Multimodality Imaging Approach to Spontaneous Coronary Artery Dissection

Spontaneous Coronary Artery Dissection (SCAD) refers to the spontaneous separation of the layers of the vessel wall caused by intramural hemorrhage, with or without an intimal tear. The typical SCAD patient is a middle-aged woman with few traditional cardiovascular risk factors, and it's frequently associated with pregnancy. Because of its low incidence, its pathophysiology is not fully understood. SCAD presents as an acute coronary syndrome, with chest pain, dyspnea, syncope, or heartbeat, even if diagnosis and clinical handling are different: coronary angiography is currently the main tool to diagnose SCAD; however, in doubtful cases, the use of both invasive and noninvasive cardiovascular imaging methods such as intravascular ultrasound or optical coherence tomography may be necessary. This paper aims to review the current state of knowledge on SCAD to address its demographic features, clinical characteristics, management, and outcomes, focusing on diagnostic algorithms and main multimodality imaging techniques.

Automated summary

Spontaneous Coronary Artery Dissection (SCAD) is the spontaneous separation of the vessel wall layers caused by intramural hemorrhage. It commonly occurs in middle-aged women with few traditional cardiovascular risk factors, often associated with pregnancy. SCAD presents as acute coronary syndrome with symptoms such as chest pain, dyspnea, syncope, or palpitations. Diagnosis is mainly done through coronary angiography, but additional imaging techniques like intravascular ultrasound or optical coherence tomography may be needed in uncertain cases. This paper aims to review the current understanding of SCAD, including its demographics, clinical characteristics, management, and outcomes, with a focus on diagnostic algorithms and multimodality imaging techniques.