Читать книгу Interventional Cardiology - Группа авторов - Страница 222

Both IVUS and OCT can be used to diagnosis of SCAD, and both modalities have strengths and weaknesses). IVUS can be preferred where there in evidence of false lumen (Type 1), and in small calibre and tortuous vessels, where the imaging probe risks being occlusive; and proximal vessel dissections, where the false lumen stretches the external elastic lamina, increasing the vessel size. However, IVUS resolution can be insufficient for the detection of intima‐media complex fenestrations as seen in OCT [5]. By IVUS, a spontaneous coronary artery dissection appears as a medial dissection with an intramural hematoma occupying some or all of the dissected false lumen without identifiable intimal tears and without a communication between the true and false lumens, typically in a non‐atherosclerotic artery (Figure 8.11).

Figure 8.11 This patient presented with restenosis at follow‐up after stent implantation in the right coronary artery (arrows on angiogram and telling angiotomography images, top panel). On IVUS, all stent struts are seen at proximal and distal references (e.g. 20 mm and 25 mm), whereas at the fracture site there is superficial calcification from 11 to 4 o’clock and no stent strut is seen (arrow).