IJCS | Volume 31, Nº6, November / December 2018

674 Figure 2 - Intravascular ultrasonography of the proximal third of the anterior descending artery, performed 8 days after the first coronary angiography, showing intramural hematoma with thrombi at 4-11h. Intramural Hematoma Leão et al. Spontaneous coronary artery dissection Int J Cardiovasc Sci. 2018;31(6)672-675 Case Report data on different therapeutic strategies are scarce and the decisions remain largely empirical. 6-8 Intracoronary imaging techniques, such as the IVUS and optical coherence tomography, are crucial to establish the diagnosis, therapeutic decisions and prognosis. 3,5,9 Through retrospective studies, it is possible to observe that adequate treatment varies depending on the clinical severity of the disease, considering the persistence or the relief of the symptoms of ischemia, the patient’s hemodynamic condition, the myocardium area at risk, the extension of the dissection, the number of arteries involved and the distal coronary flow. 4,7,9 Saw et al., 3 in a revision study, designed an algorithm for themanagement of patientswith SCAD, presenting the following basic concepts: 1) The conservative therapy is performed in stablepatients,who aremonitored inhospital from 3 to 5 days; 2) The revascularization, including coronary percutaneous intervention, if possible, should be considered for those with high-risk characteristics; 3) The use of intra-aortic balloon, oxygenation by extracorporeal membrane, left ventricular assist device or implantable cardioverter defibrillators should be considered in hemodynamically unstable patients. In spite of its rarity, SCAD is an important cause of ACS and should always be considered in the differential diagnosis, particularly when it occurs in young healthy women. Intracoronary imaging can be used both to confirm the diagnosis and to guide the treatment decisions and, in combination with data provided by previous studies, help to define a more adequate therapeutic strategy, according to each type of disease presentation.