Coronary artery dissection
Coronary artery dissection (also known as spontaneous coronary artery dissection or SCAD) is a rare cause of acute coronary syndrome especially in young patients who are otherwise healthy.
Coronary artery dissection occurs mainly in young, otherwise health patients especially in females in whom 84% of cases occur 1. One study found the prevalence of coronary artery dissection in patients undergoing coronary angiography to be 0.1% with a mean age of 44 years 2.
The features of coronary artery dissection depends on the severity and extent of the dissection with presentations ranging from those of acute coronary syndrome to sudden death 3.
Coronary artery dissection is believed to be due to an intramural hematoma in the wall of a coronary vessel creating a false lumen which then causes occlusion of the true lumen. The effect of this is reduced blood flow and consequently ischemia in the cardiac muscle 3. The majority of cases are idiopathic although it has been associated with pregnancy or being postpartum (one-third of all cases), atherosclerosis, connective disease (eg. Ehlers-Danlos syndrome type IV, Marfan's syndrome) and other conditions and toxins (eg. SLE, cocaine abuse) 3.
Most of the literature describes coronary artery dissection as being diagnosed on coronary angiogram 3. However, it has also been diagnosed on CT coronary angiography in the past, resolution of the dissection has also been assessed using CT coronary angiography 4. The role of other imaging modalities is primarily to exclude other causes other chest pain (eg. aortic dissection, pulmonary embolism). If an underlying condition is suspected or diagnosed (eg. Marfan syndrome) imaging may be needed to exclude other sites of aneurysm.
Treatment and prognosis
The survival from coronary artery dissection in one study was quoted to be up to 82% in long term follow up 1. Treatment may be performed by stenting and more rarely surgery, but medical management only has also successfully been described 5,6.
- 1. DeMaio SJ, Kinsella SH, Silverman ME. Clinical course and long-term prognosis of spontaneous coronary artery dissection. (1989) The American journal of cardiology. 64 (8): 471-4. Pubmed
- 2. Maeder M, Ammann P, Angehrn W, Rickli H. Idiopathic spontaneous coronary artery dissection: incidence, diagnosis and treatment. (2005) International journal of cardiology. 101 (3): 363-9. doi:10.1016/j.ijcard.2004.03.045 - Pubmed
- 3. Tanis W, Stella PR, Kirkels JH, Pijlman AH, Peters RH, de Man FH. Spontaneous coronary artery dissection: current insights and therapy. (2008) Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation. 16 (10): 344-9. Pubmed
- 4. Schroder C, Stoler RC, Branning GB, Choi JW. Postpartum multivessel spontaneous coronary artery dissection confirmed by coronary CT angiography. (2006) Proceedings (Baylor University. Medical Center). 19 (4): 338-41. Pubmed
- 5. Sarmento-Leite R, Machado PR, Garcia SL. Spontaneous coronary artery dissection: stent it or wait for healing?. (2003) Heart (British Cardiac Society). 89 (2): 164. Pubmed
- 6. Choi JW, Davidson CJ. Spontaneous multivessel coronary artery dissection in a long-distance runner successfully treated with oral antiplatelet therapy. (2002) The Journal of invasive cardiology. 14 (11): 675-8. Pubmed