Spontaneous coronary artery dissection: Case series from two institutions with literature review

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). Consequently, its presentation and optimal treatment are yet to be clearly defined. In the current literature, all case series report less than 50 patients, most of whom are either young peripartum women or women who have used oral contraceptives over long periods. All information in this study was compiled by the database service from two hospitals, the first one between 2003 and 2012 and the second one between 2007 and 2012, to include the clinical characteristics, angiography. and treatment approaches in the study population. The study population consisted in four women (50%) and four men (50%) whose ages ranged between 28 and 57 years. Two women had a history of oral contraceptive use and three women presented during peripartum. None of the patients had traditional cardiovascular risk factors or previous heart disease. In 88% of the cases, the principal diagnoses were non-ST segment elevation myocardial infarction and unstable angina. All patients underwent emergency coronary angiography and percutaneous coronary intervention. Half of them were treated with drug-eluting stents and the other half with bare metal stents. The most frequent type of dissection was NIHBL Type E, and the right coronary artery was the most frequently compromised. SCAD is a rare cause of ACS; however, its identification has improved due to the availability of angiography and new complementary techniques. Regarding treatment, PCI seems effective with adequate long-term results.

Spontaneous Coronary Artery Dissection (SCAD): A Series of 7 Cases, Experience of the University Hospital Center Mohammed VI, Oujda, Morocco

“…Treatment options for SCAD include medical therapy, percutaneous coronary intervention (PCI), or coronary artery bypass graft surgery (CABG) [ 17 ]. Medical treatment should be initiated in patients with spontaneous dissection localized to the middle or distal segment of the coronary arteries with monotruncular involvement and obliteration of less than 50% of the arterial lumen diameter [ 18 – 20 ]. Spontaneous healing under medical treatment alone has been described by several authors [ 21 – 27 ].…”

La dissection spontanée des artères coronaires: à propos de 2 cas

“…Dans une étude rétrospective de Shamboo et al [ 18 ], 60% des patients thrombolysés ont nécessité le recours à une intervention coronaire percutanée ou une chirurgie de sauvetage.Un patient de notre série a bénéficié d’une thrombolyseen urgence sans signes de succès mais également sans complications. La décision thérapeutique dépend de l’état hémodynamique du patient et de la localisation de la lésion ( Figure 5 ) [ 19 ]. Pour les patients présentant un arrêt du débit sanguin coronaire ou une instabilité hémodynamique, une PCI ou un pontage aorto-coronaire peuvent être proposé afin de sauver le myocarde viable, bien que le taux d’échec de la procédure de PCI peut être aussi élevé [ 17 ].…”

Iatrogenic Coronary Artery Dissection: Early or Late Intervention?

“…In clinical practice, coronary artery dissections mostly arise spontaneously or as iatrogenic complications [due to percutaneous coronary interventions (PCIs), etc.] and appear to be associated with significant morbidity and mortality [1][2][3][4][5] . Importantly, the guidance of intravascular imaging tools [intravascular ultrasound (IVUS), etc.]…”

“…Importantly, the guidance of intravascular imaging tools [intravascular ultrasound (IVUS), etc.] has been strongly recommended for the invasive management of coronary artery dissections 4 . Unfortunately, these imaging modalities may not always be readily available in all cardiovascular clinics potentially leading to a significant therapeutic challenge particularly in cases requiring urgent management.…”