Role of Intravascular Imaging in the Diagnosis and Treatment of Spontaneous Coronary Artery Dissection

Purpose of Review: The objective of this article is to review the role of intracoronary imaging in the management of patients with spontaneous coronary artery dissection (SCAD). In this review article, we discuss the types of intracoronary imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) and their relative strengths and weaknesses. Additionally, we discuss in detail the findings on IVUS and OCT and how these modalities can be used for optimization of percutaneous coronary intervention (PCI) in SCAD cases. Recent Findings: While coronary angiography is the first-line investigation for diagnosis of SCAD, it remains inconclusive in a considerable proportion of cases owing to the widely varying appearance of SCAD on angiography. Even though the vast majority of SCAD cases are treated conservatively, PCI may be required in cases with hemodynamic instability. Intracoronary imaging becomes critical in the two aforementioned situations, either for making a conclusive diagnosis of SCAD or for optimization of PCI. Summary: Intracoronary imaging has a vital role to play in the diagnosis and management of SCAD patients. Interventional cardiologists should be well versed with the findings on IVUS and OCT to diagnose SCAD and utilize it for optimization of PCI. However, it is important to exercise caution in performing intracoronary imaging and follow safe practices.