Friable coronary arteries are link between pathogenesis and treatment of spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) is increasingly being diagnosed as the cause of an acute coronary syndrome, especially in young patients. We report the case of a 32-year-old woman with postpartum SCAD of the left main and left anterior descending coronary artery which required the implantation of two drug-eluting stents. We present a literature study that correlates the pathogenesis of SCAD to the treatment options. Non-atherosclerotic SCAD is clearly associated with connective tissue disorders, vasculitis, and the peripartum period with its hormonal and haemodynamic changes. The coronary arteries of these SCAD patients are friable and should be approached with caution. Percutaneous coronary intervention has a reported success rate of only 65% and may cause propagation of the dissection. Lately, more and more authors suggest the possibility of a conservative approach in the absence of remaining cardiac ischaemia, even in this era of percutaneous stent implantation.