Spontaneous Coronary Dissection: Practical Management about 3 Cases

Spontaneous coronary artery dissection (SCAD) is an acute coronary event related to the development of a hematoma in the media, leading to separation of the intima or intima-media complex from the underlying vessel, thus compressing the true lumen, causing ischemia and myocardial infarction. It usually occurs in middle-aged women with few or no cardiovascular risk factors. Coronary angiography can make the diagnosis in most cases, and endocoronary imaging is reserved for ambiguous cases. There is currently no randomized controlled trial comparing the different management strategies for spontaneous coronary dissections (conservative approach, coronary revascularization strategies including percutaneous coronary intervention and coronary artery bypass grafting). Current practice is therefore based on case observations and registries on clinical experience and on extrapolation (when applicable) of guidelines for the treatment of acute coronary syndrome.