Contemporary review on spontaneous coronary artery dissection: insights into the angiographic finding and differential diagnosis.

Spontaneous coronary artery dissection (SCAD), although in the majority of cases presents as an acute coronary syndrome (ACS), has different pathophysiology from atherosclerosis that influences specific angiography findings and enables most patients to be solved by optimal medical therapy rather than percutaneous coronary intervention (PCI). Therefore, accurate diagnosis is essential for adequate treatment of each patient as management of SCAD differs from that of ACS of atherosclerotic aetiology. So far, invasive coronary angiography remains the most important diagnostic tool in suspected SCAD. However, there are ambiguous cases that can mimic SCAD. In this review, the authors summarize current knowledge about the diagnostic algorithms, particularly angiographic features of SCAD, pitfalls of angiography, and the role of intracoronary imaging in the context of SCAD diagnosis. Finally, apart from the pathognomonic angiographic features of SCAD that are thoroughly discussed in this review, the authors focus on obscure angiography findings and findings that can mimic SCAD as well. Differential diagnosis and the timely recognition of SCAD are crucial as there are differences in the acute and long-term management of SCAD and other causes of ACS.

Direct intracoronary stent implantation.

The standard stent implantation technique requires routine predilatation of the target lesion with balloon catheter. Since occurrence of complications is possible, direct stent implantation without previous dilatation has been performed recently. In this study, a complex case of coronary lesion treated with direct stent implantation in a patient with unstable angina after diaphragmal myocardial infarction was reported. A coronary angiography finding indicated presence of severe eccentric stenosis in the proximal third of the dominant right coronary artery. The system of the left coronary artery was without stenotic lesions. After antiaggregation combination of aspirin and ticlopidine, the stent was successfully implanted and dilated under the pressure of 14 atmospheres. The control coronary angiography did not show residual stenosis of the right coronary artery. The patient was discharged without subjective discomforts for further out-patient treatment.