Skip to main content
SpringerLink
Log in

Spontaneous coronary artery dissection: current insights and therapy

  • case report
  • Published:
Netherlands Heart Journal Aims and scope Submit manuscript

Abstract

Spontaneous coronary artery dissection (SCAD) is a very rare cause of acute coronary syndromes in young otherwise healthy patients with a striking predilection for the female gender. The pathological mechanism has not been fully clarified yet. However, several diseases and conditions have been associated with SCAD, such as atherosclerosis, connective tissue disorders and the peripartum episode. In this paper we present a review of the literature, discussing the possible mechanisms for SCAD, therapeutic options and prognosis. The review is illustrated with two SCAD patients who had a recurrence of a spontaneous dissection in another artery within a few days after the initial event. Because of the susceptibility to recurrent spontaneous dissections we propose at least one week of observation in hospital. Further, we will elaborate on the possible conservative and invasive treatment strategies in the acute phase of SCAD. Primary percutaneous coronary intervention remains the reperfusion strategy of choice; however, in small and medium-sized arteries with normalised flow conservative treatment is defendable. In addition, after the acute phase evaluation of possible underlying diseases is necessary, because it affects further treatment. (Neth Heart J 2008;16:344-9.)

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Pretty HC. Dissecting aneurysm of coronary artery in a woman aged 42:rupture. BMJ 1931;1:667.

    Google Scholar 

  2. Maeder M, Ammann P, Angehrn W, Rickli H. Idiopathic spontaneous coronary artery dissection: incidence, diagnosis and treatment. Int J Card 2005;101:363-69.

    Google Scholar 

  3. Kamineni R, Sadhu S, Alpert JS. Spontaneous coronary artery dissection: report of two cases and a 50-year review of the literature. Cardiol Rev 2002;10:279-84.

    Google Scholar 

  4. De Maio SJ Jr, Kinsella SH, Silverman ME. Clinical course and long-term prognosis of spontaneous coronary artery dissection. Am J Cardiol 1989;64:471 -4.

    Google Scholar 

  5. Coco P, Thiene G, Penelli N. Ematoma aneurisma dissecante spon-taneo delle coronarie e morte improvisa. G Ital Cardiol 1990; 20:795-800.

    Google Scholar 

  6. Koul AK, Hollander G, Moskovits N, Frankel R, Herrera L, Shani J. Coronary artery dissection during pregnancy and the postpartum period: two cases and review of the literature. Catheter Cardiovasc Interv 2001;52:88-94.

    Google Scholar 

  7. Asuncion CM, Hyun J. Dissecting intramural hematoma of the coronary artery in pregnancy and the puerperium. Obstet Gynecol 1972;40:202-10.

    Google Scholar 

  8. Heefner WA. Dissecting hematoma of the coronary artery. A possible complication of oral contraceptive therapy. JAMA 1973; 223:550-1.

    Google Scholar 

  9. Bonnet J, Aumailley M, Thomas D, Grosgogeat Y, Broustet JP, Bricaud H. Spontaneous coronary artery dissection: case report 2and evidence for a defect in collagen metabolism. Eur Heart J 1986;7:904-9.

    Google Scholar 

  10. Ichiba N, Shimada K, Hirose M, Kobayashi Y, Hirata K, Sakanoue Y. et al. Images in cardiovascular medicine. Plaque rupture causing spontaneous coronary artery dissection in a patient with acute myo-cardial infarction. Circulation 2000;101:1754-5.

    Google Scholar 

  11. Brunetti ND, Pellegrino PL, Mavilio G, Cuculo A, Ziccardi L, Correale M, et al. Spontaneous coronary dissection complicating unstable coronary plaque in young women with acute coronary syndrome: case reports. Int J Cardiol 2007 ;115:105-7.

    Google Scholar 

  12. Hering D, Piper C, Hohmann C, Schultheiss HP, Horstkotte D. Prospective study of the incidence, pathogenesis and therapy of spontaneous, by coronary angiography diagnosed coronary artery dissection. Z Kardiol 1998;87:961-70.

    Google Scholar 

  13. Celik SK, Sagcan A, Altintig A, Yuksel M, Akin M, Kultursay H. Primary spontaneous coronary artery dissections in atherosclerotic patients. Report of nine cases with review of the pertinent literature. Eur J Cardiothorac Surg 2001 ;20:573 -6.

    Google Scholar 

  14. Cheung S, Mithani V, Watson RM. Healing of spontaneous coronary dissection in the context of glycoprotein IIB/IIIA inhibitor therapy: a case report. Catheter Cardiovasc Interv 2000;51: 95-100.

    Google Scholar 

  15. Judge DP, Dietz HC. Marfan's syndrome. Lancet 2005;366: 1965-76.

    Google Scholar 

  16. Adès LC, Waltham RD, Chiodo AA, Bateman JF. Myocardial infarction resulting from coronary artery dissection in an adolescent with Ehlers-Danlos syndrome type IV due to a type III collagen mutation. Br Heart J 1995;74:112-6.

    Google Scholar 

  17. Aldoboni AH, Hamza EA, Majdi K, Ngibzadhe M, Palasaidi S, Moayed DA. Spontaneous dissection of coronary artery treated by primary stenting as the first presentation of systemic lupus erythematosus. J Invasive Cardiol 2002;14:694-6.

    Google Scholar 

  18. Sharma AK, Farb A, Maniar P, Ajani AE, Castagna M, Virmani R, et al. Spontaneous coronary artery dissection in a patient with systemic lupus erythematosis. Hawaii Med J 2003;62:248-53.

    Google Scholar 

  19. Choi JW, Davidson CJ. Spontaneous multivessel coronary dissection in a long distance runner successfully treated with oral antiplatelet therapy a case report and review of the literature. J Invasive Cardiol 2002;14:675-8.

    Google Scholar 

  20. Da Gama MN, Lemos-Neto PA, Ramirez JA, Sposito AC, Horta PE, Perin MA, et al. Spontaneous healing of primary dissection of the coronary artery. J Invasive Cardiol 1999;11:21-4.

    Google Scholar 

  21. Steinhauer JR, Caulfield JB, Spontaneous coronary artery dissection associated with cocaine abuse: case report and brief review. Cardiovasc Pathol 2001;10:141-5.

    Google Scholar 

  22. Slight R, Behranwala AA, Nzewi O, Sivaprakasam R, Brackenbury E, Mankad P. Spontaneous coronary artery dissection: a report of two cases occurring during menstruation. N Z Med J 2003;116: U585.

  23. Dhawan R, Singh G, Fesniak H. Spontaneous coronary artery dissection: the clinical spectrum. Angiology 2002;53:89-93.

    Google Scholar 

  24. Auer J, Punzengruber C, Berent R, Weber T, Lamm G, Hartl P, et al. Spontaneous coronary artery dissection involving the left main stem: assessment by intravascular ultrasound. Heart 2004;90:e39.

    Google Scholar 

  25. Buys EM, Suttorp MJ, Morshuis WJ, Plokker HW. Extension of a spontaneous coronary artery dissection due to thrombolytic therapy. Cathet Cardiovasc Diagn 1994;33:157-60.

    Google Scholar 

  26. Sarmento-Leite R, Machado PRM, Garcia SL. Spontaneous coronary artery dissection: stent or wait for healing. Heart 2003: 89;164.

  27. De PaepeA, Devereux RB, Dietz HC, Hennekam RC, Pyeritz RE. Revised diagnostic criteria for the Marfan syndrome. Am J Med Genet 1996;62:417.

    Google Scholar 

  28. Pepin M, Schwarze U, Superti-Furga A, Byers PH. Clinical and genetic features of Ehlers-Danlos syndrome type IV, the vascular type. N Engl J Med 2000;342:673-80.

    Google Scholar 

  29. Von Feldt JM. Systemic lupus erythematosus. Recognizing its various presentations. Postgrad Med 1995;97:79.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. www.bsl.nl/shop/

    W. Tanis

Authors
  1. W. Tanis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. R. Stella
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. H. Pijlman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. H. Kirkels
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. H. J. Peters
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. H. de Man
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. Tanis.

Additional information

Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands

Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands

Department of Cardiology, Tergooi Hospitals, Blaricum,the Netherlands

Department of Cardiology, Medical Spectrum Twente, Enschede, the Netherlands

Correspondence to: W. Tanis Department of Cardiology, University Medical Center Utrecht,PO Box 85500, 3508 GA Utrecht, the Netherlands

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tanis, W., Stella, P.R., Pijlman, A.H. et al. Spontaneous coronary artery dissection: current insights and therapy. NHJL 16, 344–349 (2008). https://doi.org/10.1007/BF03086176

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03086176

Search

Navigation