SCAD in Acute and Chronic Phase and Work Up for FMD

Spontaneous coronary artery dissection (SCAD) is not longer an extremely rare and exceptional disease. Over the past 10 years, we have witnessed an exponential increase in the interest and attention devoted to this condition. The publication of large patient series, some of which were prospective studies, has provided us with invaluable insights into the clinical characteristics of SCAD. The widespread utilization of coronary angiograms and intracoronary imaging in the context of acute coronary syndrome (ACS) has enabled us to apply this newfound knowledge in practice. Hence, an increasing number of patients are now being recognized as suffering from SCAD, thus replacing the diagnosis of ACS with an unknown etiology in many cases. Moreover, although clinical trials are currently unavailable, we now understand that the management and prognosis of SCAD differ significantly from those of atherothrombotic ACS. As someone once stated, “if you do not consider SCAD, you cannot diagnose SCAD.” Therefore, in this chapter, we will attempt to summarize the key aspects of SCAD: when it should be suspected, how to confirm the diagnosis, the expected outcomes and various management options, as well as the evaluation during the chronic phase.