Novel Insights from Clinical Experience
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
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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.
© 2009 S. Karger AG, Basel
Pretty HC: Dissecting aneurysms of coronary artery in woman aged 42: rupture. Br Med J 1931;1:667.
- Ciraulo DA, Chesne RB: Coronary arterial dissection: an unrecognized cause of myocardial infarction, with subsequent coronary arterial patency. Chest 1978;73:677–679.
- Steinhauer JR, Caulfield JB: Spontaneous coronary artery dissection associated with cocaine use: a case report and brief review. Cardiovasc Pathol 2001;10:141–145.
- Capuano C, Sesana M, Predolini S, Leonzi O, Cuccia C: Literature review: spontaneous coronary artery dissections. Cardiovasc Revasc Med 2006;7:231–233.
- Al-Daraji W, Howat AJ: Spontaneous coronary artery dissection. Histopathology 2005;47:215–216.
- Vicari R, Eybel C, Monson D: Survival following spontaneous coronary artery dissection: surgical repair by extrusion of intramural hematoma. Am Heart J 1986;111:593–594.
- Vanzetto G, Berger-Coz E, Barone-Rochette G, Chavanon O, Bouvaist H, Hacini R, Blin D, Machecourt J: Prevalence, therapeutic management and medium-term prognosis of spontaneous coronary artery dissection: results from a database of 11,605 patients. Eur J Cardiothorac Surg 2009;35:250–254.
- Koller PT, Cliffe CM, Ridley DJ: Immunosuppressive therapy for peripartum-type spontaneous coronary artery dissection: case report and review. Clin Cardiol 1998;21:40–46.
- Arnold JR, West NE, van Gaal WJ, Karamitsos TD, Banning AP: The role of intravascular ultrasound in the management of spontaneous coronary artery dissection. Cardiovasc Ultrasound 2008;6:24.
- Maehara A, Mintz GS, Castagna MT, Pichard AD, Satler LF, Waksman R, Suddath WO, Kent KM, Weissman NJ: Intravascular ultrasound assessment of spontaneous coronary artery dissection. Am J Cardiol 2002;89:466–468.
- Manghat NE, Morgan-Hughes GJ, Roobottom CA: Multi-detector row computed tomography: imaging in acute aortic syndrome. Clin Radiol 2005;60:1256–1267.
- Hammond AS, Bailey PL: Acute spontaneous coronary artery dissection in the peripartum period. J Cardiothorac Vasc Anesth 2006;20:837–841.
- Koul AK, Hollander G, Moskovits N, Frankel R, Herrera L, Shani J: Coronary artery dissection during pregnancy and the postpartum period: two case reports and review of literature. Catheter Cardiovasc Interv 2001;52:88–94.
Thompson EA, Ferraris S, Gress T, Ferraris V: Gender differences and predictors of mortality in spontaneous coronary artery dissection: a review of reported cases. J Invasive Cardiol 2005;17:59–61.
- Maeder M, Ammann P, Drack G, Rickli H: Pregnancy-associated spontaneous coronary artery dissection: impact of medical treatment. Case report and systematic review. Z Kardiol 2005;94:829–835.
- Koller PT, Cliffe CM: Spontaneous coronary artery dissection. Catheter Cardiovasc Interv 2001;53:577–579.
- Aqel RA, Zoghbi GJ, Iskandrian A: Spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms: a review. Echocardiography 2004;21:175–182.
- Sanchez-Recalde A, Moreno R, Jimenez-Valero S: Stenting of spontaneous intramural coronary haematoma: long-term consequences. Eur Heart J 2008;29:1593.
- Yoshida K, Mori S, Tomari S, Murakami F, Matsuura A, Hibi M, Notoya A: Coronary artery bypass grafting for spontaneous coronary artery dissection: a case report and a review of the literature. Ann Thorac Cardiovasc Surg 2000;6:57–60.
- Ferrari E, Tozzi P, von Segesser LK: Spontaneous coronary artery dissection in a young woman: from emergency coronary artery bypass grafting to heart transplantation. Eur J Cardiothorac Surg 2005;28:349–351.
- Sherif HM, Nguyen HC, Sarter BH, West JT, Lucente E, Fink DM, Quesada-Rojas A, Banbury MK: Spontaneous coronary dissection in late pregnancy: a multidisciplinary approach to management. Ann Thorac Surg 2008;85:1793–1794.
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