Spontaneous Coronary Artery Dissection: A Review of Epidemiology, Pathophysiology and Principles of Management

Spontaneous coronary artery dissection (SCAD) is a sudden rupture of coronary artery wall leading to false lumen and intramural hematoma for-mation. It commonly occurs in young and middle-aged women lacking typical cardiovascular risk factors. Fibromuscular dysplasia and pregnancy are strongly associated with SCAD. To date, the inside-out and outside-in are the 2 proposed hypothesis for the pathogenesis of SCAD. Coronary angiography is the gold standard and first line diagnostic test. Three types of SCAD have been described according to coronary angiogram. Intracoronary imaging modalities are reserved for patients with ambiguous diagnosis or to guide percutaneous coronary intervention view the increased risk of secondary iatrogenic dissection. The management of SCAD includes conservative approach, coronary revascularization strategies accounting for percutaneous coronary intervention and coronary artery bypass graft, and long-term follow-up. The overall prognosis of patients with SCAD is favorable marked by a spontaneous healing in a large proportion of cases. (Curr Probl Cardiol 2023;48:101682.)

Automated summary

Spontaneous coronary artery dissection (SCAD) is a condition characterized by sudden rupture of the coronary artery wall, leading to the formation of a false lumen and intramural hematoma. It primarily affects young and middle-aged women without typical cardiovascular risk factors. Fibromuscular dysplasia and pregnancy are strongly associated with SCAD. Two hypotheses, the inside-out and outside-in, have been proposed to explain the pathogenesis of SCAD. Coronary angiography is the gold standard diagnostic test, and intracoronary imaging modalities may be used in cases with ambiguous diagnosis or to guide treatment. Treatment options for SCAD include conservative management, coronary revascularization strategies (such as percutaneous coronary intervention and coronary artery bypass graft), and long-term follow-up. The prognosis for SCAD patients is generally favorable, with spontaneous healing observed in a significant proportion of cases.