Screening of systemic arteriopathy in patients with spontaneous coronary artery dissection

Screening of systemic arteriopathy in patients with spontaneous coronary artery dissection Image Focus 357 IMAGE FOCUS doi:10.1093/ehjci/jex255 Online publish-ahead-of-print 8 November 2017 ................................................................................................................................................... Screening of systemic arteriopathy in patients with spontaneous coronary artery dissection 1,2 2 3 3 2 Fernando Macaya *, Andre´s Aldazabal  , Manuel Moreu , Juan Arrazola , and Javier Escaned 1 2 Cardiology Department, King ´s College Hospital, King ´s College London, Denmark Hill, Brixton, London, UK; Cardiology Department, Hospital Cl ınico San Carlos IDISSC, Universidad Complutense Madrid, Calle Profesor Mart ın Lagos s/n, 28040 Madrid, Spain; and Radiology Department, Hospital Cl ınico San Carlos IDISSC, Universidad Complutense Madrid, Calle Profesor Martin Lagos s/n, 28040, Madrid, Spain * Corresponding author. Tel: 144 077 56899655; Fax: 134 913 303091. E-mail: fernando@macaya.eu Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome in young women. It has been suggested that SCAD could be a reflection of an underlying systemic arterial disorder, namely fibromuscular dysplasia (FMD), a non-inflammatory sys- temic arteriopathy. A 59-year-old woman, former smoker, with hypertension and no other medical background presented with non-ST elevation myocardial infarction. Emergent coronary angiography revealed patent major epicardial vessels with subtle irregularities, and an abrupt calibre diminish- ment (tapering) of a distal marginal branch taking off from the circumflex (Panel A,arrows; see Supplementary online, Video S1). A tentative diagnosis of SCAD was made (angiotype II, intramural haematoma) and a conservative attitude adopted. After an uneventful course, the patient was scheduled for surveillance angiography 6 months later, in which SCAD diagnosis was confirmed by evidencing vessel restoration (Panel B, arrows; see Supplementary online, Video S2). Further investigation of non-coronary arterial beds was performed with magnetic res- onance angiography (MRA) in a two-in-one screening procedure assessing cervical-cephalic and abdominal-iliac arterial systems. Cerebral vessels appeared structurally normal but markedly tortuous (Panel C). No aneurysms were detected. Distal abdominal aorta showed tan- dem focus dilatations in a ‘string-of-beads’ pattern (Panel D, arrowheads), resembling the FMDs recognizable feature. However, renal arteries appeared normal (circles). Moreover, iliofemoral arteries showed marked tortuosity, without signs of fibromuscular dysplasia. Although systemic FMD encountered in SCAD patients most typically involves renal, carotid and femoral arteries, other territories may be separately affected as illustrated in this case, which justify performing an extended screening. Because of its non-invasiveness and absence of radiation, MRA represents an ideal tool for screening systemic arteriopathy in SCAD patients. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author 2017. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/19/3/357/4604690 by Ed 'DeepDyve' Gillespie user on 22 March 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal – Cardiovascular Imaging Oxford University Press

Screening of systemic arteriopathy in patients with spontaneous coronary artery dissection

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Oxford University Press
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.
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2047-2404
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10.1093/ehjci/jex255
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Abstract

Image Focus 357 IMAGE FOCUS doi:10.1093/ehjci/jex255 Online publish-ahead-of-print 8 November 2017 ................................................................................................................................................... Screening of systemic arteriopathy in patients with spontaneous coronary artery dissection 1,2 2 3 3 2 Fernando Macaya *, Andre´s Aldazabal  , Manuel Moreu , Juan Arrazola , and Javier Escaned 1 2 Cardiology Department, King ´s College Hospital, King ´s College London, Denmark Hill, Brixton, London, UK; Cardiology Department, Hospital Cl ınico San Carlos IDISSC, Universidad Complutense Madrid, Calle Profesor Mart ın Lagos s/n, 28040 Madrid, Spain; and Radiology Department, Hospital Cl ınico San Carlos IDISSC, Universidad Complutense Madrid, Calle Profesor Martin Lagos s/n, 28040, Madrid, Spain * Corresponding author. Tel: 144 077 56899655; Fax: 134 913 303091. E-mail: fernando@macaya.eu Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome in young women. It has been suggested that SCAD could be a reflection of an underlying systemic arterial disorder, namely fibromuscular dysplasia (FMD), a non-inflammatory sys- temic arteriopathy. A 59-year-old woman, former smoker, with hypertension and no other medical background presented with non-ST elevation myocardial infarction. Emergent coronary angiography revealed patent major epicardial vessels with subtle irregularities, and an abrupt calibre diminish- ment (tapering) of a distal marginal branch taking off from the circumflex (Panel A,arrows; see Supplementary online, Video S1). A tentative diagnosis of SCAD was made (angiotype II, intramural haematoma) and a conservative attitude adopted. After an uneventful course, the patient was scheduled for surveillance angiography 6 months later, in which SCAD diagnosis was confirmed by evidencing vessel restoration (Panel B, arrows; see Supplementary online, Video S2). Further investigation of non-coronary arterial beds was performed with magnetic res- onance angiography (MRA) in a two-in-one screening procedure assessing cervical-cephalic and abdominal-iliac arterial systems. Cerebral vessels appeared structurally normal but markedly tortuous (Panel C). No aneurysms were detected. Distal abdominal aorta showed tan- dem focus dilatations in a ‘string-of-beads’ pattern (Panel D, arrowheads), resembling the FMDs recognizable feature. However, renal arteries appeared normal (circles). Moreover, iliofemoral arteries showed marked tortuosity, without signs of fibromuscular dysplasia. Although systemic FMD encountered in SCAD patients most typically involves renal, carotid and femoral arteries, other territories may be separately affected as illustrated in this case, which justify performing an extended screening. Because of its non-invasiveness and absence of radiation, MRA represents an ideal tool for screening systemic arteriopathy in SCAD patients. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author 2017. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/19/3/357/4604690 by Ed 'DeepDyve' Gillespie user on 22 March 2018

Journal

European Heart Journal – Cardiovascular ImagingOxford University Press

Published: Mar 1, 2018

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