Spontaneous Coronary Artery Dissection (SCAD): A Review Article

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A rare and sporadic disease, Spontaneous Coronary Artery Dissection (SCAD) consists of obstruction of the coronary artery by intramural hematoma, with or without rupture of the intimal layer, without association with atherosclerosis, trauma or iatrogenesis. It is an important cause of acute coronary syndrome (ACS) and sudden death in individuals without typical cardiovascular risk factors. It predominates in women between the 4th and 5th decades of life, being the most common cause of ACS associated with pregnancy, in patients with underlying arteriopathies, especially fibromuscular dysplasia; in individuals with systemic inflammatory diseases such as systemic lupus erythematosus, sarcoidosis, or inflammatory bowel disease; or with hereditary arteriopathies, such as Ehlers-Danlos vascular syndrome and Marfan syndrome. Surviving patients present as clinical manifestations of ACS, ventricular arrhythmias, cardiogenic shock or sudden cardiac arrest, with chest pain consistent with atherosclerotic ACS and elevated cardiac enzymes. The accurate diagnosis of SCAD is important, as its management differs from that of atherosclerotic ACS. If suspicion, coronary angiography should be performed, classifying the lesion according to the Saw Angiographic Classification: if multiple radiolucent lumens or contrast coloration of the arterial wall, type 1; if diffuse stenosis >20 mm, type 2, being the most common; if focal or tubular stenosis <20 mm that mimics atherosclerotic lesion, type 3. American College of Cardiology (ACC)/ American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines suggests conservative treatment in clinically stable patients, and an early invasive strategy by angioplasty coronary artery in patients with severe lesions. Coronary artery bypass surgery is considered in high-risk injuries.