Saturday, May 5, 2012

Spontaneous Coronary Artery Dissection (SCAD)

SCAD is a rare condition characterised by an acute coronary syndrome in a patient whose age and sex suggest a low probability of atherosclerotic disease. Unfortunately, the natural history, particularly with proximal or extensive dissection, is unpredictable and warrants aggressive revascularisation.

Peripartum women are at increased risk due to changes in blood flow increasing shear stress, and progesterone driven vessel wall changes which may predispose to coronary dissection. Other risk factors involve Ehler-Dahnlos type IV, Marfan’s syndrome, strenuous exercise and drug induce like cocaine.

Treatment includes aspirin, B-blockers, +/- anticoagulants or glycoprotein IIb/IIIa inhibitors. Thrombolytic agents should be avoided as they may worsen the dissection process. Percutaneous intervention with deployment of a stent is the procedure of choice.  The potential for stent deployment into the false lumen exists!  Coronary artery bypass grafting remains the treatment of choice for very extensive, multi-vessel or the left main stem dissection.

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