Role of Imaging in Spontaneous Coronary Artery Dissection – A Report and Review of Literature

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute ischaemic coronary events. It usually occurs during pregnancy or in the post-partum period in young women who have no traditional risk factors for coronary artery disease. We present two cases of SCAD in post-partum young women, who presented acutely with chest pain. Both underwent coronary angiography after worsening cardiac biomarkers. We utilised intravascular ultrasound (IVUS) in the first case, and optical coherence tomography (OCT) in the second case in order to confirm the diagnosis, define the anatomy and to measure the lesion length. This also serves to review the current literature and the available guidelines for treatment options for SCAD. We conclude that it is important to suspect SCAD as a cause of acute coronary syndrome in young female patients who present with chest pain especially in the post-partum period. These case studies also suggest a valuable role for IVUS and/or OCT in suspected cases of SCAD. This imaging is helpful in confirmation of the diagnosis, and allows optimal and precise treatment.