Management of Spontaneous Coronary Artery Dissection: Review of the Literature and Discussion Based on a Series of 12 Young Women with Acute Coronary Syndrome

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare pathology, principally affecting young women free of atheroma risk factors. Its physiopathology remains little understood, and the prognosis for such acute coronary syndromes is poor, as they occur suddenly. Management is often difficult, and no guidelines exist. The present single-center retrospective study concerns 12 cases of SCAD occurring between 2001 and 2008 in female patients under the age of 60. Eleven patients survived, with a favorable long-term evolution. Only 2 had conservative medical therapy, the other 10 undergoing percutaneous coronary intervention (2 procedures involving a coronary artery bypass graft). On the basis of this series and data from the literature, we suggest a strategy to improve the often dire prognosis of SCAD. Emergency angiography to confirm diagnosis is essential. Treatment should be guided by the extent of the lesions, the myocardial ischemia and the hemodynamic status. Conservative medical therapy is a reasonable approach in the case of distal dissection or conserved coronary flow. Percutaneous coronary intervention is feasible in the acute phase to restore coronary perfusion and hemodynamic stability. Surgery – emergency bypass or assisted circulation – should be restricted to cases where percutaneous coronary intervention has failed or is impossible.

Predictors of in-hospital mortality in coronary artery dissection: Findings from the National Inpatient Sample 2009–2010

“…Our analysis is the largest study to date on CD with a prevalence of CD (0.02%) and high mortality rate as compared to previous studies [5,[11][12][13] which may be attributed to the large sample size and the inclusion of all types of CD. There was an increased prevalence in men compared to women, whereas other studies demonstrated the opposite.…”

Disección coronaria espontánea: comunicación de 2 casos tratados quirúrgicamente

“…La cirugía se ha utilizado en casos de compromiso arterial extenso con isquemia severa o imposibilidad de realizar angioplastía por condición hemodinámica inestable, a pesar de apoyo con balón de contrapulsación intra-aórtico 6,7 . Si no es posible la revascularización, Ferrari 8 propone incluso apoyo de asistencia ventricular izquierda en espera de recuperación o trasplante cardiaco.…”

“…En esos casos, en el diagnóstico más preciso ayuda la sonografía intracoronaria 12 . Para el diagnóstico de estas complicaciones se recomienda realizar un control imagenológico 3 a 6 meses después del evento 6 .…”

“…Su presentación clínica es variable, dependiendo de la extensión y severidad de la disección, apareciendo desde un síndrome coronario agudo hasta muerte súbita 6 .…”

Coronary Artery Dissection in the Left Main Treated with Stenting in a Patient with Multiple Re-infarction – Case Report

“…Although spontaneous coronary artery dissection is considered to predominately affect young individuals, most previous studies have shown otherwise, with the higher prevalence in the 5th/6th decade of life [4]. Coronary angiography is the most widely used diagnostic technique for visualisation of the coronary arteries [5].…”