ROLE OF CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY (CCTA) IN SPONTANEOUS CORONARY ARTERY DISSECTION (SCAD)

Abstract Spontaneous Coronary Artery Dissection (SCAD) is a rare but insidious cause of myocardial infarction and sudden cardiac death especially in those who lacks of traditional cardiovascular risk factors. Although the most appropriate management of patients with SCAD is not clearly defined, it‘s essential to make an early diagnosis in order to follow a conservative approach. Nowadays, the role of Coronary Computed Tomography Angiography (CCTA) is consolidated in the study of atherosclerotic coronary pathology but its contribution in the diagnosis and follow–up of patients with SCAD does not apperar to be defined. The purpose of this study was to retrospectively investigate the diagnostic performance of CCTA and its role in the follow–up of patients with diagnosis of SCAD. We examined 307 patients admitted to emergency department for acute chest pain and an ECG diagnosis of STEMI from March 2021 to July 2023. 1 patient was diagnosed with type 2 SCAD on invasive coronary angiography (ICA) and 2 patients received a suspected diagnosis of SCAD at ICA and CCTA examination was performed to confirm the suspicion. CCTA examination showed the acute presence of Intramural hematoma (IMH) of the wall of left anterior descending artery (LAD) in 2 patients, confirming the angiographic suspect of SCAD type 2. All 3 patients were treated with conservatie therapy and subsequentely underwent CCTA of follow–up. The examination performed respectively 3 months, 45 days and 1 month after the acute event demonstrated the complete resolution of IMH in all patients and the patency of the vessel lumens. CCTA seems to be a feasible and effective imaging modality to detect the main findings of SCAD. It may play a crucial role in the management of patients with acute chest pain at low–intermediate risk of ACS in order to reduce the number of misdiagnoses. Furthermore, CCTA could facilitate follow–up of patients with diagnosis of SCAD given the high recurrency rate of this pathology. However, further large prospective studies are needed to clarify the role of CCTA in the diagnosis and in the follow–up of SCAD.