Spontaneous Coronary Artery Dissection: New Insights from the Tip of the Iceberg?
Spontaneous coronary artery dissection (SCAD) is a rare clinical entity of unknown etiology that typically affects young women without coronary risk factors1-5. Initial reports were scarce and based on autopsy findings after episodes of sudden cardiac death suggesting that the condition had a dismal prognosis1,2. An intimal tear was seldom found in autopsy series and, therefore, primary disruption with bleeding of vasa vasorum and intramedial hemorrhage was proposed as the underlying mechanism1,2. Alternatively, an intimal tear may lead to separation of coronary wall layers and, eventually, to a double lumen. Pressure-driven expansion of the false lumen induces axial propagation of the disease and true lumen compression resulting in myocardial ischemia2-4. In some patients, weakening of the arterial wall (hormonal changes, cystic medial necrosis, proteolytic enzymes from periadventitial eosinophils)2, may provide an underlying "vulnerable coronary wall". (SELECT FULL TEXT TO CONTINUE)
- intravascular imaging
- intravascular ultrasound
- optical coherence tomography
- spontaneous coronary artery dissection
- Received July 4, 2012.
- Accepted July 6, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited