Management of Spontaneous Coronary Artery Dissection: Review of the Literature and Discussion Based on a Series of 12 Young Women with Acute Coronary SyndromeMotreff P. · Souteyrand G. · Dauphin C. · Eschalier R. · Cassagnes J. · Lusson J.R.
Hôpital Gabriel Montpied, Clermont-Ferrand, France
Spontaneous coronary artery dissection (SCAD) is a rare pathology, principally affecting young women free of atheroma risk factors. Its physiopathology remains little understood, and the prognosis for such acute coronary syndromes is poor, as they occur suddenly. Management is often difficult, and no guidelines exist. The present single-center retrospective study concerns 12 cases of SCAD occurring between 2001 and 2008 in female patients under the age of 60. Eleven patients survived, with a favorable long-term evolution. Only 2 had conservative medical therapy, the other 10 undergoing percutaneous coronary intervention (2 procedures involving a coronary artery bypass graft). On the basis of this series and data from the literature, we suggest a strategy to improve the often dire prognosis of SCAD. Emergency angiography to confirm diagnosis is essential. Treatment should be guided by the extent of the lesions, the myocardial ischemia and the hemodynamic status. Conservative medical therapy is a reasonable approach in the case of distal dissection or conserved coronary flow. Percutaneous coronary intervention is feasible in the acute phase to restore coronary perfusion and hemodynamic stability. Surgery – emergency bypass or assisted circulation – should be restricted to cases where percutaneous coronary intervention has failed or is impossible.
Clermont-Ferrand University Hospital, Department of Cardiology
Rue Montalembert, FR–63000 Clermont-Ferrand (France)
Tel. +33 4 7375 1410, Fax +33 4 7375 1933
Received: June 25, 2009
Accepted: June 28, 2009
Published online: October 8, 2009
Number of Print Pages : 9
Number of Figures : 5, Number of Tables : 2, Number of References : 21
Cardiology (International Journal of Cardiovascular Medicine, Surgery, Pathology and Pharmacology)
Vol. 115, No. 1, Year 2010 (Cover Date: November 2009)
Journal Editor: Borer J.S. (New York, N.Y.)
ISSN: 0008-6312 (Print), eISSN: 1421-9751 (Online)
For additional information: http://www.karger.com/CRD