Spontaneous Coronary Artery Dissection Unveiled: Pathophysiology, Imaging, and Evolving Management Strategies

Rusali, Constantin Andrei; Lupu, Ioana Caterina; Rusali, Lavinia Maria; Cojocaru, Lucia

doi:10.3390/jcdd12080286

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Spontaneous Coronary Artery Dissection Unveiled: Pathophysiology, Imaging, and Evolving Management Strategies

by

Constantin Andrei Rusali

^1,†,

Ioana Caterina Lupu

¹

,

Lavinia Maria Rusali

¹ and

Lucia Cojocaru

^1,2,*,†

¹

Department of Internal Medicine, Ovidius University of Constanta, 145 Tomis Boulevard, 900591 Constanta, Romania

²

Department of Cardiology, Constanta County Clinical and Emergency Hospital, Ovidius University of Constanta, 145 Tomis Boulevard, 900591 Constanta, Romania

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

J. Cardiovasc. Dev. Dis. 2025, 12(8), 286; https://doi.org/10.3390/jcdd12080286

Submission received: 31 May 2025 / Revised: 17 July 2025 / Accepted: 23 July 2025 / Published: 28 July 2025

(This article belongs to the Special Issue Coronary Arterial Anomalies)

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Abstract

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized, non-atherosclerotic cause of acute coronary syndrome (ACS), particularly in younger women. This comprehensive review outlines SCAD’s unique pathophysiology, which is linked to underlying arteriopathies like fibromuscular dysplasia, and highlights the critical role of advanced intravascular imaging for accurate diagnosis. A fundamental shift in management is detailed, with evidence favoring a conservative strategy for stable patients due to high rates of spontaneous vessel healing, reserving technically challenging invasive interventions for high-risk cases. Importantly, this review also addresses long-term outcomes, noting significant rates of recurrence and Major Adverse Cardiac Events (MACE), a high prevalence of persistent chest pain, and the central role of beta-blocker therapy in secondary prevention. Ultimately, SCAD requires a departure from standard ACS protocols towards a personalized approach that emphasizes accurate diagnosis, cautious initial management, and vigilant long-term follow-up.

Keywords: spontaneous coronary artery dissection (SCAD); acute coronary syndrome (ACS); intravascular imaging; fibromuscular dysplasia (FMD); non-atherosclerotic myocardial infarction

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MDPI and ACS Style

Rusali, C.A.; Lupu, I.C.; Rusali, L.M.; Cojocaru, L. Spontaneous Coronary Artery Dissection Unveiled: Pathophysiology, Imaging, and Evolving Management Strategies. J. Cardiovasc. Dev. Dis. 2025, 12, 286. https://doi.org/10.3390/jcdd12080286

AMA Style

Rusali CA, Lupu IC, Rusali LM, Cojocaru L. Spontaneous Coronary Artery Dissection Unveiled: Pathophysiology, Imaging, and Evolving Management Strategies. Journal of Cardiovascular Development and Disease. 2025; 12(8):286. https://doi.org/10.3390/jcdd12080286

Chicago/Turabian Style

Rusali, Constantin Andrei, Ioana Caterina Lupu, Lavinia Maria Rusali, and Lucia Cojocaru. 2025. "Spontaneous Coronary Artery Dissection Unveiled: Pathophysiology, Imaging, and Evolving Management Strategies" Journal of Cardiovascular Development and Disease 12, no. 8: 286. https://doi.org/10.3390/jcdd12080286

APA Style

Rusali, C. A., Lupu, I. C., Rusali, L. M., & Cojocaru, L. (2025). Spontaneous Coronary Artery Dissection Unveiled: Pathophysiology, Imaging, and Evolving Management Strategies. Journal of Cardiovascular Development and Disease, 12(8), 286. https://doi.org/10.3390/jcdd12080286

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

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Spontaneous Coronary Artery Dissection Unveiled: Pathophysiology, Imaging, and Evolving Management Strategies

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