Algirdas Rėkus, Gediminas Jaruševičius
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). It was first described 80 years ago. Pathogenetic mechanisms are most likely to be associated with intimas tear or bleeding vasa-vasorum, which resulting in intramural haemorrhage. SCAD typically occurs in young women who do not have coronary heart disease risk factors and who have acute coronary syndrome. Half of all SCAD presents with ST – elevation myocardial infarction (STEMI), while the rest with non – ST – elevation myocardial infarction (NSTEMI). The gold standard method for diagnosis is interventional coronary artery angiography. After the acute ischemic onset syndrome, most patients have a stable, benign clinical course, and eventually experience spontaneous vessel wall healing. Therefore, conservative treatment (a watchful strategy) is recommended as the initial treatment. For the majority of cases as interventional and surgical treatment in most cases seems to be suboptimal. In this extremely complex situation, several novel and attractive coronary interventions have been proposed. The risk factors, pathogenesis theories, diagnosis, management, prognosis of SCAD will be summarized in this review.
Keyword(s): coronary artery dissection, spontaneous, acute coronary syndrome, intramural hematoma.