PMID- 27574379
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20160830
LR  - 20200930
IS  - 1061-1711 (Print)
IS  - 1615-5939 (Electronic)
IS  - 1061-1711 (Linking)
VI  - 25
IP  - 3
DP  - 2016 Sep
TI  - Spontaneous Coronary Artery Dissection: One Disease, Variable Presentations, and 
      Different Management Approaches.
PG  - 139-47
LID - 10.1055/s-0035-1563604 [doi]
AB  - Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary 
      syndrome. It occurs predominantly among younger females, typically in the absence 
      of atherosclerotic coronary artery disease. Presentations vary greatly and this 
      condition can be fatal. Given its rarity, there are no management guidelines. We 
      present six patients with SCAD with different presentations and treatment 
      approaches as examples in our literature review. Two patients presented with ST 
      elevation myocardial infarction (STEMI), two with non-STEMI (NSTEMI), and two 
      with cardiac arrest. Patients were treated according to the presentation, 
      clinical stability, and extension and distribution of the dissection. Four 
      patients underwent emergent percutaneous coronary intervention (PCI) and one was 
      clinically stable and treated medically initially and underwent an elective PCI 
      after 4 weeks when coronary angiogram showed persistent dissection. Another 
      patient was treated medically as he was hemodynamically stable and the dissection 
      affected a small branch. Intravascular ultrasound (IVUS) or optical coherence 
      tomography (OCT) was used for diagnosis confirmation as well as during and after 
      PCI to assure good stent apposition. All patients had excellent outcome. SCAD is 
      a rare cause of acute coronary syndrome and a high index of suspicion is crucial 
      for early diagnosis. In patients with early presentation, limited disease, and 
      ongoing symptoms, emergent cardiac catheterization with PCI has excellent 
      outcome. However, in stable patients, medical management and elective PCI in few 
      weeks if the dissection persists is a more reasonable approach. IVUS and OCT are 
      invaluable especially in ambiguous cases.
FAU - Al Emam, Abdel Rahman A
AU  - Al Emam AR
AD  - Division of Cardiology, University of Texas Medical Branch, Galveston, Texas.
FAU - Almomani, Ahmed
AU  - Almomani A
AD  - Department of Internal Medicine, University of Texas Medical Branch, Galveston, 
      Texas.
FAU - Gilani, Syed A
AU  - Gilani SA
AD  - Division of Cardiology, University of Texas Medical Branch, Galveston, Texas.
FAU - Khalife, Wissam I
AU  - Khalife WI
AD  - Division of Cardiology, University of Texas Medical Branch, Galveston, Texas.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20150914
PL  - United States
TA  - Int J Angiol
JT  - The International journal of angiology : official publication of the 
      International College of Angiology, Inc
JID - 9504821
PMC - PMC5001868
OTO - NOTNLM
OT  - MI
OT  - PCI
OT  - acute coronary syndrome
OT  - coronary intervention
OT  - intravascular ultrasound
OT  - non-ST elevation myocardial infarction
COIS- Conflict of Interest The authors have no conflict of interest to disclose.
EDAT- 2016/08/31 06:00
MHDA- 2016/08/31 06:01
PMCR- 2017/09/01
CRDT- 2016/08/31 06:00
PHST- 2016/08/31 06:00 [entrez]
PHST- 2016/08/31 06:00 [pubmed]
PHST- 2016/08/31 06:01 [medline]
PHST- 2017/09/01 00:00 [pmc-release]
AID - 150022 [pii]
AID - 10.1055/s-0035-1563604 [doi]
PST - ppublish
SO  - Int J Angiol. 2016 Sep;25(3):139-47. doi: 10.1055/s-0035-1563604. Epub 2015 Sep 
      14.