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A case of spontaneous coronary artery dissection diagnosed by coronary computed tomography angiography
Accepted Manuscript A case of spontaneous coronary artery dissection diagnosed by coronary computed tomography angiography Andrew Griffin, Ann Marie Navar, Lawrence Crawford, Joseph Mammarappallil, Lynne Hurwitz Koweek PII:
S1934-5925(17)30201-0
DOI:
10.1016/j.jcct.2017.09.005
Reference:
JCCT 1016
To appear in:
Journal of Cardiovascular Computed Tomograph
Received Date: 22 July 2017 Revised Date:
8 August 2017
Accepted Date: 9 September 2017
Please cite this article as: Griffin A, Navar AM, Crawford L, Mammarappallil J, Koweek LH, A case of spontaneous coronary artery dissection diagnosed by coronary computed tomography angiography, Journal of Cardiovascular Computed Tomograph (2017), doi: 10.1016/j.jcct.2017.09.005. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
A Case of Spontaneous Coronary Artery Dissection Diagnosed by Coronary Computed Tomography Angiography
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Andrew Griffin, MD, Ann Marie Navar, MD, PhD, Lawrence Crawford, MD, Joseph Mammarappallil, MD, PhD, Lynne Hurwitz Koweek, MD
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Corresponding author Andrew Griffin, MD Department of Radiology Duke University Medical Center 2301 Erwin Road, DUMC Box 3808 Durham, North Carolina 27710 Phone: 336-408-9857 Email: [email protected]
A 56-year-old female presented to the Emergency Department with chest pain. An initial computed tomography angiogram (CTA) of the aorta and coronary arteries was normal (Figure 1A). She ruled-in for a non-ST elevation myocardial infarction (NSTEMI).
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Invasive coronary angiography demonstrated a normal caliber left main, circumflex (LCX), and right coronary artery without coronary artery disease (Figure 1B) and a 70% stenosis of the distal left anterior descending (LAD) coronary artery (Figure 1C). The
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patient was discharged 1 day later on medical management. The night of her discharge, she developed chest pain and again ruled-in for NSTEMI. CTA of the aorta
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and coronary arteries demonstrated new narrowing of the proximal LCX (Figure 2A). Invasive coronary angiography demonstrated new narrowing of the proximal LCX that was unresponsive to intracoronary nitroglycerine (Figure 2B). No dissection flap was seen on invasive angiography.
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Coronary CTA was performed to differentiate vasospasm from dissection. ECG-gated coronary artery CTA demonstrated a 2 cm segment of high-grade stenosis of the proximal LCX with surrounding soft tissue, favored to represent a thrombosed false
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lumen or intramural hematoma (Figure 3A-C. Figure 3B demonstrates the normal
proximal left circumflex artery and Figure 3C demonstrates the thrombosed false lumen in cross section). The patient was discharged on medical management of coronary
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dissection.
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Coronary angiography is commonly used to evaluate for coronary artery dissection, but may not always be able to differentiate dissection from vasospasm. For dissections with a small or absent intimal tear, the intramural hematoma/thrombosed false lumen will appear as luminal narrowing on angiography. Coronary CTA can assess the vessel
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wall, allowing for differentiation of dissection from atherosclerotic disease due to lack of atherosclerotic vessel calcification and smooth lumen contour. In this case, CTA distinguished dissection from vasospasm due to the presence of soft tissue surrounding
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a vessel previously of normal caliber.
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AUTHOR DECLARATION
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Andrew Griffin, MD Department of Radiology Duke University Medical Center 2301 Erwin Road, DUMC Box 3808 Durham, North Carolina 27710 Phone: 336-408-9857 Email: [email protected] Disclosures: none
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We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property. We understand that the Corresponding Author is the sole contact for the Editorial process (including Editorial Manager and direct communications with the office). He is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. We confirm that we have provided a current, correct email address which is accessible by the Corresponding Author and which has been configured to accept email from.
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Ann Marie Navar, MD, PhD Department of Cardiology Duke University Medical Center 2400 Pratt St, Box 3850 Durham, North Carolina 27705 Phone: 919-684-8111 Email: [email protected] Disclosures: receives funding from NIH/NHLBI (K01-HL133416) Lawrence Crawford, MD Department of Cardiology Duke University Medical Center 2301 Erwin Rd, Box 7412 Durham, North Carolina 27710 Phone: 919-684-2407 Email: [email protected] Disclosures: none Joseph Mammarappallil, MD, PhD
Department of Radiology Duke University Medical Center 2301 Erwin Road, DUMC Box 3808 Durham, North Carolina 27710 Phone: 919-684-7218 Email: [email protected] Disclosures: none
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Lynne Hurwitz Koweek, MD Department of Radiology Duke University Medical Center 2301 Erwin Road, DUMC Box 3808 Durham, North Carolina 27710 Phone: 919-684-7538 Email: [email protected] Disclosures: none
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ACCEPTED MANUSCRIPT
S1934-5925(17)30201-0
DOI:
10.1016/j.jcct.2017.09.005
Reference:
JCCT 1016
To appear in:
Journal of Cardiovascular Computed Tomograph
Received Date: 22 July 2017 Revised Date:
8 August 2017
Accepted Date: 9 September 2017
Please cite this article as: Griffin A, Navar AM, Crawford L, Mammarappallil J, Koweek LH, A case of spontaneous coronary artery dissection diagnosed by coronary computed tomography angiography, Journal of Cardiovascular Computed Tomograph (2017), doi: 10.1016/j.jcct.2017.09.005. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
A Case of Spontaneous Coronary Artery Dissection Diagnosed by Coronary Computed Tomography Angiography
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Andrew Griffin, MD, Ann Marie Navar, MD, PhD, Lawrence Crawford, MD, Joseph Mammarappallil, MD, PhD, Lynne Hurwitz Koweek, MD
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Corresponding author Andrew Griffin, MD Department of Radiology Duke University Medical Center 2301 Erwin Road, DUMC Box 3808 Durham, North Carolina 27710 Phone: 336-408-9857 Email: [email protected]
A 56-year-old female presented to the Emergency Department with chest pain. An initial computed tomography angiogram (CTA) of the aorta and coronary arteries was normal (Figure 1A). She ruled-in for a non-ST elevation myocardial infarction (NSTEMI).
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Invasive coronary angiography demonstrated a normal caliber left main, circumflex (LCX), and right coronary artery without coronary artery disease (Figure 1B) and a 70% stenosis of the distal left anterior descending (LAD) coronary artery (Figure 1C). The
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patient was discharged 1 day later on medical management. The night of her discharge, she developed chest pain and again ruled-in for NSTEMI. CTA of the aorta
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and coronary arteries demonstrated new narrowing of the proximal LCX (Figure 2A). Invasive coronary angiography demonstrated new narrowing of the proximal LCX that was unresponsive to intracoronary nitroglycerine (Figure 2B). No dissection flap was seen on invasive angiography.
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Coronary CTA was performed to differentiate vasospasm from dissection. ECG-gated coronary artery CTA demonstrated a 2 cm segment of high-grade stenosis of the proximal LCX with surrounding soft tissue, favored to represent a thrombosed false
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lumen or intramural hematoma (Figure 3A-C. Figure 3B demonstrates the normal
proximal left circumflex artery and Figure 3C demonstrates the thrombosed false lumen in cross section). The patient was discharged on medical management of coronary
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dissection.
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Coronary angiography is commonly used to evaluate for coronary artery dissection, but may not always be able to differentiate dissection from vasospasm. For dissections with a small or absent intimal tear, the intramural hematoma/thrombosed false lumen will appear as luminal narrowing on angiography. Coronary CTA can assess the vessel
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wall, allowing for differentiation of dissection from atherosclerotic disease due to lack of atherosclerotic vessel calcification and smooth lumen contour. In this case, CTA distinguished dissection from vasospasm due to the presence of soft tissue surrounding
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a vessel previously of normal caliber.
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AUTHOR DECLARATION
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Andrew Griffin, MD Department of Radiology Duke University Medical Center 2301 Erwin Road, DUMC Box 3808 Durham, North Carolina 27710 Phone: 336-408-9857 Email: [email protected] Disclosures: none
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We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property. We understand that the Corresponding Author is the sole contact for the Editorial process (including Editorial Manager and direct communications with the office). He is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. We confirm that we have provided a current, correct email address which is accessible by the Corresponding Author and which has been configured to accept email from.
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Ann Marie Navar, MD, PhD Department of Cardiology Duke University Medical Center 2400 Pratt St, Box 3850 Durham, North Carolina 27705 Phone: 919-684-8111 Email: [email protected] Disclosures: receives funding from NIH/NHLBI (K01-HL133416) Lawrence Crawford, MD Department of Cardiology Duke University Medical Center 2301 Erwin Rd, Box 7412 Durham, North Carolina 27710 Phone: 919-684-2407 Email: [email protected] Disclosures: none Joseph Mammarappallil, MD, PhD
Department of Radiology Duke University Medical Center 2301 Erwin Road, DUMC Box 3808 Durham, North Carolina 27710 Phone: 919-684-7218 Email: [email protected] Disclosures: none
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Lynne Hurwitz Koweek, MD Department of Radiology Duke University Medical Center 2301 Erwin Road, DUMC Box 3808 Durham, North Carolina 27710 Phone: 919-684-7538 Email: [email protected] Disclosures: none
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