Management of Spontaneous Coronary Artery Dissection: Review of the Literature and Discussion Based on a Series of 12 Young Women with Acute Coronary Syndrome

Spontaneous coronary artery dissection (SCAD) is a rare pathology, principally affecting young women free of atheroma risk factors. Its physiopathology remains little understood, and the prognosis for such acute coronary syndromes is poor, as they occur suddenly. Management is often difficult, and n...

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Veröffentlicht in:Cardiology 2010-01, Vol.115 (1), p.10-18
Hauptverfasser: Motreff, P., Souteyrand, G., Dauphin, C., Eschalier, R., Cassagnes, J., Lusson, J.R.
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container_end_page 18
container_issue 1
container_start_page 10
container_title Cardiology
container_volume 115
creator Motreff, P.
Souteyrand, G.
Dauphin, C.
Eschalier, R.
Cassagnes, J.
Lusson, J.R.
description Spontaneous coronary artery dissection (SCAD) is a rare pathology, principally affecting young women free of atheroma risk factors. Its physiopathology remains little understood, and the prognosis for such acute coronary syndromes is poor, as they occur suddenly. Management is often difficult, and no guidelines exist. The present single-center retrospective study concerns 12 cases of SCAD occurring between 2001 and 2008 in female patients under the age of 60. Eleven patients survived, with a favorable long-term evolution. Only 2 had conservative medical therapy, the other 10 undergoing percutaneous coronary intervention (2 procedures involving a coronary artery bypass graft). On the basis of this series and data from the literature, we suggest a strategy to improve the often dire prognosis of SCAD. Emergency angiography to confirm diagnosis is essential. Treatment should be guided by the extent of the lesions, the myocardial ischemia and the hemodynamic status. Conservative medical therapy is a reasonable approach in the case of distal dissection or conserved coronary flow. Percutaneous coronary intervention is feasible in the acute phase to restore coronary perfusion and hemodynamic stability. Surgery – emergency bypass or assisted circulation – should be restricted to cases where percutaneous coronary intervention has failed or is impossible.
doi_str_mv 10.1159/000244608
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subjects Acute Coronary Syndrome - diagnosis
Acute Coronary Syndrome - etiology
Acute Coronary Syndrome - therapy
Adult
Aneurysm, Dissecting - complications
Aneurysm, Dissecting - diagnosis
Aneurysm, Dissecting - therapy
Cardiovascular disease
Clinical outcomes
Coronary Aneurysm - complications
Coronary Aneurysm - diagnosis
Coronary Aneurysm - therapy
Coronary Artery Disease - complications
Coronary Artery Disease - diagnosis
Coronary Artery Disease - therapy
Female
Heart surgery
Humans
Medical imaging
Medical treatment
Middle Aged
Novel Insights from Clinical Experience
Retrospective Studies
Rupture, Spontaneous - diagnosis
Rupture, Spontaneous - etiology
Rupture, Spontaneous - therapy
Women
Young adults
title Management of Spontaneous Coronary Artery Dissection: Review of the Literature and Discussion Based on a Series of 12 Young Women with Acute Coronary Syndrome
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