Figure 8.

Iatrogenic Dissection Versus SCAD

Spontaneous coronary artery dissection (SCAD) is associated with an increased risk for iatrogenic dissection (A1 to A3). Initial angiography demonstrating type 4 SCAD in the mid left anterior descending coronary artery (A1). During subsequent angiography, a linear filling defect is seen in the left mainstem (A2), followed on the subsequent injection by complete occlusion (A3). (B) In this case there is just a hint of a nonobstructive hematoma causing a minor stenosis (arrow) to suggest preexisting SCAD prior to extensive iatrogenic dissection (not shown) occurring on the next coronary injection. It can be difficult to be certain when dissection from the ostium is evident on the first contrast injection such as this right coronary artery injection (C), unless there are preexisting inferior electrocardiographic changes or if a nonselective injection (D, arrow) confirms dissection before catheter engagement.