1 Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, USA.
2 Department of Radiology, Mayo Clinic College of Medicine, USA.
Eur Heart J Acute Cardiovasc Care. 2019 Aug;8(5):467-475. doi: 10.1177/2048872617753799. Epub 2018 Jan 29.
The coronary computed tomography angiography features of acute spontaneous coronary artery dissection, an important cause of acute coronary syndrome in young women, have not been assessed.
The "Virtual" Multicenter Mayo Clinic Spontaneous Coronary Artery Dissection Registry was established in 2010 and includes retrospective and prospective patient data. Retrospective assessment of acute coronary computed tomography angiography images was performed for 14 patients (16 vessels) who had images performed within two days of invasive coronary angiography diagnosis of acute spontaneous coronary artery dissection.
Four pertinent diagnostic coronary features of acute spontaneous coronary artery dissection were observed in order of prevalence: 1) abrupt luminal stenosis (64%); 2) intramural hematoma (50%); 3) tapered luminal stenosis (36%); and 4) dissection (14%). Additional findings include epicardial fat stranding (42%), coronary tortuosity (29%), and coronary bridge (14%). Fifty percent of patients had myocardial hypoperfusion in the myocardial distribution of the dissected coronary artery.
We define key coronary computed tomography angiography features of acute spontaneous coronary artery dissection, the most common of which are abrupt luminal stenosis and intramural hematoma. Importantly, intramural hematoma appears similar to noncalcified atherosclerotic plaque, emphasizing the importance of invasive coronary angiography for acute diagnosis of spontaneous coronary artery dissection until the sensitivity and specificity of coronary computed tomography angiography is better understood.
急性自发性冠状动脉夹层是年轻女性急性冠状动脉综合征的一个重要原因，但其冠状动脉计算机断层血管造影特征尚未得到评估。
“虚拟”多中心梅奥诊所自发性冠状动脉夹层注册中心成立于 2010 年，包括回顾性和前瞻性患者数据。对在经皮冠状动脉造影诊断急性自发性冠状动脉夹层前两天内进行的 14 例（16 支血管）急性冠状动脉计算机断层血管造影图像进行了回顾性评估。
按流行程度依次观察到急性自发性冠状动脉夹层的四个相关诊断性冠状动脉特征：1）突然管腔狭窄（64%）；2）壁内血肿（50%）；3）管腔锥形狭窄（36%）；4）夹层（14%）。其他发现包括心包脂肪条纹（42%）、冠状动脉迂曲（29%）和冠状动脉桥（14%）。50%的患者在夹层冠状动脉的心肌分布区存在心肌灌注不足。
我们定义了急性自发性冠状动脉夹层的关键冠状动脉计算机断层血管造影特征，其中最常见的是突然管腔狭窄和壁内血肿。重要的是，壁内血肿与非钙化粥样硬化斑块相似，这强调了在更好地了解冠状动脉计算机断层血管造影的敏感性和特异性之前，经皮冠状动脉造影对急性自发性冠状动脉夹层诊断的重要性。
