Androulakis Emmanuel, Kourek Christos, Vrettos Apostolos, Kontopodis Nikolaos, Lioudaki Eirini, Prasinou Maria, Xanthopoulos Andreas, Antonopoulos Alexios, Briasoulis Alexandros, Mohiaddin Raad
Inherited Cardiac Conditions Department, St George's University Hospital, Blackshaw Rd, London SW17 0QT, UK.
Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, National and Heart Lung Institute, Imperial College London, Sydney St, London SW3 6NP, UK.
Eur Heart J Imaging Methods Pract. 2023 Dec 26;1(2):qyad044. doi: 10.1093/ehjimp/qyad044. eCollection 2023 Sep.
Spontaneous coronary artery dissection (SCAD) has been recognized as an important cause of acute coronary syndrome in women ≤ 50 years old, and up to 43% of pregnancy-associated myocardial infarction. SCAD has a strong association with extra-coronary arteriopathies, including either more common entities such as dissections, intracranial or other aneurysms, and extra-coronary and coronary arterial tortuosity or less common inherited vascular disorders such as Ehlers-Danlos syndrome, Marfan syndrome, and Loeys-Dietz syndrome, leading to the conclusion that systemic arterial disorders may underlie SCAD. Fibromuscular dysplasia is the most common extra-coronary vascular abnormality identified among these patients, also sharing a common genetic variant with SCAD. The American Heart Association, in a scientific statement regarding the management of SCAD, recommends that patients with SCAD should undergo additional evaluation with imaging techniques including either computed tomography angiography (CTA) or magnetic resonance angiography (MRA). MRA has been shown to have sufficient diagnostic accuracy in identifying extra-coronary arterial abnormalities, almost equal to CTA and conventional angiography. The aim of this review is to appraise the most recent important evidence of extra-coronary arteriopathy in the setting of SCAD and to discuss the strengths and weaknesses of various non-invasive imaging methods for screening of extra-coronary arteriopathies in patients with SCAD.
自发性冠状动脉夹层（SCAD）已被公认为50岁及以下女性急性冠状动脉综合征的重要病因，以及高达43%的妊娠相关心肌梗死的病因。SCAD与冠状动脉外动脉病变密切相关，包括较为常见的病变，如夹层、颅内或其他动脉瘤，以及冠状动脉外和冠状动脉迂曲，或不太常见的遗传性血管疾病，如埃勒斯-当洛综合征、马凡综合征和洛伊ys-迪茨综合征，由此得出结论，系统性动脉疾病可能是SCAD的基础。纤维肌发育不良是这些患者中最常见的冠状动脉外血管异常，也与SCAD有共同的基因变异。美国心脏协会在一份关于SCAD管理的科学声明中建议，SCAD患者应接受包括计算机断层扫描血管造影（CTA）或磁共振血管造影（MRA）在内的成像技术的额外评估。MRA已被证明在识别冠状动脉外动脉异常方面具有足够的诊断准确性，几乎与CTA和传统血管造影相当。本综述的目的是评估SCAD背景下冠状动脉外动脉病变的最新重要证据，并讨论各种非侵入性成像方法在筛查SCAD患者冠状动脉外动脉病变方面的优缺点。
