Abstract
Spontaneous coronary artery dissection (SCAD) has been increasingly recognized as
a potentially serious nonatherosclerotic condition that can mimic atherosclerotic
acute coronary syndromes. This condition has been identified as presenting with the
classical clinical and electrocardiographic features that are encountered with acute
coronary syndromes. Its formal identification has been historically challenging and
difficult. A high index of clinical suspicion before invasive coronary angiography
depends on the presence of some inherited and acquired risk factors. Early suspicion
plays a key role in the identification of SCAD lesions during coronary angiography.
Multiple angiographic features may be present, thus resulting in different types of
SCAD lesions. Acute SCAD management favors conservative approaches for stable cases,
with revascularization for high-risk presentations. Pharmacotherapy typically includes
antiplatelet agents and β-blockers, avoiding routine anticoagulation. Long-term care
involves recurrence prevention, monitoring, counseling, and screening for extra coronary
fibromuscular dysplasia. Significant areas of uncertainty remain, as this relates
to the best long-term management and surveillance strategies. This review aims to
summarize the current state of knowledge and evidence, while pointing out the remaining
challenges and the need for additional research.
Keywords
SCAD - dissection flap - intramural hematoma - fibromuscular dysplasia
