Pathophysiology of Spontaneous Coronary Artery Dissection Determines Anticoagulation Strategy

Area of Science:

• Cardiovascular Medicine
• Pathophysiology
• Endothelial Biology

Background:

• Spontaneous coronary artery dissection (SCAD) is uncommon with unclear causes.
• Current theories implicate intramural hematoma from bleeding vasa vasorum.
• This leads to recommendations against anticoagulation, despite limited evidence.

Purpose of the Study:

• To challenge the prevailing theory of SCAD pathophysiology.
• To propose endothelial repair failure as the primary mechanism.
• To evaluate the role of conservative management and anticoagulation.

Main Methods:

• Review of existing scientific literature and clinical statements.
• Analysis of proposed pathophysiological mechanisms, including endothelial function.
• Comparison with fibromuscular dysplasia etiology.

Main Results:

• Mechanical forces and pressure gradients do not support bleeding vasa vasorum theory.
• Endothelial dysfunction and impaired repair are proposed as the core issue.
• SCAD tears may spontaneously reseal, supporting conservative treatment.

Conclusions:

• Endothelial failure to repair, not bleeding, is a plausible SCAD cause.
• Conservative therapy, including anticoagulants, can manage complications.
• Further research into endothelial repair mechanisms is crucial for new therapies.