Materiały źródłowe

• #1 Spontaneous Coronary Artery Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK582143/

  Spontaneous coronary artery dissection (SCAD) is a tear in the wall of the epicardial coronary artery not caused by trauma, coronary intervention, or atherosclerotic plaque rupture. […] Diagnosis is confirmed primarily by cardiac catheterization and coronary angiogram; intravascular imaging can be done if a coronary angiogram is inconclusive. […] The most common presentation is ACS. ECG may show ST-segment changes, and lab work may show an elevation in cardiac troponins. […] The characteristic angiographic appearance of spontaneous coronary artery dissection is the beaded appearance of the coronary artery due to multiple radiolucent lumens with extraluminal contrast staining or near occlusion of the vessel caused by intramural hematoma or dissection flap. […] Intracoronary imaging modalities like intravascular ultrasound (IVUS) or optical coherence tomography (OCT) demonstrate dissection flaps, intramural hematoma, intimal tear, and true and false lumens.

• #2 Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9627356/

  Spontaneous coronary artery dissection (SCAD) is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic, non-traumatic separation of the coronary artery wall. […] During the last decades, the most common problem in SCAD was the lack of awareness about this condition which has led to significant underdiagnosis and misdiagnosis. However, modern imaging techniques such as optical coherence tomography, intravascular ultrasound, coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of the disease. […] The aim of the present review was to demonstrate the existing knowledge regarding the diagnostic methods and the treatment strategies of the underdiagnosed syndrome of SCAD, and highlight the role of primary PCI. […] Accuracy and early diagnosis are the most important factors for the management of SCAD. Coronary angiography is the gold standard and the first-line imaging technique for patients presenting with ACS.

• #3 Spontaneous coronary artery dissection: Principles of management | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/88/11/623

  Spontaneous coronary artery dissection (SCAD) is an acute noniatrogenic tear in the coronary arterial wall, leading to disruption of coronary blood flow and myocardial infarction. […] Diagnosing SCAD requires a high index of suspicion for young patients presenting with acute coronary syndrome. […] SCAD is primarily managed medically in clinically stable patients. […] Revascularization is recommended only for patients at high risk due to left main coronary artery dissection, ongoing ischemia, severely limited flow, hemodynamic instability, or refractory arrhythmia. […] Diagnosis of SCAD requires a high index of suspicion in all young patients presenting with ACS, particularly women without traditional risk factors for atherosclerosis. […] Coronary angiography is regarded as the gold standard to confirm the presence of SCAD.

• #4 Spontaneous Coronary Artery Dissection (SCAD) | Treatment & Diagnosis | UH Harrington Heart & Vascular Institute | University Hospitals | Cleveland, Ohio | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/spontaneous-coronary-artery-dissection

  Spontaneous coronary artery dissection (SCAD) is an uncommon emergency condition in which a tear forms in an artery in the heart, usually leading to a heart attack. […] The first step in the diagnosis of SCAD is to determine if a heart attack occurred and look for damage to the heart muscle. Tests used in the emergency room include an electrocardiogram (ECG) and blood tests that detect heart muscle damage, such as the cardiac enzyme troponin test. […] Following an initial ECG and blood tests, coronary angiography is usually needed to confirm the SCAD diagnosis. During a coronary angiogram, doctors inject a special dye into the patient’s arteries so that they are visible in x-ray imaging. X-rays may show abnormalities in the artery that confirm the SCAD diagnosis. […] SCAD is most often discovered only after it causes a heart attack. As such, the symptoms of SCAD are those commonly associated with heart attack, including: Pain, pressure or tightness in the chest that may also travel to the neck/jaw or arms/shoulders (angina), Trouble breathing, Nausea and/or vomiting, Excessive sweating with no clear cause, Dizziness or passing out due to abnormal heart rhythm and low blood pressure.

• #5 Coronary Artery Dissection (SCAD): Types, Symptoms, Treatment

  https://www.healthline.com/health/heart/coronary-artery-dissection-scad

  A coronary artery dissection is a serious heart condition that requires emergency treatment. One type of coronary artery dissection is called a spontaneous coronary artery dissection (SCAD). SCAD occurs more often in women who are over 50 years old or postmenopausal, according to a 2015 review. Research from 2014 suggests that aortic dissection is most common among men in their 60s and 70s. Symptoms of aortic dissection and SCAD are similar to signs of a heart attack, and include: chest pain, shortness of breath, pain in one or both arms, pain in the shoulders, neck, or jaw, cold sweat, nausea, dizziness. Because there is significant overlap in symptoms between SCAD, aortic dissection, and heart attack, symptoms alone can’t diagnose them. SCAD is present in about 1 in 4 heart attacks in women under the age of 60. According to the American Heart Association, if no atherosclerosis is found, a doctor should test for SCAD. Coronary angiography is the main method of diagnosing SCAD. According to a 2014 study, intravascular ultrasound (IVUS) is often used alongside coronary angiography to confirm a diagnosis of SCAD. Doctors may also diagnose an aortic dissection using one or more of the following imaging tests: CT scan, transesophageal echocardiogram, MRI scan. Medications to treat mild SCAD also include antihypertensive drugs and blood thinners to lower the risk of a blood clot forming at the site of the tear. If medications aren’t enough to treat the condition, you may need surgery or a catheter-based procedure aimed at treating the injured artery. For SCAD, open heart surgery can be performed to bypass the damaged artery with a blood vessel from elsewhere in the body. SCAD and aortic dissection are often treatable if you get immediate medical help.

• #6 Spontaneous Coronary Artery Dissection (SCAD)

  https://my.clevelandclinic.org/health/diseases/17503-spontaneous-coronary-artery-dissection-scad

  Postpartum and postmenopausal people are most at risk for spontaneous coronary artery dissection (SCAD). The inner layer of a coronary artery separates or tears, slowing blood flow to the heart. This life-threatening condition requires immediate care. […] Spontaneous coronary artery dissection (SCAD) occurs when there’s a separation or tear in the wall of a coronary artery. The tear can occur in any one of the three layers of the coronary artery wall. Blood seeps between the layers. This trapped blood causes the artery to bulge inward. The bulge blocks or slows blood flow to your heart. […] SCAD increases your risk of acute coronary syndrome. This is a type of coronary artery disease that causes chest pain or angina. You’re also at risk of having a life-threatening heart attack. […] Medical experts consider SCAD to be an underdiagnosed condition. It may account for up to 4% of all cases of acute coronary syndrome and 1 in 4 cases in females who are younger than 50.

• #7 Spontaneous coronary artery dissection – UpToDate

  https://www.uptodate.com/contents/spontaneous-coronary-artery-dissection

  Spontaneous coronary artery dissection (SCAD) is a nontraumatic, noniatrogenic separation of the coronary arterial wall and is an infrequent cause of acute myocardial infarction. It is more common in younger patients and in women. Modern usage of the term SCAD denotes nonatherosclerotic causes, which is the primary focus of this topic. […] In the general population, SCAD is the cause of ACS in 0.1 to 4 percent of cases.

• #8 Sex Differences in Spontaneous Coronary Artery Dissection | USC Journal

  https://www.uscjournal.com/articles/sex-and-gender-differences-cardiovascular-disease-review-spontaneous-coronary-artery?language_content_entity=en

  SCAD has been described in individuals ranging in age from 18 to 84 years, largely debunking the notion that it is primarily a disease of the young. […] SCAD is believed to be the etiology of MI in 24-35% of women below the age of 60 years. […] A study using data from the National Readmission Database assessed adult hospitalizations involving a primary diagnosis of SCAD and found that men were more likely than women to have atherosclerotic risk factors, including prior history of diabetes, hypertension, hyperlipidemia, and chronic kidney disease. […] Other studies suggest that cardiovascular risk profiles are similar between men and women with SCAD. […] The cause of SCAD is multifactorial with genetic factors, hormones, and arteriopathies playing a role, as well as environmental or emotional stressors precipitating the event.

• #9 Spontaneous Coronary Artery Dissection (SCAD) – REBEL EM – Emergency Medicine Blog

  https://rebelem.com/spontaneous-coronary-artery-dissection-scad/

  Spontaneous coronary artery dissection (SCAD), once thought of as a rare zebra diagnosis that was universally fatal, is now being increasingly recognized as a cause of acute coronary syndrome (ACS), particularly in women due to increased vigilance, greater utilization of coronary angiography and advanced imaging. […] SCAD is defined as a non-traumatic and non-iatrogenic tear in the coronary arterial wall. […] True incidence and prevalence is unknown and has been historically underestimated. […] It has been suggested that SCAD may be the cause up to 1 4% of ACS cases overall. […] SCAD has also been identified as the most common cause of pregnancy-associated MI. […] Diagnosis is difficult and patients may be mistakenly discharged or have an incomplete work-up done due to their relatively young age and lack of risk factors for ACS.

• #10 Spontaneous Coronary Artery Dissection (SCAD)

  https://my.clevelandclinic.org/health/diseases/17503-spontaneous-coronary-artery-dissection-scad

  Postpartum and postmenopausal people are most at risk for spontaneous coronary artery dissection (SCAD). The inner layer of a coronary artery separates or tears, slowing blood flow to the heart. This life-threatening condition requires immediate care. […] Spontaneous coronary artery dissection (SCAD) occurs when there’s a separation or tear in the wall of a coronary artery. The tear can occur in any one of the three layers of the coronary artery wall. Blood seeps between the layers. This trapped blood causes the artery to bulge inward. The bulge blocks or slows blood flow to your heart. […] SCAD increases your risk of acute coronary syndrome. This is a type of coronary artery disease that causes chest pain or angina. You’re also at risk of having a life-threatening heart attack. […] Medical experts consider SCAD to be an underdiagnosed condition. It may account for up to 4% of all cases of acute coronary syndrome and 1 in 4 cases in females who are younger than 50.

• #11 Spontaneous Coronary Artery Dissection (SCAD) – REBEL EM – Emergency Medicine Blog

  https://rebelem.com/spontaneous-coronary-artery-dissection-scad/

  Accurate diagnosis in the acute stages of ACS is paramount as the management and investigation of SCAD is different from other causes of ACS. […] Once SCAD is suspected, angiography remains the first-line diagnostic modality. […] Cardiac enzymes are frequently increased in patients with SCAD. […] Initial troponin level in patients with SCAD may be normal. […] Majority of patients have angiographic healing of SCAD lesions without intervention. […] SCAD patients with high-risk features: Left Main Coronary Artery Dissection, Ongoing or Recurrent Ischemia or Chest Pain, Ventricular Tachycardia or Ventricular Fibrillation, Cardiogenic Shock. […] PCI is associated with increased risk of complications and variables outcomes. […] CABG: Described for SCAD patients with left main or proximal dissection, those with failure of attempted PCI, and those with refractory ischemia despite conservative approach.

• #12 Spontaneous Coronary Artery Dissection (SCAD) – REBEL EM – Emergency Medicine Blog

  https://rebelem.com/spontaneous-coronary-artery-dissection-scad/

  Accurate diagnosis in the acute stages of ACS is paramount as the management and investigation of SCAD is different from other causes of ACS. […] Once SCAD is suspected, angiography remains the first-line diagnostic modality. […] Cardiac enzymes are frequently increased in patients with SCAD. […] Initial troponin level in patients with SCAD may be normal. […] Majority of patients have angiographic healing of SCAD lesions without intervention. […] SCAD patients with high-risk features: Left Main Coronary Artery Dissection, Ongoing or Recurrent Ischemia or Chest Pain, Ventricular Tachycardia or Ventricular Fibrillation, Cardiogenic Shock. […] PCI is associated with increased risk of complications and variables outcomes. […] CABG: Described for SCAD patients with left main or proximal dissection, those with failure of attempted PCI, and those with refractory ischemia despite conservative approach.

• #13 Spontaneous coronary artery dissection (SCAD) | Heart and Stroke Foundation

  https://www.heartandstroke.ca/heart-disease/conditions/spontaneous-coronary-artery-dissection

  SCAD is not widely understood and is often misdiagnosed. First, an echocardiogram will be done to check your heart activity. A doctor will also look to see if you have elevated troponin levels in your blood. This is a protein found following damage to your heart. […] An imaging test called coronary angiogram will give your doctor an idea of the location of the tear and its measurements. If you are pregnant this test may not be safe for the fetus. Sometimes, further imaging with optical coherence tomography (OCT) or an intravascular ultrasound (IVUS) may be necessary to help diagnosis. Your doctor may also perform a multidetector computed tomography scan (MDCT) to provide a detailed image of your heart.

• #14 Coronary artery dissection: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/coronary-artery-dissection

  Spontaneous coronary artery dissection (SCAD) occurs without warning and can lead to serious complications, including death. […] Diagnosis presents a challenge to doctors because people often lack common risk factors of cardiac disease. If a doctor suspects a person may have SCAD, they may perform several diagnostic tests to check for the condition. […] Testing for SCAD often includes: Coronary angiography: This is often the first tool used for diagnosis. It uses X-rays to look at the blood vessels in a persons heart. […] There are no other biomarkers in the blood to indicate SCAD, but a person typically has elevated troponin levels. […] SCAD resembles a heart attack, but it requires a different treatment plan. Due to limited knowledge about the condition, there is no standard treatment plan for a doctor to follow.

• #15 Spontaneous Coronary Artery Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK582143/

  Spontaneous coronary artery dissection (SCAD) is a tear in the wall of the epicardial coronary artery not caused by trauma, coronary intervention, or atherosclerotic plaque rupture. […] Diagnosis is confirmed primarily by cardiac catheterization and coronary angiogram; intravascular imaging can be done if a coronary angiogram is inconclusive. […] The most common presentation is ACS. ECG may show ST-segment changes, and lab work may show an elevation in cardiac troponins. […] The characteristic angiographic appearance of spontaneous coronary artery dissection is the beaded appearance of the coronary artery due to multiple radiolucent lumens with extraluminal contrast staining or near occlusion of the vessel caused by intramural hematoma or dissection flap. […] Intracoronary imaging modalities like intravascular ultrasound (IVUS) or optical coherence tomography (OCT) demonstrate dissection flaps, intramural hematoma, intimal tear, and true and false lumens.

• #16 Spontaneous coronary artery dissection – BHF

  https://www.bhf.org.uk/informationsupport/conditions/spontaneous-coronary-artery-dissection

  Spontaneous coronary artery dissection (SCAD) is an emergency condition when a tear appears in the wall of a coronary artery, which supplies blood to your heart. […] SCAD is diagnosed post event. For example after having a heart attack. Research is currently looking into what the risk factors might be. But as the name spontaneous suggests, it is not something that is easy to predict. […] The symptoms are the same as for a heart attack, so the condition is usually diagnosed through: having blood tests, ECG, a coronary angiogram, CT scan.

• #17 Incidental Spontaneous Coronary Artery Dissection | Ziffra | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/2722/2072

  Spontaneous coronary artery dissection (SCAD) is a rare diagnosis that presents both a diagnostic and therapeutic challenge. […] The diagnosis of SCAD is difficult as the presenting signs and symptoms may be non-specific. […] Diagnosis of SCAD is difficult as there may be many presenting signs and symptoms that are similar to acute coronary syndrome. Electrocardiograms can be non-specific but may also show ST-segment changes, ventricular tachycardia, or ventricular fibrillation arrest. […] Generally, cardiac angiogram is the diagnostic modality of choice. There may be a clear appearance of dissection with a false lumen. […] The ability of these tools has increased the diagnosis of SCAD as much of the presentation may be non-specific in patients who may not have coronary risk factors.

• #18 Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9627356/

  Spontaneous coronary artery dissection (SCAD) is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic, non-traumatic separation of the coronary artery wall. […] During the last decades, the most common problem in SCAD was the lack of awareness about this condition which has led to significant underdiagnosis and misdiagnosis. However, modern imaging techniques such as optical coherence tomography, intravascular ultrasound, coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of the disease. […] The aim of the present review was to demonstrate the existing knowledge regarding the diagnostic methods and the treatment strategies of the underdiagnosed syndrome of SCAD, and highlight the role of primary PCI. […] Accuracy and early diagnosis are the most important factors for the management of SCAD. Coronary angiography is the gold standard and the first-line imaging technique for patients presenting with ACS.

• #19 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndromes (ACS), with a higher incidence in younger female patients. […] Invasive coronary angiography (ICA) is the current gold-standard investigation to diagnose SCAD. […] In cases of diagnostic uncertainty, administration of intracoronary GTN, use of intravascular imaging (where safe and feasible), CTCA, and cardiac magnetic resonance imaging can be useful. […] Catheter-based ICA is the current gold standard test for the diagnosis of SCAD. […] The importance of diagnostic clarity affords appropriate management, which in SCAD is different to the management of atherosclerotic disease. […] In one study, OCT confirmed the diagnosis in 11 out of 17 patients with angiographically diagnosed SCAD. […] CTCA has the advantage of being a non-invasive diagnostic procedure and can demonstrate the presence of coronary calcification or plaque suggestive of underlying atherosclerosis as the alternative cause of coronary narrowing.

• #20 Spontaneous Coronary Artery Dissection: Clinical Considerations in Diagnosis and Treatment – American College of Cardiology

  https://www.acc.org/Latest-in-Cardiology/Articles/2019/12/20/11/41/Spontaneous-Coronary-Artery-Dissection

  Spontaneous coronary artery dissection (SCAD) is a unique clinical entity and an important cause of myocardial infarction (MI), particularly among young and middle-aged women. SCAD is defined as a non-iatrogenic, non-traumatic separation of the coronary artery wall, not associated with atherosclerosis. The predominant mechanism of myocardial injury is coronary artery obstruction caused by an intramural hematoma (IMH) or intimal disruption compromising the true lumen at the site of dissection. Early and accurate diagnosis of SCAD is vital because the management strategy employed in this condition significantly differs from that of atherosclerotic disease. Because patients with SCAD are generally younger and possess less-conventional cardiovascular risk factors, they are often more prone to misdiagnosis. Coronary angiography is the first-line diagnostic tool for patients presenting with acute coronary syndrome due to suspected SCAD and should be performed as early as possible. Pathognomonic angiographic features of SCAD may include multiple radiolucent lines, contrast staining, false lumen appearance, and late contrast clearing, all of which are indicative of intimal tear (type 1 angiographic SCAD). Intracoronary imaging methods such as optical coherence tomography or intravascular ultrasound can serve as an important tool in increasing the diagnostic yield when there is uncertainty on coronary angiography, especially for cases due to IMH without intimal tear. A proposed algorithm for diagnosis of SCAD is shown in Figure 2. A paucity of data exists regarding optimal management of SCAD due to lack of randomized trials comparing medical therapy and revascularization strategies. Observational data have shown that when repeat angiography is performed, 70-97% of conservatively managed patients displayed angiographic healing of SCAD lesions. As such, a conservative treatment strategy is recommended in most cases, which includes an extended inpatient monitoring period of 3-5 days. The backbone of long-term medical therapy in SCAD is a combination of aspirin and beta-blocker. Beta-blocker use has been associated with a lower risk of recurrent SCAD and is therefore an essential part of long-term therapy at our institution. Revascularization for SCAD should be considered in patients exhibiting active myocardial ischemia, hemodynamic instability, or left main dissection, in whom conservative management is an unsatisfactory alternative. According to observational studies, percutaneous coronary intervention (PCI) for treatment of SCAD is associated with lower success rates and higher rates of complications compared with PCI for atherosclerotic CAD. In SCAD, affected coronary arteries are more susceptible to iatrogenic dissections. There are several proposed strategies aimed at improving the success rate of PCI in SCAD. SCAD is an enigmatic disease, and our understanding of the disease has progressed in recent years, largely owing to several registries including CanSCAD. Additional studies are required to refine and unify our treatment approaches to patients with SCAD.

• #21 Spontaneous Coronary Artery Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK582143/

  Spontaneous coronary artery dissection (SCAD) is a tear in the wall of the epicardial coronary artery not caused by trauma, coronary intervention, or atherosclerotic plaque rupture. […] Diagnosis is confirmed primarily by cardiac catheterization and coronary angiogram; intravascular imaging can be done if a coronary angiogram is inconclusive. […] The most common presentation is ACS. ECG may show ST-segment changes, and lab work may show an elevation in cardiac troponins. […] The characteristic angiographic appearance of spontaneous coronary artery dissection is the beaded appearance of the coronary artery due to multiple radiolucent lumens with extraluminal contrast staining or near occlusion of the vessel caused by intramural hematoma or dissection flap. […] Intracoronary imaging modalities like intravascular ultrasound (IVUS) or optical coherence tomography (OCT) demonstrate dissection flaps, intramural hematoma, intimal tear, and true and false lumens.

• #22 Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9627356/

  The main limitation of coronary angiography is that the 2-dimensional luminogram does not allow us to display the arterial wall. As a result, further imaging techniques are required in order to set a definitive diagnosis. […] Optical coherence tomography, with an axial resolution of 15 m, is a supplementary intracoronary imaging method for the diagnosis of SCAD that provides higher spatial resolution. […] IVUS, with an axial resolution of 150 m, is also a supplementary method in SCAD diagnosis, and is able to differentiate atherosclerotic plaques from SCAD. […] MRI is another new diagnostic method for patients with SCAD. Specifically, MRI can diagnose SCAD when its underlying diagnosis cannot be initially recognized on angiography. […] The classification of SCAD is based on angiographic imaging techniques. There are 3 widely approved types of SCAD.

• #23 Spontaneous Coronary Artery Dissection Diagnosis

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2021/08/17/19/56/spontaneous-coronary-artery-dissection

  Spontaneous Coronary Artery Dissection Diagnosis […] The following are key points to remember about this state-of-the-art review on spontaneous coronary artery dissection (SCAD): pitfalls of angiographic diagnosis and an approach to ambiguous cases. […] Appropriate management of SCAD is predicated on an accurate diagnosis. Management is different from acute coronary syndrome secondary to atherosclerosis with a conservative approach favored over percutaneous coronary intervention. […] Clinical features favoring SCAD include history of fibromuscular dysplasia or connective tissue disease, pregnancy-associated myocardial infarction, and nonresponsiveness to intracoronary nitrates. SCAD is almost exclusively seen in women. […] The Yip-Saw angiographic classification of SCAD divides it into three types: In type 1 SCAD, contrast penetrates into the false lumen and there may be dye hang up. Less than one-third of SCAD presents as type 1 and can suggest late presentation. Type 1 is less likely to progress and best managed conservatively. […] Type 2 SCAD is the most common and appears as a long smooth stenosis. […] Type 3 SCAD mimics atherosclerosis and requires intracoronary imaging to make the distinction. […] Other features that suggest SCAD over atherosclerosis include presence of tortuous vessels, lack of involvement of branching points, and absence of thrombus. […] Three approaches to help distinguish SCAD from atherosclerosis in ambiguous cases include presence of luminal thrombus (atherosclerosis), intracoronary imaging, and coronary computed tomography angiography. […] The classic intravascular ultrasound feature of SCAD is the triple band (white-black-white) of the intimal-media membrane and is pathognomonic for SCAD. Optical coherence tomography is preferred due to its higher spatial resolution and better ability to visualize the intimal medial membrane, false lumen, and external elastic membrane. […] Screening for extracoronary arteriopathies with brain to pelvis imaging is recommended.

• #24 Spontaneous Coronary Artery Dissection Diagnosis

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2021/08/17/19/56/spontaneous-coronary-artery-dissection

  Spontaneous Coronary Artery Dissection Diagnosis […] The following are key points to remember about this state-of-the-art review on spontaneous coronary artery dissection (SCAD): pitfalls of angiographic diagnosis and an approach to ambiguous cases. […] Appropriate management of SCAD is predicated on an accurate diagnosis. Management is different from acute coronary syndrome secondary to atherosclerosis with a conservative approach favored over percutaneous coronary intervention. […] Clinical features favoring SCAD include history of fibromuscular dysplasia or connective tissue disease, pregnancy-associated myocardial infarction, and nonresponsiveness to intracoronary nitrates. SCAD is almost exclusively seen in women. […] The Yip-Saw angiographic classification of SCAD divides it into three types: In type 1 SCAD, contrast penetrates into the false lumen and there may be dye hang up. Less than one-third of SCAD presents as type 1 and can suggest late presentation. Type 1 is less likely to progress and best managed conservatively. […] Type 2 SCAD is the most common and appears as a long smooth stenosis. […] Type 3 SCAD mimics atherosclerosis and requires intracoronary imaging to make the distinction. […] Other features that suggest SCAD over atherosclerosis include presence of tortuous vessels, lack of involvement of branching points, and absence of thrombus. […] Three approaches to help distinguish SCAD from atherosclerosis in ambiguous cases include presence of luminal thrombus (atherosclerosis), intracoronary imaging, and coronary computed tomography angiography. […] The classic intravascular ultrasound feature of SCAD is the triple band (white-black-white) of the intimal-media membrane and is pathognomonic for SCAD. Optical coherence tomography is preferred due to its higher spatial resolution and better ability to visualize the intimal medial membrane, false lumen, and external elastic membrane. […] Screening for extracoronary arteriopathies with brain to pelvis imaging is recommended.

• #25 Spontaneous Coronary Artery Dissection in Clinical Practice: Pathophysiology and Therapeutic Approaches

  https://www.mdpi.com/1648-9144/60/2/217

  Coronary angiography is the gold standard for SCAD diagnosis. However, a simple two-dimensional exam is not always sufficient to satisfy diagnostic doubt, and adjunctive evaluation through optical coherence tomography (OCT) should be performed. Usually, SCAD involves a single coronary artery and a single artery’s segment, although multidistrict involvement has been described. The main involved artery is the LAD, followed by the left circumflex and right coronary arteries. Saw et al. found a mean SCAD length of 33.2 mm. According to Yip-Saw classification, four main types of angiographic SCAD have been described; (i) type 1, accounting for fewer than 1/3 of SCAD cases, is characterized by the distinct evidence of the false and true lumen after contrast medium passage. Type 1 SCAD has an evolving and progressive nature, although it is associated with a poor clinical progression and/or post-percutaneous coronary intervention (PCI) complications; (ii) type 2 is the most frequent angiographic SCAD, and it is characterized by a variable narrowing of interested arteries, both in terms of length and diameter involvement. According to the latter, type 2a SCAD is characterized by a normal reperfused vessel distally to the false lumen; and type 2b is characterized by distal segments narrowing extension. Type 2 is the most frequent SCAD, but also the most angiographically missed; (iii) type 3 is comparable to focal or tubular atherosclerotic lesions and not distinguishable from them. The difference between the type 2 and 3 depends on the appearance of intramural hematoma. Type 4 SCAD has been recently proposed and it is characterized by total vessel occlusion. It often involves small distal vessels, and a diagnosis of thromboembolic occlusion has to be carried out.

• #26 Spontaneous Coronary Artery Dissection: Mechanisms, Diagnosis and Management | ECR Journal

  https://www.ecrjournal.com/articles/spontaneous-coronary-artery-dissection-mechanisms-diagnosis-and-management?language_content_entity=en

  Spontaneous coronary artery dissection (SCAD) can be defined as the acute development of a false lumen within the coronary artery wall that may lead to flow limitation by compression of the true coronary lumen. This definition of SCAD excludes coronary dissections that are secondary to atherosclerotic disease, produced by the extension of an aortic dissection, iatrogenic or related to a trauma. […] […] Invasive coronary angiography is still the main technique used in the diagnosis of SCAD. The advent of ICI revealed that a large majority of SCAD cases do not show a double lumen pattern on angiography. This finding led to a specific classification of SCAD by angiographic patterns, different from those of iatrogenic dissections induced by balloon angioplasty. This classification includes three main angiographic patterns. Type 1 lesions are defined by the presence of a double lumen image. Type 2 lesions are defined by the presence of a lumen narrowing, with a lesion length usually over 20 mm. Type 2 lesions are classified in two subtypes: type 2a, when the distal vessel recovers the normal size; and type 2b, when the IMH extends distally to the end of the coronary artery. Last, type 3 lesions are defined by an abrupt lumen narrowing with distal vessel size recovering that limits a focal lesion (length 20 mm), mimicking an atherosclerotic lesion. […]

• #27 Spontaneous Coronary Artery Dissection in Clinical Practice: Pathophysiology and Therapeutic Approaches

  https://www.mdpi.com/1648-9144/60/2/217

  Coronary angiography is the gold standard for SCAD diagnosis. However, a simple two-dimensional exam is not always sufficient to satisfy diagnostic doubt, and adjunctive evaluation through optical coherence tomography (OCT) should be performed. Usually, SCAD involves a single coronary artery and a single artery’s segment, although multidistrict involvement has been described. The main involved artery is the LAD, followed by the left circumflex and right coronary arteries. Saw et al. found a mean SCAD length of 33.2 mm. According to Yip-Saw classification, four main types of angiographic SCAD have been described; (i) type 1, accounting for fewer than 1/3 of SCAD cases, is characterized by the distinct evidence of the false and true lumen after contrast medium passage. Type 1 SCAD has an evolving and progressive nature, although it is associated with a poor clinical progression and/or post-percutaneous coronary intervention (PCI) complications; (ii) type 2 is the most frequent angiographic SCAD, and it is characterized by a variable narrowing of interested arteries, both in terms of length and diameter involvement. According to the latter, type 2a SCAD is characterized by a normal reperfused vessel distally to the false lumen; and type 2b is characterized by distal segments narrowing extension. Type 2 is the most frequent SCAD, but also the most angiographically missed; (iii) type 3 is comparable to focal or tubular atherosclerotic lesions and not distinguishable from them. The difference between the type 2 and 3 depends on the appearance of intramural hematoma. Type 4 SCAD has been recently proposed and it is characterized by total vessel occlusion. It often involves small distal vessels, and a diagnosis of thromboembolic occlusion has to be carried out.

• #28 Spontaneous Coronary Artery Dissection Diagnosis

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2021/08/17/19/56/spontaneous-coronary-artery-dissection

  Spontaneous Coronary Artery Dissection Diagnosis […] The following are key points to remember about this state-of-the-art review on spontaneous coronary artery dissection (SCAD): pitfalls of angiographic diagnosis and an approach to ambiguous cases. […] Appropriate management of SCAD is predicated on an accurate diagnosis. Management is different from acute coronary syndrome secondary to atherosclerosis with a conservative approach favored over percutaneous coronary intervention. […] Clinical features favoring SCAD include history of fibromuscular dysplasia or connective tissue disease, pregnancy-associated myocardial infarction, and nonresponsiveness to intracoronary nitrates. SCAD is almost exclusively seen in women. […] The Yip-Saw angiographic classification of SCAD divides it into three types: In type 1 SCAD, contrast penetrates into the false lumen and there may be dye hang up. Less than one-third of SCAD presents as type 1 and can suggest late presentation. Type 1 is less likely to progress and best managed conservatively. […] Type 2 SCAD is the most common and appears as a long smooth stenosis. […] Type 3 SCAD mimics atherosclerosis and requires intracoronary imaging to make the distinction. […] Other features that suggest SCAD over atherosclerosis include presence of tortuous vessels, lack of involvement of branching points, and absence of thrombus. […] Three approaches to help distinguish SCAD from atherosclerosis in ambiguous cases include presence of luminal thrombus (atherosclerosis), intracoronary imaging, and coronary computed tomography angiography. […] The classic intravascular ultrasound feature of SCAD is the triple band (white-black-white) of the intimal-media membrane and is pathognomonic for SCAD. Optical coherence tomography is preferred due to its higher spatial resolution and better ability to visualize the intimal medial membrane, false lumen, and external elastic membrane. […] Screening for extracoronary arteriopathies with brain to pelvis imaging is recommended.

• #29 Spontaneous Coronary Artery Dissection in Clinical Practice: Pathophysiology and Therapeutic Approaches

  https://www.mdpi.com/1648-9144/60/2/217

  Coronary angiography is the gold standard for SCAD diagnosis. However, a simple two-dimensional exam is not always sufficient to satisfy diagnostic doubt, and adjunctive evaluation through optical coherence tomography (OCT) should be performed. Usually, SCAD involves a single coronary artery and a single artery’s segment, although multidistrict involvement has been described. The main involved artery is the LAD, followed by the left circumflex and right coronary arteries. Saw et al. found a mean SCAD length of 33.2 mm. According to Yip-Saw classification, four main types of angiographic SCAD have been described; (i) type 1, accounting for fewer than 1/3 of SCAD cases, is characterized by the distinct evidence of the false and true lumen after contrast medium passage. Type 1 SCAD has an evolving and progressive nature, although it is associated with a poor clinical progression and/or post-percutaneous coronary intervention (PCI) complications; (ii) type 2 is the most frequent angiographic SCAD, and it is characterized by a variable narrowing of interested arteries, both in terms of length and diameter involvement. According to the latter, type 2a SCAD is characterized by a normal reperfused vessel distally to the false lumen; and type 2b is characterized by distal segments narrowing extension. Type 2 is the most frequent SCAD, but also the most angiographically missed; (iii) type 3 is comparable to focal or tubular atherosclerotic lesions and not distinguishable from them. The difference between the type 2 and 3 depends on the appearance of intramural hematoma. Type 4 SCAD has been recently proposed and it is characterized by total vessel occlusion. It often involves small distal vessels, and a diagnosis of thromboembolic occlusion has to be carried out.

• #30 Spontaneous Coronary Artery Dissection in Clinical Practice: Pathophysiology and Therapeutic Approaches

  https://www.mdpi.com/1648-9144/60/2/217

  Coronary angiography is the gold standard for SCAD diagnosis. However, a simple two-dimensional exam is not always sufficient to satisfy diagnostic doubt, and adjunctive evaluation through optical coherence tomography (OCT) should be performed. Usually, SCAD involves a single coronary artery and a single artery’s segment, although multidistrict involvement has been described. The main involved artery is the LAD, followed by the left circumflex and right coronary arteries. Saw et al. found a mean SCAD length of 33.2 mm. According to Yip-Saw classification, four main types of angiographic SCAD have been described; (i) type 1, accounting for fewer than 1/3 of SCAD cases, is characterized by the distinct evidence of the false and true lumen after contrast medium passage. Type 1 SCAD has an evolving and progressive nature, although it is associated with a poor clinical progression and/or post-percutaneous coronary intervention (PCI) complications; (ii) type 2 is the most frequent angiographic SCAD, and it is characterized by a variable narrowing of interested arteries, both in terms of length and diameter involvement. According to the latter, type 2a SCAD is characterized by a normal reperfused vessel distally to the false lumen; and type 2b is characterized by distal segments narrowing extension. Type 2 is the most frequent SCAD, but also the most angiographically missed; (iii) type 3 is comparable to focal or tubular atherosclerotic lesions and not distinguishable from them. The difference between the type 2 and 3 depends on the appearance of intramural hematoma. Type 4 SCAD has been recently proposed and it is characterized by total vessel occlusion. It often involves small distal vessels, and a diagnosis of thromboembolic occlusion has to be carried out.

• #31 Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9627356/

  The main limitation of coronary angiography is that the 2-dimensional luminogram does not allow us to display the arterial wall. As a result, further imaging techniques are required in order to set a definitive diagnosis. […] Optical coherence tomography, with an axial resolution of 15 m, is a supplementary intracoronary imaging method for the diagnosis of SCAD that provides higher spatial resolution. […] IVUS, with an axial resolution of 150 m, is also a supplementary method in SCAD diagnosis, and is able to differentiate atherosclerotic plaques from SCAD. […] MRI is another new diagnostic method for patients with SCAD. Specifically, MRI can diagnose SCAD when its underlying diagnosis cannot be initially recognized on angiography. […] The classification of SCAD is based on angiographic imaging techniques. There are 3 widely approved types of SCAD.

• #32 Spontaneous coronary artery dissection: novel insights on diagnosis and management – Alfonso – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/6185/html

  The classical diagnosis of SCAD relies on the demonstration of a radiolucent intimal flap on coronary angiography, frequently associated with contrast staining on the vessel wall. However, conventional angiography may lead to misdiagnosis explaining why SCAD is frequently underdiagnosed. Coronary angiography only depicts a lumenogram and fails to visualize the underlying vessel wall. Angiography is only able to unravel the lumen compromise or indirect signs of coronary wall disruption. Until very recently, the angiographic narrowing caused by an intramural hematoma impinging into the lumen was systematically misinterpreted as atherosclerotic coronary artery disease. The accumulated experience with this disease suggests that in the appropriate clinical setting an isolated, confined, long coronary lesion in a patient with otherwise smooth normal coronary vessels, should always raise the clinical suspicious of an underlying intramural hematoma.

• #33 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndromes (ACS), with a higher incidence in younger female patients. […] Invasive coronary angiography (ICA) is the current gold-standard investigation to diagnose SCAD. […] In cases of diagnostic uncertainty, administration of intracoronary GTN, use of intravascular imaging (where safe and feasible), CTCA, and cardiac magnetic resonance imaging can be useful. […] Catheter-based ICA is the current gold standard test for the diagnosis of SCAD. […] The importance of diagnostic clarity affords appropriate management, which in SCAD is different to the management of atherosclerotic disease. […] In one study, OCT confirmed the diagnosis in 11 out of 17 patients with angiographically diagnosed SCAD. […] CTCA has the advantage of being a non-invasive diagnostic procedure and can demonstrate the presence of coronary calcification or plaque suggestive of underlying atherosclerosis as the alternative cause of coronary narrowing.

• #34 Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9627356/

  The main limitation of coronary angiography is that the 2-dimensional luminogram does not allow us to display the arterial wall. As a result, further imaging techniques are required in order to set a definitive diagnosis. […] Optical coherence tomography, with an axial resolution of 15 m, is a supplementary intracoronary imaging method for the diagnosis of SCAD that provides higher spatial resolution. […] IVUS, with an axial resolution of 150 m, is also a supplementary method in SCAD diagnosis, and is able to differentiate atherosclerotic plaques from SCAD. […] MRI is another new diagnostic method for patients with SCAD. Specifically, MRI can diagnose SCAD when its underlying diagnosis cannot be initially recognized on angiography. […] The classification of SCAD is based on angiographic imaging techniques. There are 3 widely approved types of SCAD.

• #35 Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9627356/

  The main limitation of coronary angiography is that the 2-dimensional luminogram does not allow us to display the arterial wall. As a result, further imaging techniques are required in order to set a definitive diagnosis. […] Optical coherence tomography, with an axial resolution of 15 m, is a supplementary intracoronary imaging method for the diagnosis of SCAD that provides higher spatial resolution. […] IVUS, with an axial resolution of 150 m, is also a supplementary method in SCAD diagnosis, and is able to differentiate atherosclerotic plaques from SCAD. […] MRI is another new diagnostic method for patients with SCAD. Specifically, MRI can diagnose SCAD when its underlying diagnosis cannot be initially recognized on angiography. […] The classification of SCAD is based on angiographic imaging techniques. There are 3 widely approved types of SCAD.

• #36 Spontaneous coronary artery dissection: novel insights on diagnosis and management – Alfonso – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/6185/html

  More recently, we have reported the value of optical coherence tomography (OCT) in patients with SCAD. OCT has an unsurpassed axial resolution and, therefore, provides unique and detailed insights on the underlying anatomic substrate of these patients. This technique readily depicts the length of the dissecting membrane, the presence of the 2 lumens, the occurrence of thrombosis in the false lumen or the presence of an intramural hematoma. In fact, OCT findings demonstrated that the intimal flap actually corresponds to an intimo-medial membrane (encompassing both the intima and the inner layers of the media). In addition, due to its superb near-field resolution OCT is ideally suited to accurately identify the precise location of the intimal tear and the presence of small thrombi in the true lumen.

• #37 Spontaneous coronary artery dissection: novel insights on diagnosis and management – Alfonso – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/6185/html

  More recently, we have reported the value of optical coherence tomography (OCT) in patients with SCAD. OCT has an unsurpassed axial resolution and, therefore, provides unique and detailed insights on the underlying anatomic substrate of these patients. This technique readily depicts the length of the dissecting membrane, the presence of the 2 lumens, the occurrence of thrombosis in the false lumen or the presence of an intramural hematoma. In fact, OCT findings demonstrated that the intimal flap actually corresponds to an intimo-medial membrane (encompassing both the intima and the inner layers of the media). In addition, due to its superb near-field resolution OCT is ideally suited to accurately identify the precise location of the intimal tear and the presence of small thrombi in the true lumen.

• #38 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndromes (ACS), with a higher incidence in younger female patients. […] Invasive coronary angiography (ICA) is the current gold-standard investigation to diagnose SCAD. […] In cases of diagnostic uncertainty, administration of intracoronary GTN, use of intravascular imaging (where safe and feasible), CTCA, and cardiac magnetic resonance imaging can be useful. […] Catheter-based ICA is the current gold standard test for the diagnosis of SCAD. […] The importance of diagnostic clarity affords appropriate management, which in SCAD is different to the management of atherosclerotic disease. […] In one study, OCT confirmed the diagnosis in 11 out of 17 patients with angiographically diagnosed SCAD. […] CTCA has the advantage of being a non-invasive diagnostic procedure and can demonstrate the presence of coronary calcification or plaque suggestive of underlying atherosclerosis as the alternative cause of coronary narrowing.

• #39 Spontaneous Coronary Artery Dissection: Mechanisms, Diagnosis and Management | ECR Journal

  https://www.ecrjournal.com/articles/spontaneous-coronary-artery-dissection-mechanisms-diagnosis-and-management?language_content_entity=en

  Optical coherence tomography (OCT) can detect the presence and extension of the IMH and can clearly characterise the existence of an intimo-medial flap or fenestration. Alfonso et al. first described the utility of this technique in the context of SCAD. In this study, OCT was used to confirm the diagnosis in 11 out of 17 consecutive patients with clinical suspicion of SCAD. OCT proved to be able to identify the rupture site (the entry tear), visualise the intimo-medial membrane and comprehensively assess the characteristics, extent and distribution of the true and false lumen/IMH. […]

• #40 Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9627356/

  The main limitation of coronary angiography is that the 2-dimensional luminogram does not allow us to display the arterial wall. As a result, further imaging techniques are required in order to set a definitive diagnosis. […] Optical coherence tomography, with an axial resolution of 15 m, is a supplementary intracoronary imaging method for the diagnosis of SCAD that provides higher spatial resolution. […] IVUS, with an axial resolution of 150 m, is also a supplementary method in SCAD diagnosis, and is able to differentiate atherosclerotic plaques from SCAD. […] MRI is another new diagnostic method for patients with SCAD. Specifically, MRI can diagnose SCAD when its underlying diagnosis cannot be initially recognized on angiography. […] The classification of SCAD is based on angiographic imaging techniques. There are 3 widely approved types of SCAD.

• #41 Spontaneous coronary artery dissection: novel insights on diagnosis and management – Alfonso – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/6185/html

  Recently, tomographic techniques have been able to provide novel diagnostic insights in patients with SCAD. Intravascular ultrasound (IVUS) provides a clear picture of the vessel wall and of the coronary lumen. IVUS has a spatial resolution of 150 m thus enabling an accurate visualization of the entire vessel wall. In patients with SCAD, ruling out atherosclerotic coronary artery disease remains of major value. In these patients, IVUS is able to depict angiographically silent disease and readily determines the presence of an intramural hematoma. In patients with a classical presentation of SCAD the dissecting membrane and the true and false lumens are clearly identified. Of importance, the full longitudinal and circumferential extent of an intramural hematoma is readily visualized. Thrombosis of the false lumen is nicely depicted with this technique. IVUS findings have been also used to optimize the results of stent implantation in patients with SCAD requiring coronary interventions.

• #42 Spontaneous coronary artery dissection: novel insights on diagnosis and management – Alfonso – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/6185/html

  Recently, tomographic techniques have been able to provide novel diagnostic insights in patients with SCAD. Intravascular ultrasound (IVUS) provides a clear picture of the vessel wall and of the coronary lumen. IVUS has a spatial resolution of 150 m thus enabling an accurate visualization of the entire vessel wall. In patients with SCAD, ruling out atherosclerotic coronary artery disease remains of major value. In these patients, IVUS is able to depict angiographically silent disease and readily determines the presence of an intramural hematoma. In patients with a classical presentation of SCAD the dissecting membrane and the true and false lumens are clearly identified. Of importance, the full longitudinal and circumferential extent of an intramural hematoma is readily visualized. Thrombosis of the false lumen is nicely depicted with this technique. IVUS findings have been also used to optimize the results of stent implantation in patients with SCAD requiring coronary interventions.

• #43 Spontaneous Coronary Artery Dissection Diagnosis

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2021/08/17/19/56/spontaneous-coronary-artery-dissection

  Spontaneous Coronary Artery Dissection Diagnosis […] The following are key points to remember about this state-of-the-art review on spontaneous coronary artery dissection (SCAD): pitfalls of angiographic diagnosis and an approach to ambiguous cases. […] Appropriate management of SCAD is predicated on an accurate diagnosis. Management is different from acute coronary syndrome secondary to atherosclerosis with a conservative approach favored over percutaneous coronary intervention. […] Clinical features favoring SCAD include history of fibromuscular dysplasia or connective tissue disease, pregnancy-associated myocardial infarction, and nonresponsiveness to intracoronary nitrates. SCAD is almost exclusively seen in women. […] The Yip-Saw angiographic classification of SCAD divides it into three types: In type 1 SCAD, contrast penetrates into the false lumen and there may be dye hang up. Less than one-third of SCAD presents as type 1 and can suggest late presentation. Type 1 is less likely to progress and best managed conservatively. […] Type 2 SCAD is the most common and appears as a long smooth stenosis. […] Type 3 SCAD mimics atherosclerosis and requires intracoronary imaging to make the distinction. […] Other features that suggest SCAD over atherosclerosis include presence of tortuous vessels, lack of involvement of branching points, and absence of thrombus. […] Three approaches to help distinguish SCAD from atherosclerosis in ambiguous cases include presence of luminal thrombus (atherosclerosis), intracoronary imaging, and coronary computed tomography angiography. […] The classic intravascular ultrasound feature of SCAD is the triple band (white-black-white) of the intimal-media membrane and is pathognomonic for SCAD. Optical coherence tomography is preferred due to its higher spatial resolution and better ability to visualize the intimal medial membrane, false lumen, and external elastic membrane. […] Screening for extracoronary arteriopathies with brain to pelvis imaging is recommended.

• #44 Spontaneous Coronary Artery Dissection: Mechanisms, Diagnosis and Management | ECR Journal

  https://www.ecrjournal.com/articles/spontaneous-coronary-artery-dissection-mechanisms-diagnosis-and-management?language_content_entity=en

  During the last few years, ICI has been found to help in the diagnosis of SCAD and in guiding PCI when this is needed. Where there is diagnostic uncertainty (e.g. where SCAD mimics atherosclerotic disease as in type 3 lesions), ICI has a unique role in confirming the diagnosis of SCAD. In this context, the benefits of ICI should be balanced against potential complications due to the necessity of instrumentation within an injured coronary vessel, which could make it more prone to further dissection. Compared to intravascular ultrasound (IVUS), optical coherence tomography (OCT) in this context may have some theoretical limitations due to: the necessity of contrast injection, which could potentially lead to expansion of the IMH by hydraulic pressure; and the difficulty of assessment in flow-limiting lesions. […]

• #45 Spontaneous Coronary Artery Dissection Diagnosis

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2021/08/17/19/56/spontaneous-coronary-artery-dissection

  Spontaneous Coronary Artery Dissection Diagnosis […] The following are key points to remember about this state-of-the-art review on spontaneous coronary artery dissection (SCAD): pitfalls of angiographic diagnosis and an approach to ambiguous cases. […] Appropriate management of SCAD is predicated on an accurate diagnosis. Management is different from acute coronary syndrome secondary to atherosclerosis with a conservative approach favored over percutaneous coronary intervention. […] Clinical features favoring SCAD include history of fibromuscular dysplasia or connective tissue disease, pregnancy-associated myocardial infarction, and nonresponsiveness to intracoronary nitrates. SCAD is almost exclusively seen in women. […] The Yip-Saw angiographic classification of SCAD divides it into three types: In type 1 SCAD, contrast penetrates into the false lumen and there may be dye hang up. Less than one-third of SCAD presents as type 1 and can suggest late presentation. Type 1 is less likely to progress and best managed conservatively. […] Type 2 SCAD is the most common and appears as a long smooth stenosis. […] Type 3 SCAD mimics atherosclerosis and requires intracoronary imaging to make the distinction. […] Other features that suggest SCAD over atherosclerosis include presence of tortuous vessels, lack of involvement of branching points, and absence of thrombus. […] Three approaches to help distinguish SCAD from atherosclerosis in ambiguous cases include presence of luminal thrombus (atherosclerosis), intracoronary imaging, and coronary computed tomography angiography. […] The classic intravascular ultrasound feature of SCAD is the triple band (white-black-white) of the intimal-media membrane and is pathognomonic for SCAD. Optical coherence tomography is preferred due to its higher spatial resolution and better ability to visualize the intimal medial membrane, false lumen, and external elastic membrane. […] Screening for extracoronary arteriopathies with brain to pelvis imaging is recommended.

• #46 Spontaneous coronary artery dissection (SCAD) | Heart and Stroke Foundation

  https://www.heartandstroke.ca/heart-disease/conditions/spontaneous-coronary-artery-dissection

  SCAD is not widely understood and is often misdiagnosed. First, an echocardiogram will be done to check your heart activity. A doctor will also look to see if you have elevated troponin levels in your blood. This is a protein found following damage to your heart. […] An imaging test called coronary angiogram will give your doctor an idea of the location of the tear and its measurements. If you are pregnant this test may not be safe for the fetus. Sometimes, further imaging with optical coherence tomography (OCT) or an intravascular ultrasound (IVUS) may be necessary to help diagnosis. Your doctor may also perform a multidetector computed tomography scan (MDCT) to provide a detailed image of your heart.

• #47 Spontaneous coronary artery dissection – Wikipedia

  https://en.wikipedia.org/wiki/Spontaneous_coronary_artery_dissection

  There are 3 types of SCAD based on angiographic and anatomical criteria; with the designations based on the location and extent of the hematoma within the walls of the coronary arteries. […] Intracoronary imaging (ICI), consisting of intracoronary optical coherence tomography (OCT) and intravascular ultrasound (IVUS) can help distinguish SCAD from an atherosclerotic lesion when it is difficult to do so with angiography. […] Some studies propose coronary CT angiography to evaluate SCAD in lower-risk people, with research into the approach ongoing. […] Management depends upon the presenting symptoms. In most people who are hemodynamically stable without high-risk coronary involvement, conservative medical management with blood pressure control is recommended. […] In cases involving high-risk coronaries, hemodynamic instability, or a lack of improvement or worsening after initial attempts at treatment, urgent treatment with coronary stents or coronary artery bypass surgery may be necessary.

• #48 About SCAD – SCAD Research Inc

  https://scadresearch.com.au/about-scad/

  Spontaneous Coronary Artery Dissection (SCAD) is an uncommon emergency heart condition that occurs when a tear forms in one of the blood vessels in the heart, which causes a clot to form within the wall of the blood vessel. As the clot expands, the wall of the artery bulges into the vessel, which blocks or slows blood flow to the heart, causing a heart attack, abnormalities in heart rhythm or sudden death. […] A major challenge in diagnosing a SCAD heart attack is getting health care practitioners to see beyond the young, seemingly healthy individual. If your GP or medical practitioner has not treated SCAD patients in the past, please refer them to the ‘For Healthcare Professionals’ page on this site for the latest on diagnosing SCAD and best treatment practices. […] To diagnose a spontaneous coronary artery dissection, your doctor may order the following tests after reviewing your symptoms: Blood tests – specifically testing for troponin levels, the protein in your blood stream which indicates heart muscle damage; Coronary angiogram – this is a special x-ray where dye is injected into your arteries supplying blood to the heart muscle. This may be done via a tube (catheter) in an artery at the wrist, or the groin. An angiogram will show any blockages in these arteries and possibly a tear within the artery wall; Electrocardiograms (ECG) – electrodes are attached to the skin on your chest, arms and legs to check how your heart is functioning by measuring the electrical activity of the heart; CT scans – this is like a coronary angiogram. It has the advantage of not requiring a tube to be inserted into an artery but is less precise than a coronary angiogram; Echocardiogram – Ultrasound waves from a probe placed on the chest used to look at the heart structures and the pumping action of the heart.

• #49 3. Diagnosing SCAD – SCAD Alliance

  https://scadalliance.org/scad-warrior-app/diagnosing-scad-3/

  The images may show abnormalities in an artery that help doctors confirm spontaneous coronary artery dissection (SCAD) and gather information to guide treatment decisions. […] Cardiac CT angiography may be used in addition to other tests or as a follow-up test to evaluate your condition after spontaneous coronary artery dissection (SCAD).

• #50 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndromes (ACS), with a higher incidence in younger female patients. […] Invasive coronary angiography (ICA) is the current gold-standard investigation to diagnose SCAD. […] In cases of diagnostic uncertainty, administration of intracoronary GTN, use of intravascular imaging (where safe and feasible), CTCA, and cardiac magnetic resonance imaging can be useful. […] Catheter-based ICA is the current gold standard test for the diagnosis of SCAD. […] The importance of diagnostic clarity affords appropriate management, which in SCAD is different to the management of atherosclerotic disease. […] In one study, OCT confirmed the diagnosis in 11 out of 17 patients with angiographically diagnosed SCAD. […] CTCA has the advantage of being a non-invasive diagnostic procedure and can demonstrate the presence of coronary calcification or plaque suggestive of underlying atherosclerosis as the alternative cause of coronary narrowing.

• #51 Utility of Cardiac MRI in Confirming Spontaneous Coronary Artery Dissection | Society for Cardiovascular Magnetic Resonance

  https://scmr.org/cases-of-scmr/number-22-12/

  Two recent studies demonstrated how CMR was valuable in confirming SCAD as the cause of acute MI by demonstrating evidence of necrosis in a particular vessel territory, hence ruling out other causes like Takotsubo cardiomyopathy and myocarditis. […] Our case adds to the list of CMR-confirmed SCAD cases and demonstrates how CMR is an important tool for the diagnosis in the setting of acute coronary syndrome-like presentation but with discrepant angiographic findings.

• #52 Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies

  https://www.wjgnet.com/1949-8462/full/v14/i10/522.htm

  One of the most controversial issues of modern cardiology is the management strategy of SCAD. […] The aim of conservative management in the acute phase of SCAD is to restore or preserve myocardial perfusion and cardiac function. […] The role of lipid-lower therapies is unclear and controversial. […] Thrombolysis is contraindicated in the acute management of SCAD as it might extend dissection and cause coronary rupture, leading to cardiac tamponade. […] There are specific indications for revascularization. Patients with hemodynamic instability, ongoing or recurrent ischemia, ventricular arrhythmias, or left main dissection should be considered for PCI. […] The prognosis of SCAD is usually good and patients surviving SCAD demonstrate low long-term mortality. […] Follow-up of SCAD patients should be performed every year with imaging methods including simple techniques such as echocardiography and cardiac magnetic resonance imaging, more complex techniques such as computed tomography-peripheral angiography or magnetic resonance-angiography, and invasive techniques such as coronary angiography.

• #53 Spontaneous Coronary Artery Dissection (SCAD)

  https://www.tgh.org/institutes-and-services/conditions/spontaneous-coronary-artery-dissection-scad

  SCAD is diagnosed after other cardiac issues, such as an atherosclerotic blockage and heart attack, are ruled out. […] Imaging typically plays a key role in the diagnostic process. […] A physician may order various tests, including: Electrocardiogram (EKG), Coronary angiography, Intravascular ultrasound (IVUS) and optical coherence tomography (OCT), Magnetic resonance imaging (MRI) scans of the heart and coronary arteries, Computed tomography angiography (CTA), Echocardiogram.

• #54 Spontaneous coronary artery dissection (SCAD) | Heart and Stroke Foundation

  https://www.heartandstroke.ca/heart-disease/conditions/spontaneous-coronary-artery-dissection

  SCAD is not widely understood and is often misdiagnosed. First, an echocardiogram will be done to check your heart activity. A doctor will also look to see if you have elevated troponin levels in your blood. This is a protein found following damage to your heart. […] An imaging test called coronary angiogram will give your doctor an idea of the location of the tear and its measurements. If you are pregnant this test may not be safe for the fetus. Sometimes, further imaging with optical coherence tomography (OCT) or an intravascular ultrasound (IVUS) may be necessary to help diagnosis. Your doctor may also perform a multidetector computed tomography scan (MDCT) to provide a detailed image of your heart.

• #55

  https://journals.lww.com/nuclearmed/fulltext/2023/09000/novel_diagnostic_imaging_approach_for_patients.10.aspx

  Spontaneous coronary artery dissection (SCAD) is an underdiagnosed etiology of acute coronary syndrome in women. Accurate diagnosis remains challenging but is imperative for treatment and prevention. We show here the utility of 18F-FDG PET imaging in SCAD diagnosis. […] Localized myocardial inflammation identified on 18F-FDG PET imaging can aid in diagnosing SCAD suspected on coronary angiography.

• #56

  https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2024/10000/diagnosis_and_management_of_spontaneous_coronary.64.aspx

  SCAD diagnosis requires a high index of suspicion, especially when traditional cardiac tests are inconclusive. Beyond treatment, patients should undergo further evaluation for CTDs, particularly in those with minimal risk factors for atherosclerosis. Increased awareness and a multimodal diagnostic approach are crucial for timely intervention and improved outcomes in SCAD patients. […] The authors aim to increase awareness regarding different clinical presentations of SCAD to decrease the risk of missed or late diagnosis. The authors’ case series also signifies the multimodal imaging approach’s role in evaluating chest pain. Upon diagnosis of SCAD, it is imperative to go beyond treatment and implement a reverse algorithmic strategy to discover any underlying causes and risk factors for SCAD predisposition.

• #57 Spontaneous Coronary Artery Dissection: Clinical Considerations in Diagnosis and Treatment – American College of Cardiology

  https://www.acc.org/Latest-in-Cardiology/Articles/2019/12/20/11/41/Spontaneous-Coronary-Artery-Dissection

  Spontaneous coronary artery dissection (SCAD) is a unique clinical entity and an important cause of myocardial infarction (MI), particularly among young and middle-aged women. SCAD is defined as a non-iatrogenic, non-traumatic separation of the coronary artery wall, not associated with atherosclerosis. The predominant mechanism of myocardial injury is coronary artery obstruction caused by an intramural hematoma (IMH) or intimal disruption compromising the true lumen at the site of dissection. Early and accurate diagnosis of SCAD is vital because the management strategy employed in this condition significantly differs from that of atherosclerotic disease. Because patients with SCAD are generally younger and possess less-conventional cardiovascular risk factors, they are often more prone to misdiagnosis. Coronary angiography is the first-line diagnostic tool for patients presenting with acute coronary syndrome due to suspected SCAD and should be performed as early as possible. Pathognomonic angiographic features of SCAD may include multiple radiolucent lines, contrast staining, false lumen appearance, and late contrast clearing, all of which are indicative of intimal tear (type 1 angiographic SCAD). Intracoronary imaging methods such as optical coherence tomography or intravascular ultrasound can serve as an important tool in increasing the diagnostic yield when there is uncertainty on coronary angiography, especially for cases due to IMH without intimal tear. A proposed algorithm for diagnosis of SCAD is shown in Figure 2. A paucity of data exists regarding optimal management of SCAD due to lack of randomized trials comparing medical therapy and revascularization strategies. Observational data have shown that when repeat angiography is performed, 70-97% of conservatively managed patients displayed angiographic healing of SCAD lesions. As such, a conservative treatment strategy is recommended in most cases, which includes an extended inpatient monitoring period of 3-5 days. The backbone of long-term medical therapy in SCAD is a combination of aspirin and beta-blocker. Beta-blocker use has been associated with a lower risk of recurrent SCAD and is therefore an essential part of long-term therapy at our institution. Revascularization for SCAD should be considered in patients exhibiting active myocardial ischemia, hemodynamic instability, or left main dissection, in whom conservative management is an unsatisfactory alternative. According to observational studies, percutaneous coronary intervention (PCI) for treatment of SCAD is associated with lower success rates and higher rates of complications compared with PCI for atherosclerotic CAD. In SCAD, affected coronary arteries are more susceptible to iatrogenic dissections. There are several proposed strategies aimed at improving the success rate of PCI in SCAD. SCAD is an enigmatic disease, and our understanding of the disease has progressed in recent years, largely owing to several registries including CanSCAD. Additional studies are required to refine and unify our treatment approaches to patients with SCAD.

• #58 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  Therefore, CTCA as a primary diagnostic strategy is limited and it remains an adjunctive test to ICA in people with suspected SCAD. […] The American Heart Association consensus document has proposed an algorithm to manage acute SCAD. […] In the Canadian SCAD registry of 750 patients, 86.4% were managed conservatively, with only 2.3% of these patients subsequently requiring invasive treatment. […] In a systematic review of n=4206 patients with SCAD, beta-blockers were found to be significantly associated with a reduced risk of SCAD recurrence after adjustment for confounders; RR of 0.51 (95% CI 0.33 -0.77, P=0.0013). […] In a retrospective study (n=87, median 47 months of follow up) statin use was found to be associated with increased SCAD recurrence; 50% vs 8%, p=0.022. […] The prevalence of FMD among patients with SCAD was variable between studies.

• #59 Sex Differences in Spontaneous Coronary Artery Dissection | USC Journal

  https://www.uscjournal.com/articles/sex-and-gender-differences-cardiovascular-disease-review-spontaneous-coronary-artery?language_content_entity=en

  This review highlights sex- and gender-specific considerations in cardiovascular diseases with a particular focus on pathophysiology, epidemiology, clinical presentation, risk factors, diagnosis, and management of spontaneous coronary artery dissection. […] Early invasive coronary angiography is the gold standard for the diagnosis of SCAD. […] This angiographic classification has improved the recognition and accuracy of SCAD diagnosis and increased scientific interest. […] Despite an increased awareness among patients and providers, SCAD continues to be underdiagnosed or misdiagnosed, and is usually mistaken for atherosclerotic coronary disease. An emphasis on recognition and diagnosis of SCAD is paramount to providing appropriate care and avoiding the potential harm from inappropriate treatment and procedures.

• #60 Spontaneous coronary artery dissection (SCAD) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/spontaneous-coronary-artery-dissection/diagnosis-treatment/drc-20353716

  SCAD is usually diagnosed in an emergency setting. You may be asked questions about your personal and family medical history. Tests are done to check your heart. […] Tests to diagnose SCAD are similar to tests used to detect a heart attack. They may include: […] A coronary angiogram can diagnose SCAD. It also can show any twisted arteries. […] Other tests may be done during a coronary angiogram to confirm SCAD and plan treatment. […] Spontaneous coronary artery dissection (SCAD) care at Mayo Clinic. […] After a SCAD diagnosis, you may have questions about your health. Prepare a list of questions to ask your health care provider at your next appointment, such as: […] What tests do I need? […] What’s the most appropriate treatment? […] Will the tear in my artery heal on its own? […] What is my risk of having another SCAD? […] Do I have a blood vessel condition, such as fibromuscular dysplasia, also called FMD? […] Are there any activity or eating restrictions I need to follow? […] Is it safe for me to get pregnant?

• #61 Spontaneous Coronary Artery Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK582143/

  Spontaneous coronary artery dissection (SCAD) is a tear in the wall of the epicardial coronary artery not caused by trauma, coronary intervention, or atherosclerotic plaque rupture. […] Diagnosis is confirmed primarily by cardiac catheterization and coronary angiogram; intravascular imaging can be done if a coronary angiogram is inconclusive. […] The most common presentation is ACS. ECG may show ST-segment changes, and lab work may show an elevation in cardiac troponins. […] The characteristic angiographic appearance of spontaneous coronary artery dissection is the beaded appearance of the coronary artery due to multiple radiolucent lumens with extraluminal contrast staining or near occlusion of the vessel caused by intramural hematoma or dissection flap. […] Intracoronary imaging modalities like intravascular ultrasound (IVUS) or optical coherence tomography (OCT) demonstrate dissection flaps, intramural hematoma, intimal tear, and true and false lumens.

• #62 Spontaneous coronary artery dissection (SCAD) | Heart and Stroke Foundation

  https://www.heartandstroke.ca/heart-disease/conditions/spontaneous-coronary-artery-dissection

  SCAD is not widely understood and is often misdiagnosed. First, an echocardiogram will be done to check your heart activity. A doctor will also look to see if you have elevated troponin levels in your blood. This is a protein found following damage to your heart. […] An imaging test called coronary angiogram will give your doctor an idea of the location of the tear and its measurements. If you are pregnant this test may not be safe for the fetus. Sometimes, further imaging with optical coherence tomography (OCT) or an intravascular ultrasound (IVUS) may be necessary to help diagnosis. Your doctor may also perform a multidetector computed tomography scan (MDCT) to provide a detailed image of your heart.

• #63 Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9627356/

  Spontaneous coronary artery dissection (SCAD) is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic, non-traumatic separation of the coronary artery wall. […] During the last decades, the most common problem in SCAD was the lack of awareness about this condition which has led to significant underdiagnosis and misdiagnosis. However, modern imaging techniques such as optical coherence tomography, intravascular ultrasound, coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of the disease. […] The aim of the present review was to demonstrate the existing knowledge regarding the diagnostic methods and the treatment strategies of the underdiagnosed syndrome of SCAD, and highlight the role of primary PCI. […] Accuracy and early diagnosis are the most important factors for the management of SCAD. Coronary angiography is the gold standard and the first-line imaging technique for patients presenting with ACS.

• #64 Spontaneous coronary artery dissection: A review for clinical and interventional cardiologists | Revista Portuguesa de Cardiologia

  https://revportcardiol.org/pt-spontaneous-coronary-artery-dissection-a-articulo-S0870255123000525

  While low pretest probability for atherosclerotic coronary disease might suggest a non-coronary diagnosis and lead an invasive approach to be postponed (mainly for patients presenting with NSTEMI), invasive coronary angiography is the gold standard for SCAD diagnosis and should follow recommended timeframes after ACS has been diagnosed. […] The interventional cardiologist should be aware of the angiographic patterns of SCAD to enable correct identification of SCAD and its types according to the Saw classification. […] When angiographic findings are ambiguous, intracoronary nitroglycerin (to relieve vasospasm) and intracoronary imaging are recommended to clarify the diagnosis. […] Despite the fear of iatrogenic injury, the distinct and contrasting patient management strategies between atherosclerotic and SCAD-associated ACS mean that correct diagnosis is key for deciding on ad hoc PCI versus a conservative approach and for planning appropriate medical treatment and follow-up.

• #65 Spontaneous coronary artery dissection—A review – Yip – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/5668/html

  With the advent of new imaging modalities, particularly with intracoronary imaging, there has been improved recognition of SCAD. […] Clinicians should have a high index of suspicion for SCAD especially in young women presenting with MI without traditional cardiovascular risk factors. An early invasive coronary angiography for these patients is recommended. If type 1 SCAD appearance is evident, then there is little controversy and the diagnosis of SCAD can be made. […] If type 1 SCAD appearance is not evident, SCAD diagnosis would be most objectively confirmed by OCT or IVUS. For diffuse (20 mm) and smooth stenosis (type 2 SCAD), intracoronary nitroglycerin should be administered to relieve potential overlying spasm. If the lesion remains after nitroglycerin, then OCT or IVUS may be pursued.

• #66 Spontaneous coronary artery dissection: A review for clinical and interventional cardiologists | Revista Portuguesa de Cardiologia

  https://revportcardiol.org/pt-spontaneous-coronary-artery-dissection-a-articulo-S0870255123000525

  While low pretest probability for atherosclerotic coronary disease might suggest a non-coronary diagnosis and lead an invasive approach to be postponed (mainly for patients presenting with NSTEMI), invasive coronary angiography is the gold standard for SCAD diagnosis and should follow recommended timeframes after ACS has been diagnosed. […] The interventional cardiologist should be aware of the angiographic patterns of SCAD to enable correct identification of SCAD and its types according to the Saw classification. […] When angiographic findings are ambiguous, intracoronary nitroglycerin (to relieve vasospasm) and intracoronary imaging are recommended to clarify the diagnosis. […] Despite the fear of iatrogenic injury, the distinct and contrasting patient management strategies between atherosclerotic and SCAD-associated ACS mean that correct diagnosis is key for deciding on ad hoc PCI versus a conservative approach and for planning appropriate medical treatment and follow-up.

• #67 Spontaneous coronary artery dissection—A review – Yip – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/5668/html

  With the advent of new imaging modalities, particularly with intracoronary imaging, there has been improved recognition of SCAD. […] Clinicians should have a high index of suspicion for SCAD especially in young women presenting with MI without traditional cardiovascular risk factors. An early invasive coronary angiography for these patients is recommended. If type 1 SCAD appearance is evident, then there is little controversy and the diagnosis of SCAD can be made. […] If type 1 SCAD appearance is not evident, SCAD diagnosis would be most objectively confirmed by OCT or IVUS. For diffuse (20 mm) and smooth stenosis (type 2 SCAD), intracoronary nitroglycerin should be administered to relieve potential overlying spasm. If the lesion remains after nitroglycerin, then OCT or IVUS may be pursued.

• #68 Spontaneous coronary artery dissection: contemporary aspects of diagnosis and patient management | Open Heart

  https://openheart.bmj.com/content/5/2/e000884

  The hallmark of SCAD that is revealed with ICI is the myoendothelial lamina (intimomedial flap). […] ICI should be performed essentially in the following situations: (i) when percutaneous coronary intervention (PCI) is required (diagnostic confirmation + procedural guidance) and (ii) for unclear angiographic lesions when a therapeutic decision depends on ICI findings. […] The presence of irregularities suggesting atherosclerosis in other vessels or non-dissected segments should prompt further assessment of the lesion, if feasible, with ICI to further clarify the aetiology and exclude atherosclerosis-related dissection. […] Whenever clinically possible, conservative management is the preferred strategy in SCAD. […] Because SCAD is a treacherous scenario for percutaneous coronary intervention, every precaution must be taken to prevent specific complications.

• #69 Spontaneous coronary artery dissection—A review – Yip – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/5668/html

  The decision to revascularize the dissected artery depends on the patients clinical status and affected coronary anatomy. In most cases, conservative treatment is preferred for stable patients without ongoing pain. Patients with ongoing chest pain, ischemia, ST elevation, or hemodynamic instability should undergo PCI, especially when the dissection affects major arteries with sizable myocardial jeopardy.

• #70 Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies

  https://www.wjgnet.com/1949-8462/full/v14/i10/522.htm

  One of the most controversial issues of modern cardiology is the management strategy of SCAD. […] The aim of conservative management in the acute phase of SCAD is to restore or preserve myocardial perfusion and cardiac function. […] The role of lipid-lower therapies is unclear and controversial. […] Thrombolysis is contraindicated in the acute management of SCAD as it might extend dissection and cause coronary rupture, leading to cardiac tamponade. […] There are specific indications for revascularization. Patients with hemodynamic instability, ongoing or recurrent ischemia, ventricular arrhythmias, or left main dissection should be considered for PCI. […] The prognosis of SCAD is usually good and patients surviving SCAD demonstrate low long-term mortality. […] Follow-up of SCAD patients should be performed every year with imaging methods including simple techniques such as echocardiography and cardiac magnetic resonance imaging, more complex techniques such as computed tomography-peripheral angiography or magnetic resonance-angiography, and invasive techniques such as coronary angiography.

• #71 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  FMD screening has been advocated for in all patients with SCAD. […] The role of antiplatelet therapy in SCAD has been controversial. […] The use of anticoagulation in the acute phase carries the same considerations as discussed in the antiplatelets section above. […] SCAD is one of the most common causes of MI in pregnant women with the post-partum period the most at-risk period. […] In the Canadian SCAD registry, peripartum status was found to be an independent predictor of 30-day and 3-year MACE. […] Genetic screening of all people with SCAD is generally low yield and therefore not routinely recommended. […] The diagnosis of SCAD can be challenging, and a high level of clinical suspicion in the setting of ACS in a young person or pregnancy-associated ACS, should be combined with multimodality imaging, where required.

• #72 FMD and SCAD (Spontaneous coronary artery dissection) – Fibromuscular Dysplasia

  https://www.fmd-be.be/fmd-and-scad-sudden-coronary-artery-dissection/

  SCAD is a rare cause of Myocardial Infarction (heart attack). […] The diagnosis of SCAD can be considered when a heart attack is seen in younger women, typically less than 50 years old, with few cardiovascular risks. […] SCAD is more commonly seen in women (90% of cases), in 10% of cases during pregnancy or following child birth. […] Following a SCAD event, it is recommended to screen other arteries for signs of FMD or less frequently genetic or inflammatory arterial diseases. […] Recent research has shown that patients who have suffered a SCAD often (30-80% of cases) harbour FMD lesions of the multifocal subtype (string of beads), particularly in the renal, cerebrovascular and iliac arteries. […] According to these observations, expert panels from Europe and the US have made the following recommendations: 1. Patients who have suffered a SCAD should undergo a one-time head to pelvis scan (by CTA, or MRA if contra-indicated) to screen for FMD lesions or other vascular abnormalities. […] Imaging of coronary arteries is not recommended in patients with FMD in the absence of chest pain (angina) or other suggestive symptoms.

• #73 Spontaneous coronary artery dissection: An often unrecognized cause of acute coronary syndrome | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/86/4/252

  Spontaneous coronary artery dissection (SCAD), an intramural hemorrhage leading to a separation of the layers of the coronary artery wall, is traditionally considered a rare condition associated mainly with pregnancy but is likely underdiagnosed in other settings. Its recognition by coronary angiography is key. Medical management is usually indicated, except in certain circumstances in which coronary artery bypass grafting or percutaneous coronary intervention should be considered. […] SCAD can be diagnosed by coronary angiography. There are 3 angiographic types: […] Types 1 and 2 are usually easy to recognize. To diagnose type 2, intravenous nitroglycerin should first be administered to rule out coronary spasm. […] The initial and most critical step is to make the correct diagnosis. Although the presentation of acute coronary syndrome caused by SCAD is often identical to that of atherosclerosis, the conditions have different pathophysiologies and thus require different management. […] Management algorithms for SCAD are available. […] Imaging of the renal, iliac, and cerebral vasculature is recommended for all patients with SCAD. […] Patients with SCAD should start long-term aspirin and 1 year of clopidogrel.

• #74 Spontaneous Coronary Artery Dissection Diagnosis

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2021/08/17/19/56/spontaneous-coronary-artery-dissection

  Spontaneous Coronary Artery Dissection Diagnosis […] The following are key points to remember about this state-of-the-art review on spontaneous coronary artery dissection (SCAD): pitfalls of angiographic diagnosis and an approach to ambiguous cases. […] Appropriate management of SCAD is predicated on an accurate diagnosis. Management is different from acute coronary syndrome secondary to atherosclerosis with a conservative approach favored over percutaneous coronary intervention. […] Clinical features favoring SCAD include history of fibromuscular dysplasia or connective tissue disease, pregnancy-associated myocardial infarction, and nonresponsiveness to intracoronary nitrates. SCAD is almost exclusively seen in women. […] The Yip-Saw angiographic classification of SCAD divides it into three types: In type 1 SCAD, contrast penetrates into the false lumen and there may be dye hang up. Less than one-third of SCAD presents as type 1 and can suggest late presentation. Type 1 is less likely to progress and best managed conservatively. […] Type 2 SCAD is the most common and appears as a long smooth stenosis. […] Type 3 SCAD mimics atherosclerosis and requires intracoronary imaging to make the distinction. […] Other features that suggest SCAD over atherosclerosis include presence of tortuous vessels, lack of involvement of branching points, and absence of thrombus. […] Three approaches to help distinguish SCAD from atherosclerosis in ambiguous cases include presence of luminal thrombus (atherosclerosis), intracoronary imaging, and coronary computed tomography angiography. […] The classic intravascular ultrasound feature of SCAD is the triple band (white-black-white) of the intimal-media membrane and is pathognomonic for SCAD. Optical coherence tomography is preferred due to its higher spatial resolution and better ability to visualize the intimal medial membrane, false lumen, and external elastic membrane. […] Screening for extracoronary arteriopathies with brain to pelvis imaging is recommended.

• #75 Sex Differences in Spontaneous Coronary Artery Dissection | USC Journal

  https://www.uscjournal.com/articles/sex-and-gender-differences-cardiovascular-disease-review-spontaneous-coronary-artery?language_content_entity=en

  The prevalence of FMD in patients with SCAD ranges from 45% to 72%, with recent literature suggesting a prevalence greater than 50%. […] Management in the acute phase of SCAD depends on the clinical severity, and the goal is to preserve cardiac function and myocardial perfusion. […] Patients without high-risk features such as persistent chest pain, ongoing ischemia, hemodynamic instability, ventricular arrhythmias, left main dissection, or extensive proximal multivessel SCAD are considered low risk and should be managed conservatively. […] In SCAD patients in the European DISCO multicenter registry treated with low-dose aspirin versus aspirin and clopidogrel or ticagrelor, a higher MACE rate was observed in patients who received DAPT. […] Prior to discharge and upon outpatient follow-up, it is crucial to counsel patients on appropriate lifestyle changes, activity modifications, and medications to lower the risk of recurrence. […] Understanding sex and gender differences in SCAD provides further insights. Women with SCAD are typically older and likely to have emotional triggers compared with men.

• #76 FMD and SCAD (Spontaneous coronary artery dissection) – Fibromuscular Dysplasia

  https://www.fmd-be.be/fmd-and-scad-sudden-coronary-artery-dissection/

  SCAD is a rare cause of Myocardial Infarction (heart attack). […] The diagnosis of SCAD can be considered when a heart attack is seen in younger women, typically less than 50 years old, with few cardiovascular risks. […] SCAD is more commonly seen in women (90% of cases), in 10% of cases during pregnancy or following child birth. […] Following a SCAD event, it is recommended to screen other arteries for signs of FMD or less frequently genetic or inflammatory arterial diseases. […] Recent research has shown that patients who have suffered a SCAD often (30-80% of cases) harbour FMD lesions of the multifocal subtype (string of beads), particularly in the renal, cerebrovascular and iliac arteries. […] According to these observations, expert panels from Europe and the US have made the following recommendations: 1. Patients who have suffered a SCAD should undergo a one-time head to pelvis scan (by CTA, or MRA if contra-indicated) to screen for FMD lesions or other vascular abnormalities. […] Imaging of coronary arteries is not recommended in patients with FMD in the absence of chest pain (angina) or other suggestive symptoms.

• #77 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  FMD screening has been advocated for in all patients with SCAD. […] The role of antiplatelet therapy in SCAD has been controversial. […] The use of anticoagulation in the acute phase carries the same considerations as discussed in the antiplatelets section above. […] SCAD is one of the most common causes of MI in pregnant women with the post-partum period the most at-risk period. […] In the Canadian SCAD registry, peripartum status was found to be an independent predictor of 30-day and 3-year MACE. […] Genetic screening of all people with SCAD is generally low yield and therefore not routinely recommended. […] The diagnosis of SCAD can be challenging, and a high level of clinical suspicion in the setting of ACS in a young person or pregnancy-associated ACS, should be combined with multimodality imaging, where required.

• #78 Spontaneous Coronary Artery Dissection (SCAD)

  https://www.massgeneral.org/heart-center/treatments-and-services/womens-heart-health/spontaneous-coronary-artery-dissection

  Spontaneous coronary artery dissection (SCAD) is a rare condition requiring specialized diagnosis and treatment. […] Spontaneous coronary artery dissection (SCAD) is a rare condition that occurs when a tear forms in one or more blood vessels of the heart, which can slow or block blood flow to the heart and cause a heart attack. […] Although SCAD may seem similar to other conditions that cause heart attacks, it is a unique disorder that should be managed and monitored by specialists with expertise in the disease. […] As part of your assessment, our team may recommend diagnostic testing with genetic screening and specialized imaging studies in order to define potential causes for your SCAD. […] Our team is dedicated to working with you to develop a treatment approach that allows you to lead an active life.

• #79 Spontaneous coronary artery dissection: An often unrecognized cause of acute coronary syndrome | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/86/4/252

  Spontaneous coronary artery dissection (SCAD), an intramural hemorrhage leading to a separation of the layers of the coronary artery wall, is traditionally considered a rare condition associated mainly with pregnancy but is likely underdiagnosed in other settings. Its recognition by coronary angiography is key. Medical management is usually indicated, except in certain circumstances in which coronary artery bypass grafting or percutaneous coronary intervention should be considered. […] SCAD can be diagnosed by coronary angiography. There are 3 angiographic types: […] Types 1 and 2 are usually easy to recognize. To diagnose type 2, intravenous nitroglycerin should first be administered to rule out coronary spasm. […] The initial and most critical step is to make the correct diagnosis. Although the presentation of acute coronary syndrome caused by SCAD is often identical to that of atherosclerosis, the conditions have different pathophysiologies and thus require different management. […] Management algorithms for SCAD are available. […] Imaging of the renal, iliac, and cerebral vasculature is recommended for all patients with SCAD. […] Patients with SCAD should start long-term aspirin and 1 year of clopidogrel.

• #80 Incidental Spontaneous Coronary Artery Dissection | Ziffra | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/2722/2072

  Spontaneous coronary artery dissection (SCAD) is a rare diagnosis that presents both a diagnostic and therapeutic challenge. […] The diagnosis of SCAD is difficult as the presenting signs and symptoms may be non-specific. […] Diagnosis of SCAD is difficult as there may be many presenting signs and symptoms that are similar to acute coronary syndrome. Electrocardiograms can be non-specific but may also show ST-segment changes, ventricular tachycardia, or ventricular fibrillation arrest. […] Generally, cardiac angiogram is the diagnostic modality of choice. There may be a clear appearance of dissection with a false lumen. […] The ability of these tools has increased the diagnosis of SCAD as much of the presentation may be non-specific in patients who may not have coronary risk factors.

• #81 Spontaneous Coronary Artery Dissection: Clinical Considerations in Diagnosis and Treatment – American College of Cardiology

  https://www.acc.org/Latest-in-Cardiology/Articles/2019/12/20/11/41/Spontaneous-Coronary-Artery-Dissection

  Spontaneous coronary artery dissection (SCAD) is a unique clinical entity and an important cause of myocardial infarction (MI), particularly among young and middle-aged women. SCAD is defined as a non-iatrogenic, non-traumatic separation of the coronary artery wall, not associated with atherosclerosis. The predominant mechanism of myocardial injury is coronary artery obstruction caused by an intramural hematoma (IMH) or intimal disruption compromising the true lumen at the site of dissection. Early and accurate diagnosis of SCAD is vital because the management strategy employed in this condition significantly differs from that of atherosclerotic disease. Because patients with SCAD are generally younger and possess less-conventional cardiovascular risk factors, they are often more prone to misdiagnosis. Coronary angiography is the first-line diagnostic tool for patients presenting with acute coronary syndrome due to suspected SCAD and should be performed as early as possible. Pathognomonic angiographic features of SCAD may include multiple radiolucent lines, contrast staining, false lumen appearance, and late contrast clearing, all of which are indicative of intimal tear (type 1 angiographic SCAD). Intracoronary imaging methods such as optical coherence tomography or intravascular ultrasound can serve as an important tool in increasing the diagnostic yield when there is uncertainty on coronary angiography, especially for cases due to IMH without intimal tear. A proposed algorithm for diagnosis of SCAD is shown in Figure 2. A paucity of data exists regarding optimal management of SCAD due to lack of randomized trials comparing medical therapy and revascularization strategies. Observational data have shown that when repeat angiography is performed, 70-97% of conservatively managed patients displayed angiographic healing of SCAD lesions. As such, a conservative treatment strategy is recommended in most cases, which includes an extended inpatient monitoring period of 3-5 days. The backbone of long-term medical therapy in SCAD is a combination of aspirin and beta-blocker. Beta-blocker use has been associated with a lower risk of recurrent SCAD and is therefore an essential part of long-term therapy at our institution. Revascularization for SCAD should be considered in patients exhibiting active myocardial ischemia, hemodynamic instability, or left main dissection, in whom conservative management is an unsatisfactory alternative. According to observational studies, percutaneous coronary intervention (PCI) for treatment of SCAD is associated with lower success rates and higher rates of complications compared with PCI for atherosclerotic CAD. In SCAD, affected coronary arteries are more susceptible to iatrogenic dissections. There are several proposed strategies aimed at improving the success rate of PCI in SCAD. SCAD is an enigmatic disease, and our understanding of the disease has progressed in recent years, largely owing to several registries including CanSCAD. Additional studies are required to refine and unify our treatment approaches to patients with SCAD.

• #82 Spontaneous coronary artery dissection: A review for clinical and interventional cardiologists | Revista Portuguesa de Cardiologia

  https://revportcardiol.org/pt-spontaneous-coronary-artery-dissection-a-articulo-S0870255123000525

  While low pretest probability for atherosclerotic coronary disease might suggest a non-coronary diagnosis and lead an invasive approach to be postponed (mainly for patients presenting with NSTEMI), invasive coronary angiography is the gold standard for SCAD diagnosis and should follow recommended timeframes after ACS has been diagnosed. […] The interventional cardiologist should be aware of the angiographic patterns of SCAD to enable correct identification of SCAD and its types according to the Saw classification. […] When angiographic findings are ambiguous, intracoronary nitroglycerin (to relieve vasospasm) and intracoronary imaging are recommended to clarify the diagnosis. […] Despite the fear of iatrogenic injury, the distinct and contrasting patient management strategies between atherosclerotic and SCAD-associated ACS mean that correct diagnosis is key for deciding on ad hoc PCI versus a conservative approach and for planning appropriate medical treatment and follow-up.

• #83 Utility of Cardiac MRI in Confirming Spontaneous Coronary Artery Dissection | Society for Cardiovascular Magnetic Resonance

  https://scmr.org/cases-of-scmr/number-22-12/

  Two recent studies demonstrated how CMR was valuable in confirming SCAD as the cause of acute MI by demonstrating evidence of necrosis in a particular vessel territory, hence ruling out other causes like Takotsubo cardiomyopathy and myocarditis. […] Our case adds to the list of CMR-confirmed SCAD cases and demonstrates how CMR is an important tool for the diagnosis in the setting of acute coronary syndrome-like presentation but with discrepant angiographic findings.

• #84 Utility of Cardiac MRI in Confirming Spontaneous Coronary Artery Dissection | Society for Cardiovascular Magnetic Resonance

  https://scmr.org/cases-of-scmr/number-22-12/

  Two recent studies demonstrated how CMR was valuable in confirming SCAD as the cause of acute MI by demonstrating evidence of necrosis in a particular vessel territory, hence ruling out other causes like Takotsubo cardiomyopathy and myocarditis. […] Our case adds to the list of CMR-confirmed SCAD cases and demonstrates how CMR is an important tool for the diagnosis in the setting of acute coronary syndrome-like presentation but with discrepant angiographic findings.

• #85 Spontaneous Coronary Artery Dissection in Clinical Practice: Pathophysiology and Therapeutic Approaches

  https://www.mdpi.com/1648-9144/60/2/217

  Coronary angiography is the gold standard for SCAD diagnosis. However, a simple two-dimensional exam is not always sufficient to satisfy diagnostic doubt, and adjunctive evaluation through optical coherence tomography (OCT) should be performed. Usually, SCAD involves a single coronary artery and a single artery’s segment, although multidistrict involvement has been described. The main involved artery is the LAD, followed by the left circumflex and right coronary arteries. Saw et al. found a mean SCAD length of 33.2 mm. According to Yip-Saw classification, four main types of angiographic SCAD have been described; (i) type 1, accounting for fewer than 1/3 of SCAD cases, is characterized by the distinct evidence of the false and true lumen after contrast medium passage. Type 1 SCAD has an evolving and progressive nature, although it is associated with a poor clinical progression and/or post-percutaneous coronary intervention (PCI) complications; (ii) type 2 is the most frequent angiographic SCAD, and it is characterized by a variable narrowing of interested arteries, both in terms of length and diameter involvement. According to the latter, type 2a SCAD is characterized by a normal reperfused vessel distally to the false lumen; and type 2b is characterized by distal segments narrowing extension. Type 2 is the most frequent SCAD, but also the most angiographically missed; (iii) type 3 is comparable to focal or tubular atherosclerotic lesions and not distinguishable from them. The difference between the type 2 and 3 depends on the appearance of intramural hematoma. Type 4 SCAD has been recently proposed and it is characterized by total vessel occlusion. It often involves small distal vessels, and a diagnosis of thromboembolic occlusion has to be carried out.

• #86 Spontaneous Coronary Artery Dissection (SCAD)

  https://my.clevelandclinic.org/health/diseases/17503-spontaneous-coronary-artery-dissection-scad

  Spontaneous coronary artery dissection can be challenging to diagnose. If you have chest pain or other signs of a heart attack, your provider may perform these tests to check for a SCAD: enzyme marker test, angiogram, intravascular optical coherence tomography (IVOCT), and intravascular ultrasound (IVUS). […] As many as 3 in 4 people who develop SCAD improve with medications, such as those used to manage blood pressure, manage high cholesterol, and prevent blood clots. An estimated 14% of people have severe SCAD that requires urgent, in-hospital treatments. […] SCAD can be life-threatening, claiming the lives of up to 5% of people who develop it. An artery tear increases your risk for chronic angina, disease recurrence, and heart inflammation. […] Spontaneous coronary artery dissection (SCAD) causes heart attack-like symptoms among people who are at low risk for heart problems. Females are most at risk. You should call 911 anytime you experience heart attack symptoms. If tests indicate SCAD, your healthcare provider will discuss treatment options. Even with treatment, you have a higher chance of having another artery tear. Your provider will closely monitor your heart health to lower this risk.

• #87 Sex Differences in Spontaneous Coronary Artery Dissection | USC Journal

  https://www.uscjournal.com/articles/sex-and-gender-differences-cardiovascular-disease-review-spontaneous-coronary-artery?language_content_entity=en

  This review highlights sex- and gender-specific considerations in cardiovascular diseases with a particular focus on pathophysiology, epidemiology, clinical presentation, risk factors, diagnosis, and management of spontaneous coronary artery dissection. […] Early invasive coronary angiography is the gold standard for the diagnosis of SCAD. […] This angiographic classification has improved the recognition and accuracy of SCAD diagnosis and increased scientific interest. […] Despite an increased awareness among patients and providers, SCAD continues to be underdiagnosed or misdiagnosed, and is usually mistaken for atherosclerotic coronary disease. An emphasis on recognition and diagnosis of SCAD is paramount to providing appropriate care and avoiding the potential harm from inappropriate treatment and procedures.

• #88 Spontaneous Coronary Artery Dissection In Pregnant Women

  https://www.pamedmal.com/spontaneous-coronary-artery-dissection-scad-in-pregnant-and-postpartum-women-risks-diagnosis-and-medical-malpractice/

  Despite advancements in imaging technology, SCAD is frequently misdiagnosed. This is due to a combination of factors including lack of awareness among healthcare professionals, the rarity of the condition, and its tendency to affect a population not typically associated with heart disease. Pregnant and postpartum women might also dismiss their symptoms as normal pregnancy-related discomfort, leading to delayed medical attention. […] Women misdiagnosed or not treated promptly for SCAD are at a higher risk of severe complications, including heart failure, recurrence of SCAD, or even death. It is crucial for healthcare providers to maintain a high index of suspicion for SCAD in pregnant and postpartum women presenting with cardiac symptoms, even if they don’t have typical risk factors for heart disease.

• #89 Spontaneous Coronary Artery Dissection (SCAD) – Victor Chang Cardiac Research Institute

  https://www.victorchang.edu.au/heart-disease/scad

  Spontaneous coronary artery dissection (SCAD) is a rare but serious condition that results when an inner layer of one of the blood vessels in the heart tears. […] To diagnose spontaneous coronary artery dissection (SCAD), your doctor may order the following tests after reviewing your symptoms: […] A major challenge in diagnosing SCAD is getting health care practitioners to see beyond the young, seemingly healthy individual, as they are not stereotypical patients at risk of a heart attack.

• #90 Spontaneous coronary artery dissection

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/spontaneous-coronary-artery-dissection

  Spontaneous coronary artery dissection is an important cause of acute myocardial infarction, especially in young women. […] Spontaneous coronary artery dissection (SCAD) is a rare non-atherosclerotic cause of acute coronary syndromes (ACS). […] It is important to recognise SCAD, as patient characteristics and management differ substantially from typical ACS cases. […] The diagnosis of SCAD is made at the time of coronary angiography. […] SCAD is often under-recognised and incorrectly classified as due to atherosclerosis if diagnosis is reliant upon visualisation of the classic dissection flap. […] Imaging of the vessel wall with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) is required to make the diagnosis of Type 2 and Type 3 SCAD. […] Conservative management is preferred in stable patients with SCAD as most dissected segments will heal spontaneously.

• #91 Spontaneous Coronary Artery Dissection (SCAD) – REBEL EM – Emergency Medicine Blog

  https://rebelem.com/spontaneous-coronary-artery-dissection-scad/

  Accurate diagnosis in the acute stages of ACS is paramount as the management and investigation of SCAD is different from other causes of ACS. […] Once SCAD is suspected, angiography remains the first-line diagnostic modality. […] Cardiac enzymes are frequently increased in patients with SCAD. […] Initial troponin level in patients with SCAD may be normal. […] Majority of patients have angiographic healing of SCAD lesions without intervention. […] SCAD patients with high-risk features: Left Main Coronary Artery Dissection, Ongoing or Recurrent Ischemia or Chest Pain, Ventricular Tachycardia or Ventricular Fibrillation, Cardiogenic Shock. […] PCI is associated with increased risk of complications and variables outcomes. […] CABG: Described for SCAD patients with left main or proximal dissection, those with failure of attempted PCI, and those with refractory ischemia despite conservative approach.

• #92 Spontaneous coronary artery dissection

  https://www.myamericannurse.com/spontaneous-coronary-artery-dissection/

  Nurses should have a high level of suspicion for spontaneous coronary artery dissection (SCAD) when patients, especially young women, present with chest pain and other acute coronary syndrome symptoms, in the absence of or in the presence of few atherosclerotic risk factors. […] Prompt and accurate SCAD diagnosis is critical to save lives. However, when a patient who has no cardiovascular risk factors arrives in an emergency department (ED), he or she may be misdiagnosed and prematurely discharged. The first-line approach for diagnosing SCAD is coronary angiography because of its wide availability; a grading system helps with recognition and use in early invasive SCAD management. […] SCAD is a life-threatening cause of ACS that affects predominately young seemingly healthy women without traditional cardiovascular risk factors. Consider SCAD in these patients to avoid misdiagnosis and lethal outcomes.

• #93

  https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2024/10000/diagnosis_and_management_of_spontaneous_coronary.64.aspx

  SCAD diagnosis requires a high index of suspicion, especially when traditional cardiac tests are inconclusive. Beyond treatment, patients should undergo further evaluation for CTDs, particularly in those with minimal risk factors for atherosclerosis. Increased awareness and a multimodal diagnostic approach are crucial for timely intervention and improved outcomes in SCAD patients. […] The authors aim to increase awareness regarding different clinical presentations of SCAD to decrease the risk of missed or late diagnosis. The authors’ case series also signifies the multimodal imaging approach’s role in evaluating chest pain. Upon diagnosis of SCAD, it is imperative to go beyond treatment and implement a reverse algorithmic strategy to discover any underlying causes and risk factors for SCAD predisposition.

• #94 Spontaneous coronary artery dissection

  https://www.myamericannurse.com/spontaneous-coronary-artery-dissection/

  Nurses should have a high level of suspicion for spontaneous coronary artery dissection (SCAD) when patients, especially young women, present with chest pain and other acute coronary syndrome symptoms, in the absence of or in the presence of few atherosclerotic risk factors. […] Prompt and accurate SCAD diagnosis is critical to save lives. However, when a patient who has no cardiovascular risk factors arrives in an emergency department (ED), he or she may be misdiagnosed and prematurely discharged. The first-line approach for diagnosing SCAD is coronary angiography because of its wide availability; a grading system helps with recognition and use in early invasive SCAD management. […] SCAD is a life-threatening cause of ACS that affects predominately young seemingly healthy women without traditional cardiovascular risk factors. Consider SCAD in these patients to avoid misdiagnosis and lethal outcomes.

• #95

  https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2024/10000/diagnosis_and_management_of_spontaneous_coronary.64.aspx

  SCAD diagnosis requires a high index of suspicion, especially when traditional cardiac tests are inconclusive. Beyond treatment, patients should undergo further evaluation for CTDs, particularly in those with minimal risk factors for atherosclerosis. Increased awareness and a multimodal diagnostic approach are crucial for timely intervention and improved outcomes in SCAD patients. […] The authors aim to increase awareness regarding different clinical presentations of SCAD to decrease the risk of missed or late diagnosis. The authors’ case series also signifies the multimodal imaging approach’s role in evaluating chest pain. Upon diagnosis of SCAD, it is imperative to go beyond treatment and implement a reverse algorithmic strategy to discover any underlying causes and risk factors for SCAD predisposition.

• #96 Spontaneous Coronary Artery Dissection (SCAD) – REBEL EM – Emergency Medicine Blog

  https://rebelem.com/spontaneous-coronary-artery-dissection-scad/

  Accurate diagnosis in the acute stages of ACS is paramount as the management and investigation of SCAD is different from other causes of ACS. […] Once SCAD is suspected, angiography remains the first-line diagnostic modality. […] Cardiac enzymes are frequently increased in patients with SCAD. […] Initial troponin level in patients with SCAD may be normal. […] Majority of patients have angiographic healing of SCAD lesions without intervention. […] SCAD patients with high-risk features: Left Main Coronary Artery Dissection, Ongoing or Recurrent Ischemia or Chest Pain, Ventricular Tachycardia or Ventricular Fibrillation, Cardiogenic Shock. […] PCI is associated with increased risk of complications and variables outcomes. […] CABG: Described for SCAD patients with left main or proximal dissection, those with failure of attempted PCI, and those with refractory ischemia despite conservative approach.

• #97

  https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2024/10000/diagnosis_and_management_of_spontaneous_coronary.64.aspx

  Given the rarity of this diagnosis and less prevalence in males, it can be overlooked if not associated with acute coronary syndrome. Additionally, if it presents in the outpatient setting, it can be missed, mainly when stress testing is negative, as it was in both of our cases. Our case series proposes systematic approaches to the diagnosis and workup of the patients presenting with chest pain using different noninvasive modalities in a step-wise fashion even after the initial testing is negative when the patient continues to be symptomatic. […] The author also stresses that the investigation should continue beyond the diagnosis of SCAD. Instead, patients should also be worked up for the presence of CTDs. Fibromuscular dysplasia is one of the most common causes of SCAD found in literature. In patients with suspected acute coronary syndrome (ACS) and inconclusive diagnostic tests, a rheumatology-centered physical examination is crucial.

• #98

  https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2024/10000/diagnosis_and_management_of_spontaneous_coronary.64.aspx

  Given the rarity of this diagnosis and less prevalence in males, it can be overlooked if not associated with acute coronary syndrome. Additionally, if it presents in the outpatient setting, it can be missed, mainly when stress testing is negative, as it was in both of our cases. Our case series proposes systematic approaches to the diagnosis and workup of the patients presenting with chest pain using different noninvasive modalities in a step-wise fashion even after the initial testing is negative when the patient continues to be symptomatic. […] The author also stresses that the investigation should continue beyond the diagnosis of SCAD. Instead, patients should also be worked up for the presence of CTDs. Fibromuscular dysplasia is one of the most common causes of SCAD found in literature. In patients with suspected acute coronary syndrome (ACS) and inconclusive diagnostic tests, a rheumatology-centered physical examination is crucial.

• #99 Spontaneous coronary artery dissection—A review – Yip – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/5668/html

  The decision to revascularize the dissected artery depends on the patients clinical status and affected coronary anatomy. In most cases, conservative treatment is preferred for stable patients without ongoing pain. Patients with ongoing chest pain, ischemia, ST elevation, or hemodynamic instability should undergo PCI, especially when the dissection affects major arteries with sizable myocardial jeopardy.

• #100 Spontaneous coronary artery dissection: Principles of management | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/88/11/623

  Spontaneous coronary artery dissection (SCAD) is an acute noniatrogenic tear in the coronary arterial wall, leading to disruption of coronary blood flow and myocardial infarction. […] Diagnosing SCAD requires a high index of suspicion for young patients presenting with acute coronary syndrome. […] SCAD is primarily managed medically in clinically stable patients. […] Revascularization is recommended only for patients at high risk due to left main coronary artery dissection, ongoing ischemia, severely limited flow, hemodynamic instability, or refractory arrhythmia. […] Diagnosis of SCAD requires a high index of suspicion in all young patients presenting with ACS, particularly women without traditional risk factors for atherosclerosis. […] Coronary angiography is regarded as the gold standard to confirm the presence of SCAD.

• #101 Spontaneous coronary artery dissection: A review for clinical and interventional cardiologists | Revista Portuguesa de Cardiologia

  https://revportcardiol.org/pt-spontaneous-coronary-artery-dissection-a-articulo-S0870255123000525

  Overall, PCI for SCAD is associated with worse technical results and higher rates of complications compared to PCI for other indications. […] As for atherosclerotic coronary disease, CABG can be an option when large areas of myocardium are in jeopardy. […] Admission to intensive care or to a ward with cardiac telemetry should be chosen according to clinical status. […] If the patient is stable and symptom-free, repeat coronary angiography to confirm healing is unnecessary, as angiographic healing is time-dependent, and 95% of conservatively managed patients show spontaneous recovery at 30 days post-SCAD. […] Follow-up consultations should aim at preventing recurrence, planning medication discontinuation, managing chest pain and investigating SCAD-associated conditions. […] SCAD is an increasingly recognized but incompletely understood cause of ACS in young and otherwise healthy patients. Favorable short-term outcomes following conservative therapy contrast with high recurrence rates and long-term morbidity, requiring close follow-up for cardiac events.

• #102 Spontaneous coronary artery dissection

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/spontaneous-coronary-artery-dissection

  Spontaneous coronary artery dissection is an important cause of acute myocardial infarction, especially in young women. […] Spontaneous coronary artery dissection (SCAD) is a rare non-atherosclerotic cause of acute coronary syndromes (ACS). […] It is important to recognise SCAD, as patient characteristics and management differ substantially from typical ACS cases. […] The diagnosis of SCAD is made at the time of coronary angiography. […] SCAD is often under-recognised and incorrectly classified as due to atherosclerosis if diagnosis is reliant upon visualisation of the classic dissection flap. […] Imaging of the vessel wall with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) is required to make the diagnosis of Type 2 and Type 3 SCAD. […] Conservative management is preferred in stable patients with SCAD as most dissected segments will heal spontaneously.

• #103 Spontaneous coronary artery dissection: Principles of management | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/88/11/623

  Spontaneous coronary artery dissection (SCAD) is an acute noniatrogenic tear in the coronary arterial wall, leading to disruption of coronary blood flow and myocardial infarction. […] Diagnosing SCAD requires a high index of suspicion for young patients presenting with acute coronary syndrome. […] SCAD is primarily managed medically in clinically stable patients. […] Revascularization is recommended only for patients at high risk due to left main coronary artery dissection, ongoing ischemia, severely limited flow, hemodynamic instability, or refractory arrhythmia. […] Diagnosis of SCAD requires a high index of suspicion in all young patients presenting with ACS, particularly women without traditional risk factors for atherosclerosis. […] Coronary angiography is regarded as the gold standard to confirm the presence of SCAD.

• #104

  https://link.springer.com/article/10.1007/s12471-019-1235-4

  Most (7097%) SCAD lesions heal spontaneously within several weeks. […] Therefore, prolonged in-hospital patient monitoring (35 days) after the initial event is recommended in conservatively treated patients. […] In SCAD patients who are clinically or haemodynamically unstable (TIMI score 0 or 1), who show ongoing ischaemia or in whom major arteries are affected, revascularisation either by PCI or coronary artery bypass graft is required. […] Although evidence-based guidelines are lacking, the AHA recently published a treatment algorithm for SCAD treatment. […] A recurrent SCAD should be differentiated from extension of a previous dissection and from de novo SCAD. […] Overall, patient series have reported that recurrent de novo SCAD occurs in 1227% of SCAD patients, depending on the duration of follow-up.

• #105 Spontaneous coronary artery dissection: A review for clinical and interventional cardiologists | Revista Portuguesa de Cardiologia

  https://revportcardiol.org/pt-spontaneous-coronary-artery-dissection-a-articulo-S0870255123000525

  Overall, PCI for SCAD is associated with worse technical results and higher rates of complications compared to PCI for other indications. […] As for atherosclerotic coronary disease, CABG can be an option when large areas of myocardium are in jeopardy. […] Admission to intensive care or to a ward with cardiac telemetry should be chosen according to clinical status. […] If the patient is stable and symptom-free, repeat coronary angiography to confirm healing is unnecessary, as angiographic healing is time-dependent, and 95% of conservatively managed patients show spontaneous recovery at 30 days post-SCAD. […] Follow-up consultations should aim at preventing recurrence, planning medication discontinuation, managing chest pain and investigating SCAD-associated conditions. […] SCAD is an increasingly recognized but incompletely understood cause of ACS in young and otherwise healthy patients. Favorable short-term outcomes following conservative therapy contrast with high recurrence rates and long-term morbidity, requiring close follow-up for cardiac events.

• #106 Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies

  https://www.wjgnet.com/1949-8462/full/v14/i10/522.htm

  One of the most controversial issues of modern cardiology is the management strategy of SCAD. […] The aim of conservative management in the acute phase of SCAD is to restore or preserve myocardial perfusion and cardiac function. […] The role of lipid-lower therapies is unclear and controversial. […] Thrombolysis is contraindicated in the acute management of SCAD as it might extend dissection and cause coronary rupture, leading to cardiac tamponade. […] There are specific indications for revascularization. Patients with hemodynamic instability, ongoing or recurrent ischemia, ventricular arrhythmias, or left main dissection should be considered for PCI. […] The prognosis of SCAD is usually good and patients surviving SCAD demonstrate low long-term mortality. […] Follow-up of SCAD patients should be performed every year with imaging methods including simple techniques such as echocardiography and cardiac magnetic resonance imaging, more complex techniques such as computed tomography-peripheral angiography or magnetic resonance-angiography, and invasive techniques such as coronary angiography.

• #107 Spontaneous coronary artery dissection: Principles of management | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/88/11/623

  Cardiac rehabilitation is an important component of management following SCAD, but it remains significantly underused. […] We recommend referring all patients with SCAD for cardiac rehabilitation, including young women without other comorbidities. […] Prospective and randomized-controlled studies are needed to facilitate development of an evidence-based treatment algorithm for SCAD.

• #108 Spontaneous Coronary Artery Dissection: Principles of Management

  https://consultqd.clevelandclinic.org/spontaneous-coronary-artery-dissection-principles-of-management

  The authors guidance for other medications for SCAD is as follows: A limited role for anticoagulation. […] Given these associations, a vascular medicine evaluation is recommended for all patients diagnosed with SCAD. […] Although patients with SCAD have a favorable prognosis for long-term survival, they are at risk of chronic angina, noncardiac chest pain and recurrent SCAD. […] SCAD recurrence rates of approximately 10% to 27% have been reported in the literature. […] Cardiac rehabilitation is an important component of management following SCAD, but it remains significantly underused despite clear short- and long-term benefits for perceived physical and mental health and a consistent record of safety in patients with SCAD. […] They also issue a call for prospective, randomized controlled studies to facilitate development of an evidence-based treatment algorithm for SCAD, particularly addressing the role and duration of dual antiplatelet therapy, the use of statin therapy, and indications for and timing of revascularization.

• #109 Spontaneous Coronary Artery Dissection: Principles of Management

  https://consultqd.clevelandclinic.org/spontaneous-coronary-artery-dissection-principles-of-management

  The authors guidance for other medications for SCAD is as follows: A limited role for anticoagulation. […] Given these associations, a vascular medicine evaluation is recommended for all patients diagnosed with SCAD. […] Although patients with SCAD have a favorable prognosis for long-term survival, they are at risk of chronic angina, noncardiac chest pain and recurrent SCAD. […] SCAD recurrence rates of approximately 10% to 27% have been reported in the literature. […] Cardiac rehabilitation is an important component of management following SCAD, but it remains significantly underused despite clear short- and long-term benefits for perceived physical and mental health and a consistent record of safety in patients with SCAD. […] They also issue a call for prospective, randomized controlled studies to facilitate development of an evidence-based treatment algorithm for SCAD, particularly addressing the role and duration of dual antiplatelet therapy, the use of statin therapy, and indications for and timing of revascularization.

• #110 Spontaneous coronary artery dissection – Wikipedia

  https://en.wikipedia.org/wiki/Spontaneous_coronary_artery_dissection

  People with SCAD have a low in-hospital mortality after treatment. However, the lesion may worsen after leaving the hospital within the first month. […] Given the lack of consensus on the cause of SCAD, prevention of future SCAD may include medical therapy, counseling about becoming pregnant again (for those who had pregnancy-associated SCAD), or avoidance of estrogen therapy.

• #111 Spontaneous coronary artery dissection – Wikipedia

  https://en.wikipedia.org/wiki/Spontaneous_coronary_artery_dissection

  People with SCAD have a low in-hospital mortality after treatment. However, the lesion may worsen after leaving the hospital within the first month. […] Given the lack of consensus on the cause of SCAD, prevention of future SCAD may include medical therapy, counseling about becoming pregnant again (for those who had pregnancy-associated SCAD), or avoidance of estrogen therapy.

• #112 Spontaneous coronary artery dissection (SCAD) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/spontaneous-coronary-artery-dissection/symptoms-causes/syc-20353711

  Spontaneous coronary artery dissection is an emergency condition that occurs when a tear forms in a wall of a heart artery. Spontaneous coronary artery dissection also is called SCAD. […] SCAD can slow or block blood flow to the heart, causing a heart attack, heart rhythm problems or sudden death. […] SCAD can cause sudden death if it isn’t treated promptly. Get emergency medical help if you have heart attack symptoms even if you think you aren’t at risk of a heart attack. […] A tear develops on the inside of a coronary artery, allowing blood to create a split between two layers of the wall. This may result in a loose flap of tissue on the inside of the artery. […] SCAD can reduce or block blood flow through the artery, which can cause a heart attack. A heart attack as a result of SCAD is different from a heart attack caused by atherosclerosis. […] A possible complication of SCAD is heart attack. SCAD slows or stops blood flow through an artery. This weakens the heart and may lead to a heart attack. […] Even with successful treatment, SCAD can happen more than once. It might happen soon after the first episode or years later.

• #113

  https://link.springer.com/article/10.1007/s12471-019-1235-4

  Most (7097%) SCAD lesions heal spontaneously within several weeks. […] Therefore, prolonged in-hospital patient monitoring (35 days) after the initial event is recommended in conservatively treated patients. […] In SCAD patients who are clinically or haemodynamically unstable (TIMI score 0 or 1), who show ongoing ischaemia or in whom major arteries are affected, revascularisation either by PCI or coronary artery bypass graft is required. […] Although evidence-based guidelines are lacking, the AHA recently published a treatment algorithm for SCAD treatment. […] A recurrent SCAD should be differentiated from extension of a previous dissection and from de novo SCAD. […] Overall, patient series have reported that recurrent de novo SCAD occurs in 1227% of SCAD patients, depending on the duration of follow-up.

• #114 Spontaneous coronary artery dissection: novel insights on diagnosis and management – Alfonso – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/6185/html

  Overall, the long-term prognosis of patients who survived their initial SCAD presentation is very favorable. Nevertheless, some of these patients are still at risk for recurrences and, therefore, should be closely followed. Interestingly, recurrent SCAD events almost always affect new segments rather than initially dissected vessels. Finally, it is important to keep in mind that late vessel healing occurs in most patients. This remains a major consideration supporting the initial use of a conservative initial strategy for most of these patients.

• #115

  https://link.springer.com/article/10.1007/s12471-019-1235-4

  To date, risk factors for recurrence remain to be further elucidated. […] Although our understanding of SCAD has increased enormously over past decades, more knowledge is needed regarding predisposing factors, diagnostics and therapy. […] Presumably, the currently most important task in improving cardiovascular care for SCAD patients is to increase awareness and suspicion among clinicians in the field of cardiology, especially for ACS in younger women.

• #116 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  Therefore, CTCA as a primary diagnostic strategy is limited and it remains an adjunctive test to ICA in people with suspected SCAD. […] The American Heart Association consensus document has proposed an algorithm to manage acute SCAD. […] In the Canadian SCAD registry of 750 patients, 86.4% were managed conservatively, with only 2.3% of these patients subsequently requiring invasive treatment. […] In a systematic review of n=4206 patients with SCAD, beta-blockers were found to be significantly associated with a reduced risk of SCAD recurrence after adjustment for confounders; RR of 0.51 (95% CI 0.33 -0.77, P=0.0013). […] In a retrospective study (n=87, median 47 months of follow up) statin use was found to be associated with increased SCAD recurrence; 50% vs 8%, p=0.022. […] The prevalence of FMD among patients with SCAD was variable between studies.

• #117 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  Therefore, CTCA as a primary diagnostic strategy is limited and it remains an adjunctive test to ICA in people with suspected SCAD. […] The American Heart Association consensus document has proposed an algorithm to manage acute SCAD. […] In the Canadian SCAD registry of 750 patients, 86.4% were managed conservatively, with only 2.3% of these patients subsequently requiring invasive treatment. […] In a systematic review of n=4206 patients with SCAD, beta-blockers were found to be significantly associated with a reduced risk of SCAD recurrence after adjustment for confounders; RR of 0.51 (95% CI 0.33 -0.77, P=0.0013). […] In a retrospective study (n=87, median 47 months of follow up) statin use was found to be associated with increased SCAD recurrence; 50% vs 8%, p=0.022. […] The prevalence of FMD among patients with SCAD was variable between studies.

• #118 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  FMD screening has been advocated for in all patients with SCAD. […] The role of antiplatelet therapy in SCAD has been controversial. […] The use of anticoagulation in the acute phase carries the same considerations as discussed in the antiplatelets section above. […] SCAD is one of the most common causes of MI in pregnant women with the post-partum period the most at-risk period. […] In the Canadian SCAD registry, peripartum status was found to be an independent predictor of 30-day and 3-year MACE. […] Genetic screening of all people with SCAD is generally low yield and therefore not routinely recommended. […] The diagnosis of SCAD can be challenging, and a high level of clinical suspicion in the setting of ACS in a young person or pregnancy-associated ACS, should be combined with multimodality imaging, where required.

• #119 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  FMD screening has been advocated for in all patients with SCAD. […] The role of antiplatelet therapy in SCAD has been controversial. […] The use of anticoagulation in the acute phase carries the same considerations as discussed in the antiplatelets section above. […] SCAD is one of the most common causes of MI in pregnant women with the post-partum period the most at-risk period. […] In the Canadian SCAD registry, peripartum status was found to be an independent predictor of 30-day and 3-year MACE. […] Genetic screening of all people with SCAD is generally low yield and therefore not routinely recommended. […] The diagnosis of SCAD can be challenging, and a high level of clinical suspicion in the setting of ACS in a young person or pregnancy-associated ACS, should be combined with multimodality imaging, where required.

• #120 Sex Differences in Spontaneous Coronary Artery Dissection | USC Journal

  https://www.uscjournal.com/articles/sex-and-gender-differences-cardiovascular-disease-review-spontaneous-coronary-artery?language_content_entity=en

  When comparing outcomes in SCAD patients by gender, McAlister et al. showed that recurrent chest pain was the most frequent presenting symptom after SCAD. […] Pregnancy-associated SCAD is the most common cause of MI in pregnant persons and should always be considered as the etiology of chest pain or ACS in young peripartum or postpartum patients without risk factors for coronary artery disease. […] The risk of recurrent p-SCAD with a prior history of dissections has not been well studied. […] Given the unpredictable nature of SCAD and the minimal value of cardiovascular testing as surveillance to predict recurrence and increased severity of presentation associated with pregnancy, patients must undergo detailed preconception counseling to avoid unplanned pregnancies. […] SCAD events have been shown to occur just before or during menstruation in premenopausal females, corresponding to the luteal phase of the menstrual cycle, and shortly after pregnancy in postpartum females.

• #121 Spontaneous coronary artery dissection (SCAD) | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/spontaneous-coronary-artery-dissection-scad?content_id=CON-20188640

  Spontaneous coronary artery dissection is an emergency condition that occurs when a tear forms in a wall of a heart artery. […] SCAD is usually diagnosed in an emergency setting. You may be asked questions about your personal and family medical history. Tests are done to check your heart. […] Tests to diagnose SCAD are similar to tests used to detect a heart attack. They may include: […] A coronary angiogram can diagnose SCAD. It also can show any twisted arteries. […] Other tests may be done during a coronary angiogram to confirm SCAD and plan treatment. […] A possible complication of SCAD is heart attack. SCAD slows or stops blood flow through an artery. […] The goals of SCAD treatment are to: Restore blood flow to the heart. Manage chest pain. Prevent SCAD from happening again. […] Treatment may include medicines and a procedure or surgery to open the artery and restore blood flow. […] If you’ve had SCAD, talk to a health care professional before becoming pregnant. Pregnancy may not be safe after having SCAD.

• #122 Spontaneous coronary artery dissection: new insights on diagnosis and management

  https://recintervcardiol.org/en/editorial/spontaneous-coronary-artery-dissection-new-insights-on-diagnosis-and-management

  Over the last decade, understanding of spontaneous coronary artery dissection (SCAD) has progressed from a condition once considered very rare and the subject largely of esoteric case reports to a disease now recognised as a significant cause of acute coronary syndromes, predominantly in young to middle-aged women. […] Accurate diagnosis is the key first management step for SCAD. This paper gives important insights into the diagnostic role of computed tomography coronary angiography (CTCA). […] A key difference between the management of SCAD and atherosclerotic acute coronary syndromes is the increased risk of complications during percutaneous coronary intervention following SCAD. […] Optimal medical management following diagnosis remains unclear. […] The recognition of extra-coronary arteriopathies in SCAD patients has led to a consensus favouring arterial screening by brain to pelvis imaging in all SCAD-survivors.

• #123 Sex Differences in Spontaneous Coronary Artery Dissection | USC Journal

  https://www.uscjournal.com/articles/sex-and-gender-differences-cardiovascular-disease-review-spontaneous-coronary-artery?language_content_entity=en

  This review highlights sex- and gender-specific considerations in cardiovascular diseases with a particular focus on pathophysiology, epidemiology, clinical presentation, risk factors, diagnosis, and management of spontaneous coronary artery dissection. […] Early invasive coronary angiography is the gold standard for the diagnosis of SCAD. […] This angiographic classification has improved the recognition and accuracy of SCAD diagnosis and increased scientific interest. […] Despite an increased awareness among patients and providers, SCAD continues to be underdiagnosed or misdiagnosed, and is usually mistaken for atherosclerotic coronary disease. An emphasis on recognition and diagnosis of SCAD is paramount to providing appropriate care and avoiding the potential harm from inappropriate treatment and procedures.

• #124 Sex Differences in Spontaneous Coronary Artery Dissection | USC Journal

  https://www.uscjournal.com/articles/sex-and-gender-differences-cardiovascular-disease-review-spontaneous-coronary-artery?language_content_entity=en

  This review highlights sex- and gender-specific considerations in cardiovascular diseases with a particular focus on pathophysiology, epidemiology, clinical presentation, risk factors, diagnosis, and management of spontaneous coronary artery dissection. […] Early invasive coronary angiography is the gold standard for the diagnosis of SCAD. […] This angiographic classification has improved the recognition and accuracy of SCAD diagnosis and increased scientific interest. […] Despite an increased awareness among patients and providers, SCAD continues to be underdiagnosed or misdiagnosed, and is usually mistaken for atherosclerotic coronary disease. An emphasis on recognition and diagnosis of SCAD is paramount to providing appropriate care and avoiding the potential harm from inappropriate treatment and procedures.

• #125 Spontaneous coronary artery dissection: Principles of management | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/88/11/623

  Spontaneous coronary artery dissection (SCAD) is an acute noniatrogenic tear in the coronary arterial wall, leading to disruption of coronary blood flow and myocardial infarction. […] Diagnosing SCAD requires a high index of suspicion for young patients presenting with acute coronary syndrome. […] SCAD is primarily managed medically in clinically stable patients. […] Revascularization is recommended only for patients at high risk due to left main coronary artery dissection, ongoing ischemia, severely limited flow, hemodynamic instability, or refractory arrhythmia. […] Diagnosis of SCAD requires a high index of suspicion in all young patients presenting with ACS, particularly women without traditional risk factors for atherosclerosis. […] Coronary angiography is regarded as the gold standard to confirm the presence of SCAD.

• #126 Spontaneous coronary artery dissection: Principles of management | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/88/11/623

  Cardiac rehabilitation is an important component of management following SCAD, but it remains significantly underused. […] We recommend referring all patients with SCAD for cardiac rehabilitation, including young women without other comorbidities. […] Prospective and randomized-controlled studies are needed to facilitate development of an evidence-based treatment algorithm for SCAD.

• #127 Spontaneous Coronary Artery Dissection: Current State of Diagnosis and Treatment | Frontiers Research Topic

  https://www.frontiersin.org/research-topics/50735/spontaneous-coronary-artery-dissection-current-state-of-diagnosis-and-treatment/magazine

  Spontaneous coronary artery dissection (SCAD) is a non-traumatic, non-atherosclerotic, dissection of the coronary artery wall, due to the presence of a subintimal hematoma or an intimal tear with the creation of a false lumen that compresses the true lumen and restricts or obstructs flow. SCAD is an unpredictable disease, which can have a fatal course in acute coronary syndrome. Results from randomized studies are lacking, however, in the therapeutic approach of SCAD clinicians are guided by the findings from observational studies. The therapeutic approach in acute coronary syndrome caused by SCAD is mainly based on the individual operator’s decision. Much more knowledge is needed about the causes of SCAD, the course of the disease, as well as the therapeutic approach and thus the prognosis.

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