Brief Summary of Pathogenesis, Diagnosis and Management of Spontaneous Coronary Artery Dissection

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). It was first described 80 years ago. Pathogenetic me­chanisms are most likely to be associated with inti­mas tear or bleeding vasa-vasorum, which resulting in intramural haemorrhage. SCAD typically occurs in young women who do not have coronary heart disease risk factors and who have acute coronary syndrome. Half of all SCAD presents with ST – ele­vation myocardial infarction (STEMI), while the rest with non – ST – elevation myocardial infarction (NSTEMI). The gold standard method for diagnosis is interventional coronary artery angiography. After the acute ischemic onset syndrome, most patients have a stable, benign clinical course, and eventually expe­rience spontaneous vessel wall healing. Therefore, conservative treatment (a watchful strategy) is recom­mended as the initial treatment. For the majority of cases as interventional and surgical treatment in most cases seems to be suboptimal. In this extremely com­plex situation, several novel and attractive coronary interventions have been proposed. The risk factors, pathogenesis theories, diagnosis, management, pro­gnosis of SCAD will be summarized in this review.