Spontaneous coronary artery dissection

Abstract

Spontaneous coronary artery dissection (SCAD) is an infrequent cause of coronary artery disease. Whilst a recognized disease entity since 1930s, its pathogenesis remains unclear and various hypotheses have been postulated from clinical and clinic-pathological association. Whilst angiography alone has traditionally been perceived to significantly under diagnose this condition, recent development in intravascular imaging, particularly optical coherence tomography (OCT), have seen significant advances in the understanding of SCAD. From a histopathological perspective, OCT has shown that there may be distinct pathological subsets in SCAD in reference to a dissection flap and an intramural hematoma. Early data also suggests that OCT may be important in optimizing PCI results in SCAD. The future is particularly promising if a collaborative approach is undertaken to utilize OCT as an in vivo microscope to shed more light in this poorly understood disease entity.