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Review
. 2015 Feb;5(1):37-48.
doi: 10.3978/j.issn.2223-3652.2015.01.08.

Spontaneous coronary artery dissection-A review

Amelia Yip  1 , Jacqueline Saw  1
Affiliations
Review

Spontaneous coronary artery dissection-A review

Amelia Yip et al. Cardiovasc Diagn Ther. 2015 Feb.

Abstract

Spontaneous coronary artery dissection (SCAD) is an infrequent and often missed diagnosis among patients presenting with acute coronary syndrome (ACS). Unfortunately, SCAD can result in significant morbidities such as myocardial ischemia and infarction, ventricular arrhythmias and sudden cardiac death. Lack of angiographic recognition from clinicians is a major factor of under-diagnosis. With the advent of new imaging modalities, particularly with intracoronary imaging, there has been improved diagnosis of SCAD. The aim of this paper is to review the epidemiology, etiology, presentation, diagnosis and management of SCAD.

Keywords: Spontaneous coronary artery dissection (SCAD); coronary angiogram; optical coherence tomography (OCT); women.

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Figures

Figure 1
Figure 1
Schematic diagram of the mechanisms of spontaneous coronary artery dissection. Reproduced with permission from (4).
Figure 2
Figure 2
Renal angiograms showing bilateral renal artery FMD (arrows) in a patient presenting with SCAD. FMD, fibromuscular dysplasia; SCAD, spontaneous coronary artery dissection.
Figure 3
Figure 3
Type 1 SCAD. (A) Cranial projection showing double-lumen (arrow) with contrast dye hang-up in the proximal LAD, and occluded mid LAD from SCAD; (B) caudal projection showing double-lumen (arrow) of proximal LAD from SCAD. SCAD, spontaneous coronary artery dissection; LAD, left descending artery.
Figure 4
Figure 4
Type 2 SCAD. (A) Diffuse narrowing of ramus (arrow) from mid to apical segment due to intramural hematoma; (B) healed ramus artery (arrow) 1 year later on repeat coronary angiography. SCAD, spontaneous coronary artery dissection.
Figure 5
Figure 5
Type 3 SCAD. (A) Moderate stenosis of the mid circumflex artery (between arrows) due to SCAD; (B,C) intramural hematoma in the false lumen on OCT in this lesion. SCAD, spontaneous coronary artery dissection; OCT, optical coherence tomography.
Figure 6
Figure 6
Algorithm for the angiographic diagnosis and confirmation of SCAD. SCAD, spontaneous coronary artery dissection.
Figure 7
Figure 7
Management algorithm including revascularization for acute presentation of SCAD. Reproduced with permission from (13). SCAD, spontaneous coronary artery dissection; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting.
See this image and copyright information in PMC

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