Spontaneous coronary artery dissection: the emerging role of coronary computed tomography
Valeria Pergola, Saverio Continisio, Francesca Mantovani, Raffaella Motta, Giulia Mattesi, Gemma Marrazzo, Carlo Maria Dellino, Carolina Montonati, Giorgio De Conti, Domenico Galzerano, Vito Maurizio Parato, Alessia Gimelli, Agatella Barchitta, Marco Campana, Antonello D’Andrea
Abstract
Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome and myocardial infarction, more frequent among young women. Invasive coronary angiography (ICA) is the gold standard for the diagnosis of SCAD, although the risk of propagating dissection flap is considerable. Therefore, coronary computed tomography angiography (CCTA) is an emerging alternative modality to diagnose SCAD with the advantage of being a non-invasive technique. Clinicians should be aware of the predisposing conditions and pathophysiology to raise the pre-test probability of SCAD and select the most appropriate diagnostic tools. In recent times, improvements in spatial and temporal resolution and the use of semi-automated software providing quantitative assessment make CCTA a valid alternative to ICA also for the follow-up. Moreover, CCTA may be helpful to screen and evaluate extra-coronary arteriopathies closely related to SCAD. In this review, we illustrate the current and the potential role of CCTA in the diagnosis of SCAD, highlighting advantages and disadvantages of this imaging modality compared to ICA.