Spontaneous Coronary Artery Dissection

Saw, Jacqueline; Ricci, Donald R.; Starovoytov, Andrew; Fox, Rebecca; Buller, Christopher E.

doi:10.1016/j.jcin.2012.08.017

Cited by 349 publications

(153 citation statements)

References 27 publications

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“…However, our recent discovery of a dominant association between SCAD and extracoronary FMD strongly suggested that underlying coronary involvement with FMD predisposed these patients to dissection of their coronary arteries. [8][9][10] Furthermore, this high frequency of association also implied that coronary FMD was more frequent than previously believed. However, the angiographic diagnosis of CFMD had been elusive, Figure 5.…”

Section: Dilatationmentioning

confidence: 50%

“…8 Subsequently, in our larger SCAD cohort that was prospectively followed up, we found FMD to be present in 72% to 86% of patients with SCAD routinely screened for FMD in multiple vascular territories. 9,10 Given that SCAD and FMD are deemed relatively rare, this strong association implicates causality of SCAD owing to underlying coronary FMD (CFMD). This mechanism is plausible because arteries affected by FMD are structurally weakened and prone to dissection.…”

Section: Clinical Perspective On P 1559mentioning

confidence: 99%

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Angiographic and Intracoronary Manifestations of Coronary Fibromuscular Dysplasia

et al. 2016

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Background-We previously described a strong association between fibromuscular dysplasia (FMD) and spontaneous coronary artery dissection. Angiographic manifestations of coronary FMD aside from dissection were considered rare. However, we observed several coronary FMD angiographic abnormalities with corresponding optical coherence tomography abnormalities. Methods and Results-Baseline demographics and imaging of patients with suspected coronary FMD at Vancouver GeneralHospital were reviewed. Presence of multifocal (string-of-beads) extracoronary FMD was confirmed by 2 specialists. In these patients, coronary angiographic findings (excluding dissected segments) were reviewed and classified by 2 experienced angiographers for irregular stenosis, that is, stenosis with irregular borders in a focal or diffuse pattern with/without systolic accentuation; smooth stenosis, diffuse or focal; segmental dilatation/ectasia; and tortuosity. Optical coherence tomography was performed in a subset of patients. Of 32 patients with extracoronary FMD and suspected coronary involvement, 28 were women (88%), and their mean age was 59.4±9.9 years. Nineteen presented with myocardial infarction (13 caused by spontaneous coronary artery dissection), and 13 had stable symptoms. The observed coronary angiographic abnormalities included tortuosity in all cases (91% were moderate to severe), irregular stenosis in 59%, smooth stenosis in 19%, and segmental dilatation/ectasia in 56%. [11][12][13] However, the angiographic manifestation of CFMD is elusive and not well described. A recent attempt to describe CFMD angiographic features mostly reiterated the appearance of overlying SCAD. 7 Because there are many potential causes of SCAD besides CFMD, the presence of SCAD is not synonymous with CFMD.The angiographic appearance of CFMD in nondissected coronary arteries is reported to be rare and had not been previously studied. Because Vancouver General Hospital is a quaternary referral center for SCAD, a relatively large volume of patients with SCAD and FMD are seen at our cardiac catheterization laboratory. We observed several angiographic abnormalities in nondissected portions of the coronary tree in patients with extracoronary FMD, which we believe to represent CFMD because these features are similar to FMD changes observed in extracoronary beds. We sought to describe and classify these abnormal coronary angiographic appearances of CFMD and to provide the underlying optical coherence tomography (OCT) findings. MethodsWe performed a retrospective chart and angiographic review of patients with documented FMD in at least 1 extracoronary vascular bed and angiographic nonatherosclerotic coronary artery abnormalities that were suspected to be attributable to CFMD. This cohort included patients who underwent coronary angiography at Vancouver General Hospital for stable symptoms or acute coronary syndrome. We searched for the term FMD in our cardiac catheterization database and our SCAD registries over a 5-year period. These coronary angiograms were rev...

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Section: Dilatationmentioning

confidence: 50%

Section: Clinical Perspective On P 1559mentioning

confidence: 99%

Angiographic and Intracoronary Manifestations of Coronary Fibromuscular Dysplasia

et al. 2016

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“…33 More recently, a frequent association between SCAD and FMD of extracoronary vessels has been demonstrated in several single-center patient series, with prevalence varying from 52% to 86%. [33][34][35][36][37] The largest and best explored series included 168 patients with SCAD, of which 72% had FMD of the renal, iliac, or cerebrovascular arteries. 33 In an earlier series of 50 patients published by the same group, lesions of ≥2 noncoronary vascular beds were found in 42% of patients.…”

Section: Spontaneous Coronary Artery Dissection and Fmdmentioning

confidence: 99%

Revisiting Fibromuscular Dysplasia

et al. 2016

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“…However, a recent contemporary review suspect that the true prevalence in patients presenting with ACS might be as high as 1.7–4% on the basis of moderate series [4,5]. SCAD affects women in more than 90% of the cases, and with the exclusion of the atherosclerotic cases, women constitute up to 95% of the cases [4,6–8]. In men, however, the atherosclerotic entity is more prevalent [9].…”

Section: Discussionmentioning

confidence: 99%

“…Potential predisposing factors include fibromuscular dysplasia (FMD), postpartum status, multiparty, connective tissue disorders, and hormonal therapy [6–8,10]. Precipitating stressors such as intense exercise or emotional stress, labour and delivery, intense Valsalva-type activities, or recreational drug uses were reported as a provoking factor of the acute coronary event in over 50 percent of cases in a contemporary series [6]. Of note, our patient has no risk factor for atherosclerosis nor any predisposing factor.…”

Section: Discussionmentioning

confidence: 99%

A case of spontaneous coronary artery dissection presenting with acute anterior wall myocardial infarction in a young adult male – an increasingly recognized rare disease

Taha

Latt

Al‐Khafaji

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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Background: Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of myocardial infarction and sudden death. Although some correlations have been noted in relation to aetiology, no direct causes have been identified in a large number of patients. Most of the patients are women in peripartum period or of childbearing age, with few if any risk factors for coronary heart disease. In men, however, risk factors for atherosclerosis are more prevalent in cases of SCADCase report: We report a case of a 43-years-old healthy male, with no known risk factors, who presented with ischemic chest pain and elevated troponin levels. He underwent an emergent percutaneous transluminal coronary angiography which revealed a total occlusion of the left anterior descending artery at its origin with an evidence of spontaneous dissection as the cause of the occlusion, which was subsequently treated with placement of a drug-eluting stent and thrombectomy from the distal occluded portion. This case highlights the importance of including spontaneous coronary artery dissection as a cause of ischemic cardiac insults and illustrates the approach to treatment.Conclusion: Internists should have a low threshold of clinical suspicion for SCAD especially in a young patient with no known risk factors and should know the importance of emergency in management.

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Spontaneous Coronary Artery Dissection

Abstract: Nonatherosclerotic SCAD predominantly affects women, and most have concomitant FMD. We suspect these patients have underlying coronary FMD that predisposed them to SCAD, but this requires proof from histology or intracoronary imaging of the affected coronary arteries.

Cited by 349 publications

References 27 publications

Angiographic and Intracoronary Manifestations of Coronary Fibromuscular Dysplasia

Angiographic and Intracoronary Manifestations of Coronary Fibromuscular Dysplasia

Revisiting Fibromuscular Dysplasia

A case of spontaneous coronary artery dissection presenting with acute anterior wall myocardial infarction in a young adult male – an increasingly recognized rare disease

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