Spontaneous Coronary Artery Dissection (SCAD): Case Series and Mini Review

Boulmpou, Aristi; Kassimis, George; Zioutas, Dimitrios; Meletidou, Magdalini; Mouselimis, Dimitrios; Tsarouchas, Anastasios; Tzikas, Stergios; Vassilikos, Vassilios; Kanonidis, Ioannis; Tsounos, Ioannis; Papadopoulos, Christodoulos

doi:10.1016/j.carrev.2020.03.013

Cited by 15 publications

(22 citation statements)

References 27 publications

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“…The chief complaint of patients presenting with SCAD is typically chest pain that radiates into the arm, neck or back, dyspnea and diaphoresis [1,23,24]. Tweet, et al found that the majority of patients with SCAD present with ACS symptoms including chest pain radiating into the left arm, neck, back, epigastric pain, nausea, vomiting, diaphoresis or dyspnea [25,26]. While SCAD manifests much like an MI, a high index of suspicion should be warranted despite normal troponin levels.…”

Section: Diagnosismentioning

confidence: 99%

Acute Management of a Spontaneous Coronary Artery Dissection with a Distal Occlusive Thrombus

Trinava¹,

Jason²,

Brown³

et al. 2022

Int J Clin Cardiol

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Background: Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (MI) and sudden cardiac death (SCD). SCAD is mostly described in young females with a sparse cardiac history. The pathophysiology of SCAD has not been clearly elucidated in the literature and the underlying etiology continues to be investigated. Case presentation:We describe a unique case of a 57-year-old female who presented with chest pain who was found to have a ST segment elevation myocardial infarction (STEMI) on electrocardiogram. Cardiac coronary angiography demonstrated SCAD of the mid to distal left anterior descending (LAD) artery who was originally treated with, but ultimately failed, medical management. Less than 24 hours after presentation, she had a ventricular fibrillation cardiac arrest with repeat coronary angiography indicating complete occlusion of her mid to distal LAD, resulting in management with coronary artery bypass grafting (CABG). Conclusion:Conservative management of SCAD should be attempted with patients however LAD lesions are at high risk for cardiac decompensation, requiring invasive revascularization with PCI or CABG.

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Section: Diagnosismentioning

confidence: 99%

Acute Management of a Spontaneous Coronary Artery Dissection with a Distal Occlusive Thrombus

Trinava¹,

Jason²,

Brown³

et al. 2022

Int J Clin Cardiol

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“…This makes the diagnosis of SCAD by angiography challenging to almost impossible in the absence of pathognomonic multiple radiolucent lumens with contrast staining of the arterial wall. For this reason, intracoronary imaging with optical coherence tomography (OCT) or intravascular ultrasound (IVUS) is the true gold standard for SCAD diagnosis [ 7 , 18 , 19 ].…”

Section: Reviewmentioning

confidence: 99%

“…In selected patients, PCI or coronary artery bypass grafting (CABG) is considered; indications for revascularization include left main coronary artery or severe proximal 2-vessel dissection, ongoing ischemic symptoms, hemodynamic instability, cardiogenic shock or ventricular arrhythmias [ 18 ]. In recent studies, only about half of the revascularization attempts via PCI were successful in SCAD, while the risk of iatrogenically induced worsening of the dissection was very high [ 18 , 19 , 23 ]. Recurrent SCAD is well recognized.…”

Section: Reviewmentioning

confidence: 99%

The Self Sabotaging Vessel: A Case Report and Literature Review of Spontaneous Coronary Artery Dissection

Akhigbe¹,

Ezeh²,

Mansoor³

et al. 2021

Cureus

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Spontaneous coronary artery dissection (SCAD) is a very rare cause of acute coronary syndrome. Despite the recent advances in the management of cardiovascular diseases, the diagnoses and management of SCAD remain a dilemma. It has been described to majorly affect females of childbearing age, immediately postpartum or on oral contraceptives. Recent cases have also identified underlying connective tissue disease as a risk factor. Since its discovery, only a limited number of cases affecting males have been reported in the literature. This makes our case unique. In this, we present a 31-year-old male without any traditional risk factors who presented with atypical chest pain. Electrocardiogram showed ST-segment changes with echocardiogram revealing apical left ventricular akinesis. A diagnostic left heart catheterization showed multiple lumens in the distal left anterior descending artery (LAD). The patient was managed conservatively and discharged home on guideline-directed medical therapy.

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“…The core pathophysiology of SCAD involves the formation of an intramural hematoma. Depending on the size and extent of dissection, the intramural hematoma can eventually form an occlusion resulting in myocardial ischemia [ 2 ]. SCAD presents similarly to ACS with a chief complaint of chest pain, positive cardiac biomarkers, and electrocardiogram changes including ST deviations [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Depending on the size and extent of dissection, the intramural hematoma can eventually form an occlusion resulting in myocardial ischemia [ 2 ]. SCAD presents similarly to ACS with a chief complaint of chest pain, positive cardiac biomarkers, and electrocardiogram changes including ST deviations [ 2 ]. The management of SCAD differs from traditional ACS secondary to acute plaque rupture as the coronary vessels are very friable due to damage of the tunica media.…”

Section: Introductionmentioning

confidence: 99%

Double Trouble - Spontaneous Coronary Artery Dissection of the Left Anterior Descending and Posterior Descending Arteries in a Right Dominant Circuit: A Case Report

et al. 2021

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Acute myocardial infarction is a condition that classically presents with chest pain and corresponding biomarkers and changes on electrocardiogram. Although most causes of acute coronary syndrome are due to acute plaque rupture resulting in coronary thrombosis, an increasingly prevalent condition known as spontaneous coronary artery dissection (SCAD) is becoming more commonly diagnosed. SCAD is characterized by a tear in the tunica media resulting in an intramural hematoma. Depending on the size of the hematoma, progressive extension can ultimately lead to coronary occlusion. Our team presents a 52-year-old female patient that presented with substernal chest pain and positive cardiac enzymes. Urgent coronary catheterization revealed bilateral SCAD involving the left anterior descending and posterior descending arteries in a right coronary dominant circuit. Our patient was treated with medical therapy alone and was safely discharged to home after close monitoring in the coronary care unit. Our team hopes to contribute to a growing body of evidence that bilateral SCAD can occur and can be successfully treated without percutaneous coronary intervention.

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Spontaneous Coronary Artery Dissection (SCAD): Case Series and Mini Review

Cited by 15 publications

References 27 publications

Acute Management of a Spontaneous Coronary Artery Dissection with a Distal Occlusive Thrombus

Acute Management of a Spontaneous Coronary Artery Dissection with a Distal Occlusive Thrombus

The Self Sabotaging Vessel: A Case Report and Literature Review of Spontaneous Coronary Artery Dissection

Double Trouble - Spontaneous Coronary Artery Dissection of the Left Anterior Descending and Posterior Descending Arteries in a Right Dominant Circuit: A Case Report

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