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Offen S, Yang C, Saw J. Spontaneous coronary artery dissection (SCAD): A contemporary review. Clin Cardiol 2024; 47:e24236. [PMID: 38859725 PMCID: PMC11165169 DOI: 10.1002/clc.24236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 06/12/2024] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction that most frequently affects younger women, making it an important cause of morbidity and mortality within these demographics. The evolution of intracoronary imaging, improved diagnosis with coronary angiography, and ongoing research efforts and attention via social media, has led to increasing recognition of this previously underdiagnosed condition. In this review, we provide a summary of the current body of knowledge, as well as focused updates on the pathogenesis of SCAD, insights on genetic susceptibility, contemporary diagnostic tools, and immediate, short- and long-term management.
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Affiliation(s)
- Sophie Offen
- Division of CardiologyVancouver General Hospital, University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cathevine Yang
- Division of CardiologyVancouver General Hospital, University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Jacqueline Saw
- Division of CardiologyVancouver General Hospital, University of British ColumbiaVancouverBritish ColumbiaCanada
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2
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Lionakis N, Briasoulis A, Zouganeli V, Dimopoulos S, Kalpakos D, Kourek C. Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies. World J Cardiol 2022; 14:522-536. [PMID: 36339886 PMCID: PMC9627356 DOI: 10.4330/wjc.v14.i10.522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/14/2022] [Accepted: 10/06/2022] [Indexed: 02/05/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic, non-traumatic separation of the coronary artery wall. The most common profile is a middle-aged woman between 44 and 53 years with few cardiovascular risk factors. SCAD is frequently linked with predisposing factors, such as postpartum, fibromuscular dysplasia or other vasculopathies, connective tissue disease and hormonal therapy, and it is often triggered by intense physical or emotional stress, sympathomimetic drugs, childbirth and activities increasing shear stress of the coronary artery walls. Patients with SCAD usually present at the emergency department with chest discomfort, chest pain, and rapid heartbeat or fluttery. During the last decades, the most common problem of SCAD was the lack of awareness about this condition which has led to significant underdiagnosis and misdiagnosis. However, modern imaging techniques such as optical coherence tomography, intravascular ultrasound, coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of the disease. Treatment of SCAD remains controversial, especially during the last years, where invasive techniques are being used more often and in more emergent cardiac syndromes. Although conservative treatment combining aspirin and beta-blocker remains the recommended strategy in most cases, revascularization could also be suggested as a method of treatment in specific indications, but with a higher risk of complications. The prognosis of SCAD is usually good and long-term mortality seems to be low in these patients. Follow-up should be performed on a regular basis.
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Affiliation(s)
- Nikolaos Lionakis
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, Alexandra Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa Hospitals and Clinics, IA 52242, United States
| | - Virginia Zouganeli
- Second Cardiology Department, Attikon University Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Stavros Dimopoulos
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 10676, Greece
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Dionisios Kalpakos
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
| | - Christos Kourek
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 10676, Greece
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3
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Buccheri D. Sudden cardiac arrest in a young football player due to documented spontaneous coronary artery dissection. Future Cardiol 2021; 17:1167-1169. [PMID: 33851538 DOI: 10.2217/fca-2021-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Dario Buccheri
- Interventional Cardiology, S Antonio Abate Hospital, Erice, TP, Italy
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Buccheri D, Lombardo RM, Vinci D, Frasheri A. A 'parachute effect' mockingly sealing a spontaneous coronary artery dissection: what we have learnt from intravascular imaging. Future Cardiol 2020; 17:95-99. [PMID: 32583686 DOI: 10.2217/fca-2019-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Spontaneous coronary artery dissection is often underdiagnosed. It accounts for a certain amount of acute coronary syndromes. Intravascular imaging, either intravascular ultrasound or optical coherence tomography, represents a relevant ally for interventional cardiologist. Here we report an intriguing case of spontaneous coronary artery dissection not immediately diagnosed due to the explained parachute effect, managed invasively according to an algorithm previously published, with a good long-term outcome.
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Affiliation(s)
- Dario Buccheri
- Interventional cardiology, S Antonio Abate Hospital, Erice, TP, Italy
| | - Renzo M Lombardo
- Interventional cardiology, S Antonio Abate Hospital, Erice, TP, Italy
| | - Daniele Vinci
- Interventional cardiology, S Antonio Abate Hospital, Erice, TP, Italy
| | - Arian Frasheri
- Interventional cardiology, S Antonio Abate Hospital, Erice, TP, Italy
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5
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Buccheri D. Focus on spontaneous coronary artery dissection: Where are we now? Rev Port Cardiol 2018; 37:953-955. [PMID: 30466817 DOI: 10.1016/j.repc.2018.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/24/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Dario Buccheri
- Interventional Cardiology, "S. Antonio Abate" Hospital, Via Cosenza, 80, 91016 Erice (TP), Italy.
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Buccheri D. How to manage a spontaneous coronary artery dissection: reconsidering diagnosis and therapy. Future Cardiol 2018; 14:427-429. [DOI: 10.2217/fca-2018-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Dario Buccheri
- Interventional cardiology unit, S. Antonio Abate Hospital, Trapani, Italy
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7
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Buccheri D. Focus on spontaneous coronary artery dissection: Where are we now? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Buccheri D, Milazzo D, Geraci S, Vaccaro G, Caramanno G. A lesson from intravascular imaging: insights for recognizing a spontaneous coronary artery dissection. J Thorac Dis 2017; 9:5363-5367. [PMID: 29312747 DOI: 10.21037/jtd.2017.10.146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) is still today an underdiagnosed disease due to the absence of angiographic hallmarks in more than 70% of cases. In several cases, an intravascular imaging is a sole tool for recognizing a dissection. Particularly, optical coherence tomography analysis (OCT) could represent the gold standard technique of easy interpretation and prompt diagnosis. Here we present a rare case of multivessel spontaneous coronary artery disease (SCAD) with atypical collateral circulation.
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Affiliation(s)
- Dario Buccheri
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Diego Milazzo
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Salvatore Geraci
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Giovanni Vaccaro
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Giuseppe Caramanno
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy
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Buccheri D, Zambelli G, Alfonso F, Cortese B. Pulse on Spontaneous Coronary Artery Dissections. JACC Cardiovasc Interv 2017; 10:1469-1471. [DOI: 10.1016/j.jcin.2017.05.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 04/27/2017] [Accepted: 05/17/2017] [Indexed: 10/19/2022]
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Buccheri D, Piraino D, Andolina G, Cortese B. Intravascular imaging for spontaneous coronary artery dissection: A clinical-angiographic score may help the choice. Catheter Cardiovasc Interv 2017; 89:505-506. [DOI: 10.1002/ccd.26681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/08/2016] [Accepted: 07/03/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Dario Buccheri
- Interventional Cardiology, a.O. Fatebenefratelli; Milano Italy
- Interventional Cardiology, a.O.U.P. Paolo Giaccone; Palermo Italy
| | - Davide Piraino
- Interventional Cardiology, a.O. Fatebenefratelli; Milano Italy
- Interventional Cardiology, a.O.U.P. Paolo Giaccone; Palermo Italy
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Buccheri D. Spontaneous coronary artery dissection and Takotsubo's cardiomyopathy: A random association? Int J Cardiol 2017; 229:25. [DOI: 10.1016/j.ijcard.2016.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
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12
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Buccheri D, Zambelli G. Focusing on spontaneous coronary artery dissection: actuality and future perspectives. J Thorac Dis 2016; 8:E1784-E1786. [PMID: 28149642 DOI: 10.21037/jtd.2016.12.79] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dario Buccheri
- Interventional Cardiology, "Paolo Giaccone" Hospital, Palermo, Italy; ; Department of Cardiology, San Giacomo d'Altopasso Hospital, Licata (Agrigento), Italy
| | - Giulia Zambelli
- Interventional Cardiology, "Paolo Giaccone" Hospital, Palermo, Italy
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Sanz-Ruiz R, Díez-Delhoyo F, Fernández-Avilés F. Further insights on spontaneous coronary artery dissection: Scores, imaging and optimal management. Int J Cardiol 2016; 222:997-998. [PMID: 27526382 DOI: 10.1016/j.ijcard.2016.08.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Ricardo Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
| | - Felipe Díez-Delhoyo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
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Lezcano Gort LE, Romani SA, Rodríguez Carreras CR, Fernández Portales FJ. Score System Approach to Diagnose and Manage Spontaneous Coronary Artery Dissection. Response. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2016; 69:879-880. [PMID: 27435877 DOI: 10.1016/j.rec.2016.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/31/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Luis Enrique Lezcano Gort
- Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital San Pedro de Alcántara, Cáceres, Spain.
| | - Sebastián Alejandro Romani
- Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Cecilio Raúl Rodríguez Carreras
- Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital San Pedro de Alcántara, Cáceres, Spain
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Lezcano Gort LE, Romani SA, Rodríguez Carreras CR, Fernández Portales FJ. Sistema de puntuación para el enfoque diagnóstico y terapéutico de la disección coronaria espontánea. Respuesta. Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2016.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Sistema de puntuación para el enfoque diagnóstico y terapéutico de la disección coronaria espontánea. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Buccheri D, Piraino D, Andolina G. Score System Approach to Diagnose and Manage Spontaneous Coronary Artery Dissection. ACTA ACUST UNITED AC 2016; 69:878-9. [PMID: 27445193 DOI: 10.1016/j.rec.2016.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/06/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Dario Buccheri
- Interventional Cardiology, A.O.U.P. Paolo Giaccone Hospital, Palermo, Italy.
| | - Davide Piraino
- Interventional Cardiology, A.O.U.P. Paolo Giaccone Hospital, Palermo, Italy
| | - Giuseppe Andolina
- Interventional Cardiology, A.O.U.P. Paolo Giaccone Hospital, Palermo, Italy
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Buccheri D, Piraino D, Andolina G. Spontaneous coronary artery dissection: To stent or not to stent? That is the question. Int J Cardiol 2016; 215:399. [PMID: 27128570 DOI: 10.1016/j.ijcard.2016.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Dario Buccheri
- Interventional Cardiology, A.O.U.P. Paolo Giaccone, Palermo, Italy.
| | - Davide Piraino
- Interventional Cardiology, A.O.U.P. Paolo Giaccone, Palermo, Italy
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Buccheri D, Piraino D, Andolina G. Multimodality imaging for spontaneous coronary artery dissection: A clinical points system may be a shortcut to diagnosis. Int J Cardiol 2016; 214:391-2. [PMID: 27085652 DOI: 10.1016/j.ijcard.2016.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/02/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Dario Buccheri
- Interventional Cardiology, A.O.U.P. Paolo Giaccone, Palermo, Italy.
| | - Davide Piraino
- Interventional Cardiology, A.O.U.P. Paolo Giaccone, Palermo, Italy
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Buccheri D, Piraino D, Andolina G. Biovascular resorbable scaffold for spontaneous coronary artery dissection: RAIders on the storm of a debatable therapy. Int J Cardiol 2016; 214:387-8. [DOI: 10.1016/j.ijcard.2016.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/03/2016] [Indexed: 11/26/2022]
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Buccheri D, Piraino D, Andolina G. Behçet disease and spontaneous coronary artery dissection: The chicken or the egg? Int J Cardiol 2016; 215:504-5. [PMID: 27135821 DOI: 10.1016/j.ijcard.2016.04.145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 04/16/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Dario Buccheri
- Interventional Cardiology, A.O.U.P. Paolo Giaccone, Palermo, Italy.
| | - Davide Piraino
- Interventional Cardiology, A.O.U.P. Paolo Giaccone, Palermo, Italy
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