Spontaneous coronary artery dissection: new insights on diagnosis and management

Over the last decade, understanding of spontaneous coronary artery dissection (SCAD) has progressed from a condition once considered very rare and the subject largely of esoteric case reports to a disease now recognised as a significant cause of acute coronary syndromes, predominantly in young to middle-aged women. Large observational series have been presented, led by groups in the Mayo Clinic, United States and Vancouver, Canada.1-3 This increased understanding has led to the publication of consensus documents on best practice in both the US and Europe.4,5 Despite this, SCAD remains a condition devoid of randomised clinical trial data and debate continues over many aspects of what constitutes optimal management. In a recent article published in REC: Interventional Cardiology, Bastante et al.6 present data on a highly characterised series from a Spanish centre at the forefront of the progressive management of this condition. Their data provide supporting evidence on findings of direct clinical relevance to contemporary clinical practice and provides novel insight, particularly into the relative merits of antiplatelet therapies for this condition. The Yip-Saw angiographic classification for SCAD7 coupled with an increased recognition of the central role of intracoronary imaging to aid diagnosis where there is uncertainty, particularly with optical coherence tomography,8 has...