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Spontaneous Coronary Artery Dissection in Clinical Practice: Pathophysiology and Therapeutic Approaches

Authors :
Andrea D’Amato
Marco Valerio Mariani
Silvia Prosperi
Lorenzo Colombo
Andrea De Prisco
Carlo Lavalle
Massimo Mancone
Carmine Dario Vizza
Paolo Severino
Source :
Medicina, Vol 60, Iss 2, p 217 (2024)
Publication Year :
2024
Publisher :
MDPI AG, 2024.

Abstract

Spontaneous coronary artery dissection (SCAD) is a cause of myocardial infarction without obstructive coronary artery disease (MINOCA). It is determined by a coronary artery wall layers separation, which occurs regardless of traumatic or iatrogenic injuries. Even if it is often a missed diagnosis, its incidence is growing along with the improvement of intracoronary imaging techniques that allow for better detection. The main angiographical classification distinguishes three different forms, with slightly different prognoses at long-term follow up. SCAD is a recurrent condition, severely hampering the life quality of affected patients. The predominantly young age of patients with SCAD and the high prevalence of females among them have made the topic increasingly important, especially regarding therapeutic strategies. According to the data, the most recommended treatment is conservative, based on the use of antiplatelet agents and supportive anti-ischemic therapy. However, there are conflicting opinions concerning the need for dual antiplatelet therapy and its duration. In the case of invasive treatment, the choice between percutaneous coronary intervention and coronary artery bypass graft depends on the patient’s clinical stability and the interested vessel. The purpose of the current review is to revise the pathophysiological mechanisms underlying SCAD and the current knowledge of its treatment.

Details

Language :
English
ISSN :
16489144 and 1010660X
Volume :
60
Issue :
2
Database :
Directory of Open Access Journals
Journal :
Medicina
Publication Type :
Academic Journal
Accession number :
edsdoj.37689a3f350844bfb4756b73c0a710d3
Document Type :
article
Full Text :
https://doi.org/10.3390/medicina60020217