Macaya Fernando, Moreu Manuel, Ruiz-Pizarro Virginia, Salazar Carlos H, Pozo Eduardo, Aldazábal Andrés, Guerra Reddy, Rosati Santiago, Salinas Pablo, Gonzalo Nieves, Pérez-Vizcayno María J, Pérez de Isla Leopoldo, Fernández-Ortiz Antonio, Macaya Carlos, Adlam David, Arrazola Juan, Escaned Javier
Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain.
Leicester NIHR Biomedical Research Unit, Glenfield Hospital, Leicester University, Leicester, UK.
Cardiovasc Diagn Ther. 2019 Jun;9(3):229-238. doi: 10.21037/cdt.2019.04.09.
Current consensus recommends extended vascular investigation in patients with spontaneous coronary artery dissection (SCAD). We here report our experience with the use of magnetic resonance angiography (MRA) for screening extra-coronary arteriopathy in patients presenting with SCAD.
Patients presenting with SCAD in a Spanish centre underwent prospective contrast-enhanced MRA to assess the cephalic and abdominopelvic arterial territories. Fibromuscular dysplasia (FMD) was diagnosed following European consensus criteria. Other vascular abnormalities were recorded separately. Two vascular radiologists supervised the acquisitions and independently analysed the results for all cases.
Forty patients with SCAD [mean age 50.9±8.6 years, 90% (n=36) women] were included in the study, 12 patients declined to participate and 5 were excluded (metallic implanted devices). All enrolled patients underwent the screening protocol without complications. MRA demonstrated at least one extra-coronary vascular abnormality in 16 patients (40%): 5 (12.5%) were diagnosed with FMD, 6 (15%) showed arterial tortuosity, 3 (7.5%) had non-FMD focal stenoses, and 2 (5%) were found to have small aneurysms at the celiac trunk and splenic artery. No intracranial aneurysms were detected. At a mean follow-up of 4±3 years from the index episode, two cases experienced SCAD recurrences, one in a patient with FMD and the other one in a patient with arterial tortuosity. No deaths or strokes occurred.
Systematic extended vascular study with MRA was feasible and demonstrated associated extra-coronary arteriopathy in a substantial proportion of patients presenting with SCAD; however, none required additional intervention or led to vascular events. MRA, being a radiation-free modality, may be the preferred method for screening extracoronary arteriopathy in SCAD, a condition primarily affecting young and middle-age women sensitive to the risks of radiation.
目前的共识建议对自发性冠状动脉夹层（SCAD）患者进行广泛的血管检查。我们在此报告我们使用磁共振血管造影（MRA）筛查SCAD患者冠状动脉外动脉病变的经验。
西班牙一家中心的SCAD患者接受了前瞻性对比增强MRA，以评估头颈部和腹盆腔动脉区域。纤维肌发育不良（FMD）根据欧洲共识标准进行诊断。其他血管异常分别记录。两名血管放射科医生监督采集过程并独立分析所有病例的结果。
40例SCAD患者（平均年龄50.9±8.6岁，90%（n = 36）为女性）纳入研究，12例患者拒绝参与，5例被排除（有金属植入装置）。所有纳入患者均接受了筛查方案，无并发症发生。MRA显示16例患者（40%）至少有一处冠状动脉外血管异常：5例（12.5%）被诊断为FMD，6例（15%）显示动脉迂曲，3例（7.5%）有非FMD局灶性狭窄，2例（5%）在腹腔干和脾动脉发现小动脉瘤。未检测到颅内动脉瘤。自首次发作起平均随访4±3年，2例发生SCAD复发，1例为FMD患者，另1例为动脉迂曲患者。无死亡或中风发生。
MRA系统性广泛血管研究可行，且在相当比例的SCAD患者中显示出相关的冠状动脉外动脉病变；然而，无一例需要额外干预或导致血管事件。MRA作为一种无辐射的检查方式，可能是筛查SCAD患者冠状动脉外动脉病变的首选方法，SCAD主要影响对辐射风险敏感的中青年女性。
