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Spontaneous Coronary Artery Dissection: Diagnosis and Management

  • Coronary Artery Disease (D Feldman and V Voudris, Section Editors)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

Spontaneous coronary artery dissection (SCAD) is a non-iatrogenic and non-traumatic separation of the coronary arterial wall. While SCAD represents an important cause of myocardial infarction, optimal diagnostic and therapeutic options remain challenging. We sought to review recent studies and provide an update on diagnosis and management of SCAD.

Recent findings

Coronary angiography is the first-line diagnostic modality for SCAD, with three angiographic features commonly observed in SCAD: type 1 (pathognomonic angiographic appearance with contrast staining of the arterial wall), type 2 (long coronary stenosis), and type 3 (focal tubular stenosis). In addition, adjunctive intracoronary imaging can aid in identifying coronary dissections. Conservative management with beta-blockers and aspirin remains the mainstay of therapy. However, patients with high-risk features and recurrent symptoms may require revascularization. Several techniques have been reported, such as long stents to seal the entire length of the dissection, stepwise stenting starting at the distal edge followed by proximal edge stenting, use of bioabsorbable stents, and cutting balloon angioplasty. Furthermore, cardiac rehabilitation appears to be safe and offers significant benefits for patients with SCAD.

Summary

Coronary angiographic classification contributed to the increased recognition of SCAD in recent years. Selecting the most suitable and appropriate therapy based on accurate diagnosis is the cornerstone of management in SCAD. Further studies are needed to establish optimal treatment of SCAD depending on anatomical and/or clinical features.

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Acknowledgements

We thank Amy Zhong, MA for her medical illustration of this article.

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Authors and Affiliations

  1. Department of Medicine, Icahn School of Medicine at Mount Sinai/The Mount Sinai Hospital, One Gustave L. Levy Place, Box 1086, New York, NY, 10029-6574, USA

    Ilhwan Yeo MD, MS

  2. Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA

    Dmitriy N. Feldman MD & Luke K. Kim MD

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Correspondence to Ilhwan Yeo MD, MS.

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Ilhwan Yeo and Luke K. Kim each declare no potential conflicts of interest.

Dmitriy N. Feldman is a section editor for Current Treatment Options in Cardiovascular Medicine.

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This article is part of the Topical Collection on Coronary Artery Disease

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Yeo, I., Feldman, D.N. & Kim, L.K. Spontaneous Coronary Artery Dissection: Diagnosis and Management. Curr Treat Options Cardio Med 20, 27 (2018). https://doi.org/10.1007/s11936-018-0622-2

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