Spontaneous Coronary Artery Dissection: Evidence‑Based Clinical and Diagnostic Guidelines
Clinical Presentation
Demographics & Risk Context
Angiographic Classification (Primary Diagnostic Method)
Advanced Imaging for Diagnostic Confirmation
Initial Evaluation (Work‑up Algorithm)
Management of Diagnostic Uncertainty
Screening for Associated Conditions
High‑Risk Features Requiring Urgent Evaluation
Common Diagnostic Pitfalls
SCAD: Triggers, High‑Risk Populations, Diagnosis, and Management
Triggers and Mechanisms
High‑Risk Populations
Pathophysiology
Diagnostic Approach
Acute Management
Long‑Term Prevention
CT/MR Screening for Fibromuscular Dysplasia in SCAD Patients
Research Priorities
- The American Heart Association highlights fibromuscular dysplasia (FMD) as a key research priority for elucidating its proportionate contribution, alongside other systemic arteriopathies, to the development and recurrence of spontaneous coronary artery dissection (SCAD)【15】【16】.
Risk Factors and Prognosis
- Coronary tortuosity—considered a manifestation of FMD—is currently the only identified risk factor associated with SCAD recurrence【17】.
- Over a 10‑year follow‑up, the estimated rate of major adverse cardiac events in SCAD patients approaches 50%, with recurrent SCAD occurring in approximately 17‑30% of cases【17】.
Diagnostic Screening Recommendations
- Upon confirmation of SCAD by coronary angiography, a systematic screening protocol should be performed using CT or MR angiography that includes the renal, carotid, and iliac arterial territories【18】.
- Imaging evaluation should specifically assess for the classic “string‑of‑beads” appearance indicative of multifocal FMD【18】.