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. 2021 Aug 23;14(16):1743–1756. doi: 10.1016/j.jcin.2021.06.027

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© 2021 The Authors

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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Normal Coronary SCAD Mimics

(A1) Contrast streaming in the mid left anterior descending coronary artery (LAD) after a short stenosis gives the appearance of type 1 spontaneous coronary artery dissection (SCAD) (circled and arrows). (A2) A few frames later, as more contrast is injected, this appearance is lost upstream, but an apparent dual-lumen appearance now appears more distally (arrow). (B) A mid right coronary artery (RCA) probable type 1 SCAD is shown for comparison; note that the lack of heterogeneity in the dark contrast-opacified vessel makes streaming unlikely. This patient also had confirmed LAD SCAD. (C1) Catheter-induced coronary spasm of the RCA is relieved by intracoronary nitrate (C2). Subsequent assessment of the distal vessel confirms a type 2b dissection of the posterior descending branch (arrows, C3).