Spontaneous Coronary Artery Dissection

Improvement of symptoms and coronary perfusion gradient with mechanical left ventricular unloading in flow‐limiting complex spontaneous coronary artery dissection, without revascularization

“…Instead of plaque rupture or erosion, the peculiar pathophysiological feature of SCAD is medial dissection with or without an intimal tear. 4 Although PCI is the mainstay of guideline‐based revascularization for acute coronary syndromes (ACS), it might be complicated by increased risk of procedural complications, (e.g., extension of the dissection and abrupt vessel occlusion), in the setting of SCAD. Furthermore, at long‐term, the resorption of the intramural hematoma may cause late malapposition of the stent struts with the risk of late target vessel failure.…”

“…The therapeutic management is influenced by a major difference between this condition and atherosclerotic myocardial infarction. Instead of plaque rupture or erosion, the peculiar pathophysiological feature of SCAD is medial dissection with or without an intimal tear 4 . Although PCI is the mainstay of guideline‐based revascularization for acute coronary syndromes (ACS), it might be complicated by increased risk of procedural complications, (e.g., extension of the dissection and abrupt vessel occlusion), in the setting of SCAD.…”

The diagnosis and management of spontaneous coronary artery dissection — expert opinion of the Association of Cardiovascular Interventions (ACVI) of Polish Cardiac Society

“…With both mechanisms, the intramural hematoma causes compression of the true lumen resulting in compromised blood flow (Figure 1). Recent intracoronary imaging studies have shown that in a large proportion of SCAD cases, an intimal tear is not present or is preceded by intramural hematoma development, supporting the "outside-in" hypothesis as the predominant mechanism for SCAD [10][11][12][13].…”

“…The benefits of OCT have to be weighed against the potential risk of further dissection propagation related to the high-pressure contrast injection required for good quality image acquisition (Figure 3). Thus, the modality should be limited to ambiguous lesions and to cases where imaging is required for clinical reasons (i.e., PCI optimization) Nevertheless, recent evidence suggests that OCT interrogation can be safely performed in SCAD patients [10,12,16,42,43].…”

Management of myocardial infarction with Nonobstructive Coronary Arteries (MINOCA): a subset of acute coronary syndrome patients

“…It is the consequence of blood accumulation in the tunica media after an endothelium-intimal tear formation "inside-out mechanism" or microvessel rupture in the vascular wall "outside-in mechanism" [22,23]. A recent OCT based study found that the absence of fenestration in SCAD increases the pressure in false lumen and subsequently the external compression of the true lumen [24].…”