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Review
. 2024 May 31:11:1409278.
doi: 10.3389/fcvm.2024.1409278. eCollection 2024.

Spontaneous coronary artery dissection and fibromuscular dysplasia: insights into recent developments

Ayah Eltabbakh  1 , Ahmed Khudair  1 , Aiman Khudair  1 , Salim Fredericks  1
Affiliations
Review

Spontaneous coronary artery dissection and fibromuscular dysplasia: insights into recent developments

Ayah Eltabbakh et al. Front Cardiovasc Med. .

Abstract

Spontaneous coronary artery dissection (SCAD), an uncommon cause of acute coronary syndrome, continues to be a poorly understood disease predominantly affecting females. It is characterized by an abrupt separation in the coronary arterial wall due to intramural bleeding. Fibromuscular dysplasia (FMD) is a non-atherosclerotic arteriopathy manifesting in medium and small-sized arteries. It is a concomitant disease found among SCAD patients. In some studies, FMD prevalence in SCAD patients ranges between 25%-86%, which can be explained through varying screening techniques or modalities. The potential association has been elucidated in some studies; notably, not only has a genetic link been recently delineated between SCAD and FMD, but there is data to suggest that FMD not only can predispose to SCAD but can also be a potential predictor of its recurrence. However, a clear-cut correlation between the two has still not been established due to conflicting reports in the literature. To further dive into its pathology, it is crucial to highlight the importance of systematic screening in SCAD in order to identify associated risk factors and to be used as a method of FMD detection in such patients. Together, the two pathologies pose unique challenges in understanding its pathophysiology, diagnosis and management, as there is no clear evidence of a definitive treatment plan for patients with SCAD and FMD. A potentially beneficial modality of management is physical exercise, which is currently understudied in the long-term approach to treatment for patients with concomitant SCAD and FMD. Limited research in this field brings disadvantages to the understanding of the association between these two diseases, in order to give rise to better management recommendations. This mini-review aims to highlight the recent developments in the association between SCAD and FMD, its potential genetic association and some insights in screening, diagnosis, and management.

Keywords: PHACTR1; SCAD; acute coronary syndrome; fibromuscular dysplasia; spontaneous coronary artery dissection.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Risk factors for spontaneous coronary artery dissection. Created with BioRender.com.
Figure 2
Figure 2
The associations between SCAD and FMD. Created with BioRender.com. SCAD: Spontaneous Coronary Artery Dissection; FMD: Fibromuscular Dysplasia; PHACTR1: phosphatase and actin regulator 1; TGF-β: Transforming growth factor-beta.
See this image and copyright information in PMC

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