Clinical perspectives of the primary spontaneous coronary artery dissection

Spontaneous aortic dissection limited to sinus of Valsalva and involving the left main coronary artery

“…Were the LSV dissected and the LMC involved or the LMC sustained a spontaneous dissection with retrograde extension to aorta? The first possibility is more probable, because dissections of the aorta are not uncommon, while spontaneous dissection of normal coronary artery is a very rare event and typically it affects young women, in peripartum state or using oral contraceptives [4]. Actually, it is impossible to answer this question for certain.…”

Causation or coincidence? A case of sudden death due to spontaneous coronary artery dissection in presence of myocardial bridging

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Spontaneous coronary artery dissection (SCAD) is an uncommon cause of sudden death [1] and consists in a haemorrhagic separation, usually occurring in the outer third of the tunica media or between the media and external elastic lamina [2], eventually associated with a tear in the intima [3]. It results in the creation of a false lumen whose expansion (due to blood or clot accumulation) causes the distal propagation of the dissection and the subsequent compression/occlusion of the true lumen of the coronary, producing distal blood flow obstruction and myocardial ischemia, infarction or sudden death [3].

SCAD has been reported in autopsy studies as the cause of sudden death in the young with a percentage of 2% [4] and the incidence of SCAD at angiography ranges from 0.07% to 1.1% [5].

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“…It results in the creation of a false lumen whose expansion (due to blood or clot accumulation) causes the distal propagation of the dissection and the subsequent compression/occlusion of the true lumen of the coronary, producing distal blood flow obstruction and myocardial ischemia, infarction or sudden death [3].SCAD has been reported in autopsy studies as the cause of sudden death in the young with a percentage of 2% [4] and the incidence of SCAD at angiography ranges from 0.07% to 1.1% [5]. It typically occurs between 30 and 45 years and women are affected in more than 70% of cases.…”

“…It results in the creation of a false lumen whose expansion (due to blood or clot accumulation) causes the distal propagation of the dissection and the subsequent compression/occlusion of the true lumen of the coronary, producing distal blood flow obstruction and myocardial ischemia, infarction or sudden death [3].…”

Idiopathic spontaneous coronary artery dissection and drug-eluting stents

“…As this is a very rare clinical condition [2] and treatment is unproven [3], the experience of all interventional cardiologists is very important and should be shared to improve our familiarity with the treatment. The etiology of all coronary artery dissections is questionable and we cannot be sure that a dissection, especially of the proximal portion of a coronary artery, is truly spontaneous or was caused by a diagnostic catheter during insertion into the ostium prior to test injection of contrast medium.…”