic College of Medicine, USA.
Eur Heart J Acute Cardiovasc Care. 2018 Oct;7(7):609-613. doi: 10.1177/2048872616687098. Epub 2017 Jan 31.
There is limited understanding of the role of cardiac computed tomography angiography (CCTA) for assessment of patients with spontaneous coronary artery dissection (SCAD).
In this report we describe the diagnostic utility of CCTA in three young women presenting with signs and symptoms of myocardial ischemia who were eventually diagnosed with SCAD.
None of the women had traditional atherosclerotic risk factors. SCAD was not initially identified on CCTA in any of the three women, but was visualized during retrospective analysis in two patients after invasive coronary angiography. In two patients follow-up CCTA imaging was used successfully for subsequent management.
In patients presenting with signs or symptoms of acute coronary syndrome, SCAD may be missed or not detectable on CCTA. A negative CCTA should not exclude a diagnosis of SCAD, and invasive coronary angiography should be considered for further evaluation.
对于自发性冠状动脉夹层（SCAD）患者，心脏计算机断层血管造影（CCTA）的作用知之甚少。
本报告描述了 CCTA 在三位出现心肌缺血症状和体征的年轻女性中的诊断作用，这些女性最终被诊断为 SCAD。
这三位女性均无传统的动脉粥样硬化危险因素。在三位女性中，CCTA 均未在最初发现 SCAD，但在两位患者进行了有创冠状动脉造影后，在回顾性分析中发现了 SCAD。在两位患者中，随后使用随访 CCTA 成像来进行后续管理。
在出现急性冠状动脉综合征症状或体征的患者中，CCTA 可能会漏诊或无法检测到 SCAD。阴性 CCTA 不能排除 SCAD 的诊断，应考虑进行有创冠状动脉造影以进一步评估。
