Spontaneous Coronary Artery Dissection
Journal
Macedonian Journal of Anesthesia
Date Issued
2023-04
Author(s)
Bojoski I
Jovanoski M
Abstract
Spontaneous coronary artery dissection (SCAD) is non-iatrogenic, non-traumatic and nonatherosclerotic separation of the coronary artery wall caused by intramural hematoma development
with or without simultaneous co-existence of coronary wall tear. The net effect is compression of
the true coronary artery lumen with development of ischemia. SCAD typically occurs in relatively
young population, dominantly females (around 90%), often in peripartum, in which there are
absent or very rare classical risk-factors for coronary artery disease (CAD). The most frequent
clinical manifestation of SCAD is acute coronary syndrome (ACS – STEMI or NSTEMI), rarely
cardiogenic shock or life-threatening arrhythmias (VT or VF), and sometimes sudden cardiac
death. Diagnosis (which sometimes can be challenging) is dominantly established by coronary
angiography, and sometimes modalities of intravascular visualization may be useful (IVUS,
OCT). The most of the patients with SCAD are treated conservatively and small proportion of
them requires revascularization (PCI or CABG). In addition, we present several cases with SCAD.
Conclusion: Timely and accurate diagnosis and treatment is extremely important in SCAD,
which is a potentially life-threatening condition.
with or without simultaneous co-existence of coronary wall tear. The net effect is compression of
the true coronary artery lumen with development of ischemia. SCAD typically occurs in relatively
young population, dominantly females (around 90%), often in peripartum, in which there are
absent or very rare classical risk-factors for coronary artery disease (CAD). The most frequent
clinical manifestation of SCAD is acute coronary syndrome (ACS – STEMI or NSTEMI), rarely
cardiogenic shock or life-threatening arrhythmias (VT or VF), and sometimes sudden cardiac
death. Diagnosis (which sometimes can be challenging) is dominantly established by coronary
angiography, and sometimes modalities of intravascular visualization may be useful (IVUS,
OCT). The most of the patients with SCAD are treated conservatively and small proportion of
them requires revascularization (PCI or CABG). In addition, we present several cases with SCAD.
Conclusion: Timely and accurate diagnosis and treatment is extremely important in SCAD,
which is a potentially life-threatening condition.
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