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Introduction: Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic cause of myocardial infarction. Migraine headache has been reported to be common among patients with SCAD, but the degree of migraine-related disability has not been quantified. Methods: Clinical data and headache variables were obtained from the baseline assessment of the prospective, multicenter iSCAD Registry. Migraine-related disability was quantified using the self-reported Migraine Disability Assessment (MIDAS). Demographic, clinical, psychosocial, and medical characteristics from data entry forms were compared between patients with and without migraine. Results: Of the 773 patients with available data, 46% reported previous or current migraines. Those with migraines were more likely to be women (96.9% vs 90.3%, p = 0.0003). The presence of underlying carotid fibromuscular dysplasia was associated with migraine (35% vs 27%, p = 0.0175). There was not a significant association with carotid artery dissection and migraine. Current migraine frequency was less than monthly (58%), monthly (24%), weekly (16%), and daily (3%). Triptan use was reported in 32.5% of patients, and 17.5% used daily migraine prophylactic medications. Using the MIDAS to quantify disability related to migraine, 60.2% reported little or no disability, 14.4% mild, 12.7% moderate, and 12.7% severe. The mean MIDAS score was 9.9 (mild to moderate disability). Patients with SCAD had higher rates of depression and anxiety (28.2% vs 17.7% [ p = 0.0004] and 35.3% vs 26.7% [ p = 0.0099], respectively). Conclusions: Migraines are common, frequent, and a source of disability in patients with SCAD. The association between female sex, anxiety, and depression may provide some insight for potential treatment modalities. [ABSTRACT FROM AUTHOR]

This letter published in the journal Vascular Medicine discusses the prevalence of extracoronary vascular abnormalities (EVAs) in patients with spontaneous coronary artery dissection (SCAD) and whether it varies by age. The study included 193 patients with SCAD and found that the prevalence of certain conditions like hypertension and dyslipidemia increased with age. However, there were no significant differences in SCAD presentation or vessel involvement based on age. EVAs, including fibromuscular dysplasia, were highly prevalent across all age groups. The study concludes that the prevalence of EVAs does not vary by age in patients with SCAD and emphasizes the importance of accurate disease recognition in older SCAD patients. Further research is needed to understand the determinants of age at first SCAD event. [Extracted from the article]

Patient advocacy groups provide physicians with a unique perspective of what is important to patients and a platform to allow patients to participate in improving care. Over the past few decades, there has been a wider recognition of peripheral vascular disease as a unique set of disease processes that affect a larger population of patients than initially appreciated. Finally, crowdsourcing, where patients can submit their own data and samples, is a unique way to increase patient recruitment and participation, and is an underutilized method for patient recruitment and participation. Most patients presenting with AAD aneurysm do so at sizes below prophylactic guidelines for aneurysm repair, with ascending diameters < 5.0 cm in 40% of Type A patients, and descending diameters < 5.5 cm in 81.6% of Type B patients. [Extracted from the article]

This article discusses the importance of recognizing and addressing rare vascular diseases. The National Organization of Rare Diseases estimates that millions of Americans and individuals worldwide are affected by rare diseases, including rare vascular diseases. The author, a physician specializing in fibromuscular dysplasia (FMD), emphasizes the need for quality medical care and research for patients with rare vascular diseases. The article highlights the role of vascular medicine specialists in raising awareness and conducting research on these conditions. The special issue of Vascular Medicine includes articles on various rare vascular diseases, providing up-to-date information on their management and potential new approaches. The author acknowledges that there is still much work to be done in this field, but assures patients that there is a community of clinicians and researchers dedicated to finding answers and cures for rare vascular diseases. [Extracted from the article]

Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome. Guidance regarding the optimal management of patients with SCAD has been published over the past 10 years, but the impact on clinical practice has not been evaluated. The present study aims to examine if approaches to invasive management, medical therapy, and vascular imaging have changed over time. Methods: This is a retrospective cohort study of 157 patients treated for SCAD between 2005 and 2019 at an academic health system in Philadelphia, Pennsylvania. We aimed to examine change in management over time, including rates of coronary revascularization, discharge medications, and vascular imaging. Results: Conservative management of SCAD increased over time from 35% before 2013 to 89% in 2019, p < 0.001. Revascularization was associated with younger age, pregnancy-associated SCAD, and lesions of the left main artery, left anterior descending artery, and multiple vessels, p < 0.05 for all. Partial imaging for extracoronary vascular abnormalities ranged from 33% before 2013 to 71% in 2018, p = 0.146. The rate of comprehensive vascular imaging (cross-sectional head to pelvis imaging) remained low in all time categories (10–18%) and did not change over time. Patients who underwent comprehensive imaging were more likely to be diagnosed with fibromuscular dysplasia (FMD) compared to those with partial imaging (63% vs 15%, p < 0.001). Conclusion: Management of spontaneous coronary artery dissection has changed over time. More patients are being managed conservatively and undergo screening for extracoronary vascular abnormalities such as FMD. Future efforts should focus on improving rates of comprehensive vascular screening. [ABSTRACT FROM AUTHOR]

Introduction: Mitral valve prolapse and aortic root dilatation are reported in association with hypermobile Ehlers–Danlos syndrome (hEDS), but the full phenotypic spectrum of cardiovascular complications in this condition has not been studied in the aftermath of updated nosology and diagnostic criteria. Methods: We performed a retrospective review of 258 patients (> 94% adults) referred to a multidisciplinary clinic for evaluation of joint hypermobility between January 2017 and December 2020 and diagnosed with hEDS or a hypermobility spectrum disorder (HSD) to determine the incidence and spectrum of cardiovascular involvement. Results: Mitral valve prolapse was present in 7.5% and thoracic aortic dilatation in 15.2%. Aortic dilatation was more frequent in individuals with hEDS (20.7%) than with HSD (7.7%) and similarly prevalent between males and females, although was mild in > 90% of females and moderate-to-severe in 50% of males. Five individuals (1.9%) with hEDS/HSD had extra-aortic arterial involvement, including cervical artery dissection (CeAD, n = 2), spontaneous coronary artery dissection (SCAD, n = 2), and SCAD plus celiac artery pseudoaneurysm (n = 1). This is the first series to report the prevalence of CeAD and SCAD in hEDS/HSD. Conclusions: Cardiovascular manifestations in adults with hEDS/HSD, especially females, are typically mild and readily assessed by echocardiography. Since the risk of progression has not yet been defined, adults with hEDS/HSD who are found to have aortic dilatation at baseline should continue ongoing surveillance to monitor for progressive dilatation. Cardiovascular medicine specialists, neurologists, and neurosurgeons should consider hEDS/HSD on the differential for patients with CeAD or SCAD who also have joint hypermobility. [ABSTRACT FROM AUTHOR]

Spontaneous coronary intramural hematoma (SCIH) was one type of spontaneous coronary artery dissection without obvious intimal tear, which is easy to misdiagnose. We aimed to study the characteristics, management, and prognosis of SCIH in our center. All the SCIH patients (n = 30) diagnosed by coronary angiography from January 1, 2012 to December 31, 2018 were enrolled. The demographic characteristics, history, therapy, and follow-up were collected. The mean age of the patients was 51.8 ± 9.5 years. Most of the patients were females (66.7%) with hypertension. Patients with diffuse lesion, focal lesion, and multiple vessels were 70%, 13.3%, and 16.7%, respectively. Conservative treatment was the first choice (76.7%). The mean follow-up time was 29.3 ± 13.5 months. None of the patients had unplanned readmission due to worsening symptoms. Nine patients underwent coronary artery computed tomography reexamination after 10.3 ± 7.5 months, which showed complete recovery of SCIH. Eight patients were hospitalized for coronary angiography 6.4 ± 4.7 months later, which did not show any sign of SCIH. Spontaneous coronary intramural hematoma was most common in post-menopausal women with hypertension. Possibly, antiplatelet drugs should be avoided in SCIH. Waiting for the hematoma to heal was preferable and had a good prognosis. [ABSTRACT FROM AUTHOR]

Background: There was no previous report on the three-dimensional simultaneous non-contrast angiography and intra-plaque hemorrhage (3D-SNAP) magnetic resonance imaging (MRI) sequence to diagnose intracranial artery dissection (IAD). Purpose: To improve the diagnostic accuracy and guide the clinical treatment for IAD by elucidating its pathological features using 3D-SNAP MRI. Material and Methods: From January 2015 to September 2018, 113 patients with suspected IAD were analyzed. They were divided into IAD and non-IAD groups according to the spontaneous coronary artery dissection (SCAD) criteria. All patients underwent 3D-SNAP, 3D-TOF, T2W imaging, 3D-PD, 3D-T1W-VISTA, and 3D-T1WCE) using 3.0-T MRI; clinical data were collected. The IAD imaging findings (intramural hematoma, double lumen, intimal flap, aneurysmal dilatation, stenosis, or occlusion) in every sequence were analyzed. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficiency of each sequence. Results: There was a significant difference in the probability of intramural hematoma, relative signal intensity of intramural hematoma, double lumen, stenosis, or occlusion signs on 3D-TOF, T2W, 3D-PD, 3D-T1W-VISTA, 3D-SNAP, and 3D-T1WCE sequences (P <0.05). The 3D-SNAP and 3D-T1WCE sequences were most sensitive for diagnosing intramural hematoma and displaying double-lumen signs, respectively. The diagnostic efficiency of the 3D-SNAP sequence combined with 3D-T1WCE was the highest (area under the curve [AUC] 0.966). The AUC value of the 3D-SNAP sequence (AUC 0.897) was slightly inferior to that of 3D-T1W enhancement (AUC 0.903). Conclusion: 3D-SNAP MRI is a non-invasive and effective method and had the greatest potential among those methods tested for improving the diagnostic accuracy for IAD. [ABSTRACT FROM AUTHOR]

Data on spontaneous coronary artery dissection (SCAD) is based on European and North American registries. We assessed the prevalence, epidemiology, and outcomes of patients presenting with SCAD in Arab Gulf countries. Patients (n = 83) were diagnosed with SCAD based on angiographic and intravascular imaging whenever available. Thirty centers in 4 Arab Gulf countries (Kingdom of Saudi Arabia, United Arab Emirates, Kuwait, and Bahrain) were involved from January 2011 to December 2017. In-hospital (myocardial infarction [MI], percutaneous coronary intervention, ventricular tachycardia/fibrillation, cardiogenic shock, death, implantable cardioverter-defibrillator placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were recorded. Median age was 44 (37-55) years, 42 (51%) were females and 28.5% were pregnancy-associated (21.4% were multiparous). Of the patients, 47% presented with non-ST-elevation acute coronary syndrome, 49% with acute ST-elevation myocardial infarction, 12% had left main involvement, 43% left anterior descending, 21.7% right coronary, 9.6% left circumflex, and 9.6% multivessel; 52% of the SCAD were type 1, 42% type 2, 3.6% type 3, and 2.4% multitype; 40% managed medically, 53% underwent percutaneous coronary intervention, 7% underwent coronary artery bypass grafting. Females were more likely than males to experience overall (in-hospital and follow-up) adverse cardiovascular events (P =.029). [ABSTRACT FROM AUTHOR]

Despite the above recommendation, Feldbaum and colleagues[1] show that comprehensive screening for EVAs even in a tertiary academic medical center, is abysmal, with less than 20% of patients with SCAD undergoing comprehensive screening. Keywords: cardiovascular disease; coronary artery disease; spontaneous coronary artery dissection (SCAD) EN cardiovascular disease coronary artery disease spontaneous coronary artery dissection (SCAD) 139 140 2 04/12/23 20230401 NES 230401 Commentary on: Feldbaum E, Thompson EW, Cook TS, et al. [Extracted from the article]

This article is a comprehensive document on the diagnosis and management of fibromuscular dysplasia (FMD), which was commissioned by the working group 'Hypertension and the Kidney' of the European Society of Hypertension (ESH) and the Society for Vascular Medicine (SVM). This document updates previous consensus documents/scientific statements on FMD published in 2014 with full harmonization of the position of European and US experts. In addition to practical consensus-based clinical recommendations, including a consensus protocol for catheter-based angiography and percutaneous angioplasty for renal FMD, the document also includes the first analysis of the European/International FMD Registry and provides updated data from the US Registry for FMD. Finally, it provides insights on ongoing research programs and proposes future research directions for understanding this multifaceted arterial disease. [ABSTRACT FROM AUTHOR]

Although coronary obstruction due to atherosclerosis is the most common cause of myocardial ischemia, a significant proportion of patients have myocardial ischemia in the absence of obstructive epicardial coronary artery disease (CAD). This finding is more common among women and alternative causes can mediate myocardial ischemia. Abnormalities in vascular structure, alterations in coronary vasomotion and dysfunction of the coronary microcirculation can all cause ischemia in the absence of obstructive CAD due to atherosclerosis. In this review, we provide an update on three alternative causes of myocardial ischemia: spontaneous coronary artery dissection (SCAD), vasospastic angina (VSA) and coronary microvascular dysfunction (CMVD). We review pathophysiology, clinical presentation, diagnosis, treatment and outcomes related to these important clinical entities. There is increasing interest in better defining this patient population with use of advanced imaging and testing tools. Despite the increased associated risk with future cardiac events, evidencebased treatments for these diagnoses remain under-studied and poorly defined. These alternative diagnoses should be kept in mind when evaluating women with myocardial ischemia without obstructive CAD due to atherosclerosis. [ABSTRACT FROM AUTHOR]