Spontaneous coronary artery dissection percutaneous coronary intervention

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Spontaneous Coronary Artery Dissection Microchapters



Historical Perspective




Differentiating Spontaneous coronary artery dissection from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


Diagnostic Approach

History and Symptoms

Physical Examination

Laboratory Findings






Other Imaging Findings

Other Diagnostic Studies


Treatment Approach

Medical Therapy

Percutaneous Coronary Intervention


Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Type 1

Type 2A

Type 2B

Type 3

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arzu Kalayci, M.D. [2] Nate Michalak, B.A.

Synonyms and keywords: SCAD


Conservative management should be the first choice if emergent revascularization is not necessary. However, optimal management is in question due to insufficient clinical experience. There are some treatment options including conservative management, emergency revascularization (PCI or CABG), fibrinolytic therapy, mechanical hemodynamic support, and even cardiac transplantation.The preference of the approach should be tailored to the patient’s clinical status.


Conservative management should be first choice if emergent revascularization is not necessary. [1]

Percutaneous Coronary Intervention

Challenges and Suggestions With SCAD PCI
Challenges during PCI of SCAD
  • Difficulty advancing coronary wire into the distal true lumen
  • Often extensive dissected segments require long stents, increasing stent restenosis
Suggestions if PCI is pursued for SCAD
  • Meticulous guide catheter manipulation, preferably through femoral access approach
  • Long stents covering 5-10 mm of proximal and distal edges of IMH
  • Placing short stents at proximal and distal edges first, before placing a long stent in the middle
  • Consider bioabsorbable stents (temporary scaffold to avoid long-term malapposition)
  • Possible and careful use of cutting balloon (to fenestrate IMH)
  • Consider follow-up OCT to assess for malapposed/ uncovered struts before stopping DAPT
DAPT= dual antiplatelet therapy; IMH= intramural hematoma; IVUS= intravascular ultrasound; PCI= percutaneous coronary intervention. [9]


  1. Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS; et al. (2014). "Spontaneous coronary artery dissection: revascularization versus conservative therapy". Circ Cardiovasc Interv. 7 (6): 777–86. doi:10.1161/CIRCINTERVENTIONS.114.001659. PMID 25406203.
  2. 2.0 2.1 Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D; et al. (2014). "Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes". Circ Cardiovasc Interv. 7 (5): 645–55. doi:10.1161/CIRCINTERVENTIONS.114.001760. PMID 25294399.
  3. Saw J, Aymong E, Mancini GB, Sedlak T, Starovoytov A, Ricci D (2014). dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24726091 "Nonatherosclerotic coronary artery disease in young women" Check |url= value (help). Can J Cardiol. 30 (7): 814–9. doi:10.1016/j.cjca.2014.01.011. PMID 24726091.
  4. Alfonso F, Paulo M, Lennie V, Dutary J, Bernardo E, Jiménez-Quevedo P; et al. (2012). "Spontaneous coronary artery dissection: long-term follow-up of a large series of patients prospectively managed with a "conservative" therapeutic strategy". JACC Cardiovasc Interv. 5 (10): 1062–70. doi:10.1016/j.jcin.2012.06.014. PMID 23078737.
  5. Higgins GL, Borofsky JS, Irish CB, Cochran TS, Strout TD (2013). "Spontaneous peripartum coronary artery dissection presentation and outcome". J Am Board Fam Med. 26 (1): 82–9. doi:10.3122/jabfm.2013.01.120019. PMID 23288285.
  6. Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ; et al. (2012). "Clinical features, management, and prognosis of spontaneous coronary artery dissection". Circulation. 126 (5): 579–88. doi:10.1161/CIRCULATIONAHA.112.105718. PMID 22800851.
  7. Vrints CJ (2010). "Spontaneous coronary artery dissection". Heart. 96 (10): 801–8. doi:10.1136/hrt.2008.162073. PMID 20448134.
  8. Vijayaraghavan R, Verma S, Gupta N, Saw J (2014). "Pregnancy-related spontaneous coronary artery dissection". Circulation. 130 (21): 1915–20. doi:10.1161/CIRCULATIONAHA.114.011422. PMID 25403597.
  9. Saw J, Mancini GBJ, Humphries KH (2016). "Contemporary Review on Spontaneous Coronary Artery Dissection". J Am Coll Cardiol. 68 (3): 297–312. doi:10.1016/j.jacc.2016.05.034. PMID 27417009.