Extracoronary Arterial Pathologies in Patients With Spontaneous Coronary Artery Dissection

Abstract

Spontaneous coronary artery dissection (SCAD) is increasingly recognized as a cause of acute coronary syndrome and has been associated with extracoronary arteriopathies, such as fibromuscular dysplasia (FMD), aneurysms, and dissections across other vascular beds. However, these associations remain understudied in the literature. This study aims to characterize the prevalence and distribution of extracoronary arteriopathies in a large cohort of SCAD patients. Patients diagnosed with SCAD were extracted from 2018 to 2024. Baseline characteristics and comorbidities were collected. Available vascular imaging, including echocardiograms, computed tomography, and magnetic resonance, were used to assess for extracoronary arteriopathies. The prevalence and location of FMD, aneurysms, and dissections in extracoronary vascular beds were documented. Among 1,380 SCAD patients, 564 (40.9%) were found to have FMD, 166 (12.0%) had extra-coronary arterial dissections, and 228 (16.5%) had aneurysms in at least 1 extracoronary vascular bed. The most common sites of FMD were renal, carotid, vertebral, and iliac/femoral arteries. Aneurysms were most frequently located in cerebral, carotid, renal, and splenic arteries. Dissections were most prevalent in the carotid, vertebral, extremity, and celiac arteries. Thoracic aortic aneurysms were rare, with only 4 patients showing thoracic aortic dissection. Extracoronary arteriopathies are prevalent in patients with SCAD, affecting more than 47% of the cohort described here. These findings underscore the importance of comprehensive vascular imaging in patients with SCAD to detect extracoronary vascular abnormalities, which may have implications for surveillance and management strategies.