Spontaneous coronary artery dissection: Case series and review of literature

Abstract

The awareness of SCAD is important for all clinicians involved in STEMI care. A prompt suspicion can avoid administration of thrombolytic therapy. Early coronary angiography will provide an accurate diagnosis and help in deciding appropriate therapy. Percutaneous intervention can be challenging.

Challenges in Diagnosis and Management of Spontaneous Coronary Artery Dissection in a Young Patient

“…A recent study with 168 patients with SCAD revealed that only 26.1% of patients presented with ST-segment elevation, and 3.6% had ventricular fibrillation or ventricular tachycardia [4] . The LAD was found to be the most prevailing site of SCAD, as in our patient [2,6,7] .…”

“…SCAD is a spontaneous tear of the inner layer in the coronary artery, creating a false lumen between the inner and central layer. This results in decreased coronary blood flow leading to acute coronary syndrome (ACS) [1,2] . The first reported case of SCAD was in 1931 during an autopsy in a 42-year-old woman.…”

“…SCAD is divided into atherosclerotic and non-atherosclerotic types: Atherosclerotic SCAD is characterized by rupture of an atherosclerotic plaque; non-atherosclerotic SCAD is related to other pathophysiologies, such as connective tissue disorders, systemic inflammation, coronary vasospasm, severe hypertension, physical stress, use of oral hormonal contraceptive, cocaine abuse, peripartum, and up to 72% due to fibromuscular dysplasia [2-4] .…”

“…Though the diagnosis of SCAD remains challenging, it should be considered in any young female presenting with ACS symptoms, with or without ST segment elevation [2] . A recent study with 168 patients with SCAD revealed that only 26.1% of patients presented with ST-segment elevation, and 3.6% had ventricular fibrillation or ventricular tachycardia [4] .…”

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

“…The long-term prognosis is generally good at 95% after a follow-up of 2 years [ 36 ]. Several authors reported excellent long-term follow-up in patients who were managed conservatively [ 16 , 37 – 41 ].…”