Spontaneous Coronary Artery Dissection; A Literature Review

Abstract

Spontaneous coronary artery dissection (SCAD) is the spontaneous splitting of the coronary tunica media with the formation of a false lumen in the vessel wall and compression of the true lumen. Its incidence is often underestimated, especially in cases of sudden cardiac death before coronary angiography. Predisposing factors include pregnancy, systemic arteriopathy (such as fibromuscular dysplasia), systemic inflammatory conditions ( such as systemic lupus erythematosus and polyarteritis nodosa), systemic connective tissue diseases ( such as Marfan and Ehlers-Danlos syndromes), hypertension and migraine. Common triggering factors involve straining, stress, and hormonal treatment. SCAD is usually diagnosed through coronary angiography, with CT coronary angiography as a non-invasive diagnostic tool. Experts advise minimal coronary instrumentation due to vessel fragility and the risk of dissection extension and vessel occlusion. SCAD patients can have percutaneous coronary intervention (PCI) if they have ongoing ischemia or hemodynamic instability. Coronary artery bypass grafting (CABG) can be an option in cases of failed PCI and high-risk anatomy.