Spontaneous coronary artery dissections: A call for action for an underestimated entity

Reconsidering Spontaneous Coronary Artery Dissection Mimicking Takotsubo Cardiomyopathy

“…On the other side, patient hemodynamically stable/ asymptomatic and if SCAD involves a distal vessel or its diameter is <3.0 mm, we suggest to consider a conservative management firstly, according to the clinical/angiographic characteristics of the patient [3].…”

“…Conversely, a TT due to hyperkinesis of the basal left ventricular segments could damage the mid LAD due to high mechanical solicitations on the transition point between hyperkinesis and akinesia: the chicken or the egg? We believe that in the occurrence of SCAD should be excluded also a TT diagnosis and vice-versa.Moreover, last year our group proposed a flow-chart for SCAD diagnosis and management [2,3]. According to our score, the case here presented could benefit of an optical coherence tomography (OCT) at first because of higher resolution images and also considering a BVS approach.…”

“…Moreover, last year our group proposed a flow-chart for SCAD diagnosis and management [2,3]. According to our score, the case here presented could benefit of an optical coherence tomography (OCT) at first because of higher resolution images and also considering a BVS approach.…”

Focusing on spontaneous coronary artery dissection: actuality and future perspectives

“…Known predisposing factors are related to the patient such as female gender, age <50 years, peripartum period or multiple prior pregnancies and hormonal therapy or to his vascular anatomy, e.g., coronary artery tortuosity, the absence of atherosclerotic plaques in remaining arteries and extra-coronary vascular abnormalities, especially connective tissue disorders (2,3,5). Additionally, the Canadian group from Vancouver recently discovered the existence of a strong connection between SCAD and fibromuscular dysplasia (FMD), a condition that also affects women (6).…”

“…Conversely, an invasive approach with bioresorbable vascular scaffold (BVS) should be preferred in the case of proximal/middle vessel lesions, occurring in larger vessels (≥3.0 mm vessel diameter) and whenever the patient is still symptomatic or hemodynamically unstable (5,9). Although large trials are needed, BVS strategy has been described as safe and efficient in several case reports as well as in our own case series (10) and experience (5).…”