Literature review: spontaneous coronary artery dissections

Coronary artery dissection can be primary or secondary: the primary dissections occur spontaneously, but the secondary dissections occur as an extension from aortic root dissection or following an insult as a consequence of coronary angiography, coronary intervention, cardiac surgery, or chest or cardiac trauma. Spontaneous coronary artery dissection (SCAD) results in a hemorrhagic separation of the media, with creation of false lumen, with or without an associated tear in the intima. The separated media can force the intimal–medial layer toward the true lumen of the coronary artery, leading to distal myocardial ischemia, infarction, or sudden death. The false lumen created by dissections may heal spontaneously without further compromise to the true lumen or may occlude the true lumen, especially if it forms an expanding cul-de-sac. SCAD is rare, but it is now being increasingly recognized as a prominent cause of acute ischemic coronary events that usually occur in relatively young patients who are predominantly female. It is a rare cause of acute myocardial ischemia that commonly presents as sudden cardiac death [1]. Up to 75% of published cases were diagnosed at autopsy, while the rest were diagnosed antemortem via coronary angiography [2,3]. The incidence of SCAD was 0.1% in one angiographic series and 0.28% in another [2,3]. SCAD can occur as an intimal tear with medial dissection (that can be recognized angiographically) or as a medial dissection with hematoma formation