Spontaneous Coronary Artery Dissection: An Underdiagnosed Clinical                     Entity—A Primer for Cardiac Imagers

Aslam, Anum; Stojanovska, Jadranka; Khokhar, Usman; Weinberg, Richard L.; Ganesh, Santhi K.; LaBounty, Troy; Sutton, Nadia R.; Patel, Smita

doi:10.1148/rg.2021210062

Cited by 13 publications

(17 citation statements)

References 62 publications

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“… 2 The second theory proposes that the primary event is spontaneous haemorrhage in the vasa vasorum of the vessel wall. 4 Regardless of the initial mechanism, SCAD is characterised by the spontaneous formation of haematoma in the coronary wall (specifically the outer third of the media), leading to progressive narrowing of the true lumen and potential myocardial ischaemia and infarction. In this case report, we postulate a similar series of events; dissection of the intima caused pain at presentation but without vessel occlusion and only mild troponin rise.…”

Section: Discussionmentioning

confidence: 99%

“…There is a paucity of prospective data on how CTCA compares with ICA in diagnosing suspected SCAD and sensitivity and specificity for diagnosis have not yet been defined. 4 CTCA findings in SCAD include lack of atherosclerotic plaque, tapered luminal stenosis, abrupt luminal stenosis, luminal occlusion, intramural haematoma, dissection flap and perivascular epicardial fat stranding. 5 Additionally, patients with SCAD have a high prevalence of coronary artery tortuosity and myocardial bridging which can be readily identified with CTCA and may define a high risk phenotype.…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous coronary artery dissection in cutis laxa

et al. 2022

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We describe the case of a 21-year-old female with Cutis Laxa presenting with an acute coronary syndrome. A CT coronary angiogram (CTCA) diagnosed spontaneous coronary artery dissection (SCAD) of the right coronary artery, which was successfully managed with medical therapy. Cutis Laxa is a rare connective-tissue disorder in which the skin becomes inelastic. Lax, redundant skin hangs in folds give a prematurely aged appearance and several forms of the disease have been described,. Although certain cardiovascular complications are recognised in Cutis Laxa, to our knowledge SCAD has not been previously described. SCAD is an uncommon cause of acute coronary syndrome (ACS) and sudden cardiac death. The condition particularly affects young females, those with connective tissue diseases, arteriopathies, pregnant females, contraceptive use and cocaine use. Atherosclerotic risk factors are seldom reported. The condition is under diagnosed as symptoms may not generate a high index of clinical suspicion in this demographic. Diagnosis is traditionally made on invasive coronary angiogram although the procedure carries risks in SCAD and non-invasive CTCA should be considered in appropriately selected patient cohorts or as an adjunctive measure to assess for extra coronary vascular abnormalities. Our patient was diagnosed on CTCA, avoiding the need for invasive catheter angiogram.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Spontaneous coronary artery dissection in cutis laxa

et al. 2022

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“…SCAD typically affects patients with few or no traditional cardiovascular risk factors, in whom suspicion for ACS is low and therefore often goes undiagnosed, as confirmed by a recent meta-analysis in which FMD was present in 68% of patients, and hypertension in 45% with a diagnose of SCAD [65]. The estimated prevalence of SCAD as the cause of myocardial infarction is approximately 0.1-0.4% and accounts for 0.4% of sudden cardiac death [66]. SCAD predominantly occurs in women, accounting for about 35% of MIs in women under the age of 50 and representing the most common cause of pregnancy-related Mis [63].…”

Section: Spontaneous Coronary Artery Dissection (Scad)mentioning

confidence: 91%

Advanced Cardiac Imaging and Women’s Chest Pain: A Question of Gender

Dell’Aversana,

Tedeschi,

Comune

et al. 2023

Diagnostics

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Awareness of gender differences in cardiovascular disease (CVD) has increased: both the different impact of traditional cardiovascular risk factors on women and the existence of sex-specific risk factors have been demonstrated. Therefore, it is essential to recognize typical aspects of ischemic heart disease (IHD) in women, who usually show a lower prevalence of obstructive coronary artery disease (CAD) as a cause of acute coronary syndrome (ACS). It is also important to know how to recognize pathologies that can cause acute chest pain with a higher incidence in women, such as spontaneous coronary artery dissection (SCAD) and myocardial infarction with non-obstructive coronary arteries (MINOCA). Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance imaging (CMR) gained a pivotal role in the context of cardiac emergencies. Thus, the aim of our review is to investigate the most frequent scenarios in women with acute chest pain and how advanced cardiac imaging can help in the management and diagnosis of ACS.

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“…However, noninvasive follow-up with CCTA may be useful in patients with SCAD in proximal or large-caliber coronary arteries 23 ; it is likely less sensitive in identifying discrete dissections in distal small-caliber coronary arteries. 24 Pathophysiologic and diagnostic SCAD details have been published previously in chapter 5 of this Atlas. 25 …”

Section: Acute Presentations: Diagnosis and Treatmentmentioning

confidence: 99%