Spontaneous Coronary Artery Dissection: Mechanisms, Diagnosis and Management

García-Guimarães, Marcos; Bastante, Teresa; Antuña, Paula; Jimenez, César; Cuerda, Francisco de la; Cuesta, Javier; Rivero, Fernando; Premawardhana, Diluka; Adlam, David; Alfonso, Fernándo

doi:10.15420/ecr.2019.01

Cited by 48 publications

(73 citation statements)

References 85 publications

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“…SCAD is characterized by the spontaneous formation of an intramural hematoma within the wall of a coronary artery. 1,2 As described in this case, SCAD is frequently associated with FMD, which is a nonatherosclerotic arteriopathy that can result in stenosis, aneurysm, dissection, or occlusion that can affect nearly any arterial bed. 3,4 The association between the 2 disease entities has led investigators to suggest that a proportion of SCAD may be due to coronary FMD.…”

Section: Discussionmentioning

confidence: 81%

Multivessel Spontaneous Coronary Artery Dissection With Coronary Artery Fibromuscular Dysplasia

et al. 2021

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A 53-year-old woman underwent a cardiac catheterization for evaluation of acute coronary syndrome. The coronary angiogram revealed evidence of spontaneous coronary artery dissection in multiple coronary arteries including the left anterior descending artery, posterior descending artery, and posterior left ventricular artery. Further diagnostic imaging revealed associated bilateral vertebral artery and renal artery fibromuscular dysplasia (FMD). Follow-up coronary angiogram 6 weeks later revealed a "string of beads" appearance of the posterior descending artery. This case highlights the importance of extracoronary imaging for FMD and demonstrates angiogram findings suggestive of coronary FMD.

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Section: Discussionmentioning

confidence: 81%

Multivessel Spontaneous Coronary Artery Dissection With Coronary Artery Fibromuscular Dysplasia

et al. 2021

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“… [35] This is an important issue as collagen vascular disorders like MFS or vEDS are predisposing conditions related to SCAD. [36] miR-let-7f-5p also seems regulate the expression of endothelin 1 (EDN1); [37] this is highly expressed in vascular endothelial and smooth muscle cells, macrophages and podocytes among other type of cells, and it has been also recently associated with SCAD. [ 28 , 38 , 39 ]…”

Section: Discussionmentioning

confidence: 99%

Differential miRNAs in acute spontaneous coronary artery dissection: Pathophysiological insights from a potential biomarker

et al. 2021

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Background Spontaneous Coronary Artery Dissection (SCAD) is an important cause of acute coronary syndromes, particularly in young to middle-aged women. Differentiating acute SCAD from coronary atherothrombosis remains a major clinical challenge. Methods A case-control study was used to explore the usefulness of circulating miRNAs to discriminate both clinical entities. The profile of miRNAs was evaluated using an unbiased human RT-PCR platform and confirmed using individual primers. miRNAs were evaluated in plasma samples from acute SCAD and atherothrombotic acute myocardial infarction (AT-AMI) from two independent cohorts; discovery cohort (SCAD n = 15, AT-AMI n = 15), and validation cohort (SCAD n = 11, AT-AMI n = 41) with 9 healthy control subjects. Plasma levels of IL-8, TGFB1, TGBR1, Endothelin-1 and MMP2 were analysed by ELISA assays. Findings From 15 differentially expressed miRNAs detected in cohort 1, we confirmed in cohort 2 the differential expression of 4 miRNAs: miR-let-7f-5p, miR-146a-5p, miR-151a-3p and miR-223-5p, whose expression was higher in SCAD compared to AT-AMI. The combined expression of these 4 miRNAs showed the best predictive value to distinguish between both entities (AUC: 0.879, 95% CI 0.72–1.0) compared to individual miRNAs. Functional profiling of target genes identified an association with blood vessel biology, TGF-beta pathway and cytoskeletal traction force. ELISA assays showed high plasma levels of IL-8, TGFB1, TGFBR1, Endothelin-1 and MMP2 in SCAD patients compared to AT-AMI. Interpretation We present a novel signature of plasma miRNAs in patients with SCAD. miR-let-7f-5p, miR-146a-5p, miR-151a-3p and miR-223-5p discriminate SCAD from AT-AMI patients and also shed light on the pathological mechanisms underlying this condition. Funding Spanish Ministry of Economy and Competitiveness (MINECO): Plan Nacional de Salud SAF2017-82886-R, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV). Fundación BBVA a equipos de Investigación Científica 2018 and from Caixa Banking Foundation under the project code HR17-00016 to F.S.M. Instituto de Salud Carlos III (AES 2019): PI19/00565 to F.R, PI19/00545 to P.M. CAM (S2017/BMD-3671-INFLAMUNE-CM) from Comunidad de Madrid to FSM and PM. The UK SCAD study was supported by BeatSCAD, the British Heart Foundation (BHF) PG/13/96/30608 the NIHR rare disease translational collaboration and the Leicester NIHR Biomedical Research Centre.

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“…OCT studies suggest the presence of a crescent-shaped false lumen and the presence of fenestrations between the true lumen and false lumen as characteristics of SCAD [ 28 – 31 ]. Most experts recommend OCT over IVUS to assess SCAD, due to its better spatial resolution [ 32 ]. Furthermore, ICI provides insight into the composition of coronary arterial thrombus and stent thrombosis.…”

Section: Lesion Characterization and Decision-makingmentioning

confidence: 99%

Optical Coherence Tomography: Current Applications for the Assessment of Coronary Artery Disease and Guidance of Percutaneous Coronary Interventions

et al. 2020

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Introduction Coronary angiography (CAG) is the standard modality for assessment of coronary stenoses and intraprocedural guidance of percutaneous coronary interventions (PCI). However, the limitations of CAG are well recognized. Intracoronary imaging (ICI) can potentially overcome these limitations. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are the main ICI techniques utilized in clinical practice. Aim This narrative literature review addresses the current clinical applications of OCT in relation to IVUS and CAG in patients with coronary artery disease (CAD). Items reviewed are: technical implications of OCT and IVUS, lesion characterization and decision-making, stent optimization criteria, post-stenting results, safety in terms of procedural complications, clinical outcomes, and indications. Main Findings OCT is able to reveal more detail than IVUS due to its higher resolution. However, this higher resolution comes at the cost of a lower penetration depth. Pre-stenting OCT results in procedural change in more than 50% of the cases in terms of stent length and diameter. Post-stenting OCT resulting in stent optimization is reported in at least 27% of the cases. Malapposition and under-expansion are treated with post-dilatations, while edge dissections are treated with additional stent placement. Stent expansion, stent apposition, distal stent edge dissections, and reference lumen areas seem to be the most important stent optimization criteria for both decision-making and for reducing the risk of adverse events during follow-up. Both OCT and IVUS are superior in terms of post-stenting results compared with CAG alone. However, there is no consensus about whether OCT guidance results in better stent expansion than IVUS guidance. OCT, IVUS, and CAG are safe procedures with few reported procedural complications. In general, OCT guidance seems to contribute to favorable clinical outcomes compared with CAG guidance only. However, OCT guidance results in similar clinical outcomes as with IVUS guidance. OCT could be considered for lumen assessment and stent-related morphology in more complex cases in which CAG interpretation remains uncertain. Since OCT and IVUS have distinct characteristics, these techniques are complementary and should be considered carefully for each patient case based on the benefits and limitations of both techniques. Electronic supplementary material The online version of this article (10.1007/s40119-020-00185-4) contains supplementary material, which is available to authorized users.

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Spontaneous Coronary Artery Dissection: Mechanisms, Diagnosis and Management

Cited by 48 publications

References 85 publications

Multivessel Spontaneous Coronary Artery Dissection With Coronary Artery Fibromuscular Dysplasia

Multivessel Spontaneous Coronary Artery Dissection With Coronary Artery Fibromuscular Dysplasia

Differential miRNAs in acute spontaneous coronary artery dissection: Pathophysiological insights from a potential biomarker

Optical Coherence Tomography: Current Applications for the Assessment of Coronary Artery Disease and Guidance of Percutaneous Coronary Interventions

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