![]() ![]() Published on behalf of the European Society of Cardiology. MINOCA Myocardial infarction with non-obstructive coronary arteries SCAD Spontaneous coronary artery dissection. Spontaneous coronary artery dissection events may occur in intra-myocardial coronary arteries, approaching the resolution limits of invasive coronary angiography. First septal perforator SCAD prevalence is likely greater than reported herein and dependent on local expertise and availability of CMR imaging. Patients were treated conservatively, each with ejection fraction >50%.įirst septal perforator SCAD events may be overlooked at initial angiography and mis-diagnosed as 'no culprit' MI. First septal perforator SCAD diagnosis was established by review of initial coronary angiogram consequent to cardiovascular magnetic resonance (CMR) demonstrating focal septal late gadolinium enhancement with corresponding oedema (n = 3), occurrence of subsequent SCAD event (n = 2), or second angiogram showing healed S1-SCAD (n = 1). Unfortunately, the underlying mechanisms and predictors of plaque. Initial angiographic interpretation failed to recognize S1-SCAD in 6 (55%) patients (no culprit, n = 5, septal embolism, n = 1). Plaque rupture and subsequent thrombogenesis induce acute coronary syndrome (ACS) (3,5). ![]() Angiographic type 2 SCAD was present in 7 (64%) patients with S1 TIMI 3 flow in 7 (64%) and TIMI 0 flow in 2 (18%). Initial electrocardiogram demonstrated ischaemia in 5 (45%) septal wall motion abnormality was present in 4 (36%). Each presented with acute chest pain, troponin elevation, and non-ST-elevation MI diagnosis. Among 11 patients, age range was 38-64 years, 9 (82%) were female. First septal perforator SCAD prevalence was 11 of 1490 (0.7%). Patients were gathered from SCAD registries at Minneapolis Heart Institute and Vancouver General Hospital. Herein, we describe characteristics of patients with acute myocardial infarction (MI) caused by first septal perforator (S1) SCAD. Shown below is a coronary angiogram demonstrating TIMI flow grade 3 in the RCA.Ĭlick here for other examples of TIMI flow grade 3.Spontaneous coronary artery dissection (SCAD) diagnosis is challenging as angiographic findings are often subtle and differ from coronary atherosclerosis. Antegrade flow into the bed distal to the obstruction occurs as promptly as antegrade flow into the bed proximal to the obstruction, and clearance of contrast material from the involved bed is as rapid as clearance from an uninvolved bed in the same vessel or the opposite artery. TIMI grade 3 flow is defined as complete perfusion. Synonyms and keywords: TIMI 3, TIMI 3 flow, TIMI 3 flow grade, TFG 3, TFG3 Technique Quantification of LV Function Quantification of Mitral RegurgitationĮditor-In-Chief: C. Quantitative Coronary Angiography Definitions of Preprocedural Lesion Morphology Irregular Lesion Disease Extent Arterial Foreshortening Infarct Related Artery Restenosis Degenerated SVG Collaterals Aneurysm Bifurcation Trifurcation Ulceration Preprocedural Lesion Morphology Eccentricity Irregularity Ulceration Intimal Flap Aneurysm Sawtooth Pattern Length Ostial location Angulation Proximal tortuosity Degenerated SVG Calcification Total occlusion Coronary Artery Thrombus TIMI Thrombus Grade TIMI Thrombus Grade 0 TIMI Thrombus Grade 1 TIMI Thrombus Grade 2 TIMI Thrombus Grade 3 TIMI Thrombus Grade 4 TIMI Thrombus Grade 5 TIMI Thrombus Grade 6 TIMI Myocardial Perfusion Grade TMP Grade 0 TMP Grade 0.5 TMP Grade 1 TMP Grade 2 TMP Grade 3ĪCC/AHA Lesion-Specific Classification of the Primary Target Stenosis TIMI Flow Grade TIMI Grade 0 Flow TIMI Grade 1 Flow TIMI Grade 2 Flow TIMI Grade 3 Flow TIMI Grade 4 Flow Pulsatile Flow Deceleration Standard Views Left Coronary Artery Right Coronary Artery Separate Ostia Anomalous Origins Case Example Fistula Appropriate Use Criteria for RevascularizationĬoronary arteries Dominance Right System Left System Left Main Left Anterior Descending Circumflex Median Ramus ![]()
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