Spontaneous Coronary Artery Dissection: Current Concepts and Clinical Management

Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic, noniatrogenic cause of acute coronary syndrome (ACS) that predominantly affects women, including those of reproductive age. Misdiagnosis as atherosclerotic coronary disease may lead to inappropriate interventions and antithrombotic therapy. This narrative review summarizes consensus statements, registry data, and observational studies published through July 2026 to provide a structured, clinically oriented overview of the diagnosis, acute management, and long-term care of SCAD. Most recommendations are based on observational studies or registry-level evidence; randomized trial data remain limited. A narrative review of the literature was performed using MEDLINE/PubMed, EMBASE, and the Cochrane Library. Search terms included "spontaneous coronary artery dissection," "SCAD," "fibromuscular dysplasia," "intramural hematoma," and related terms. The search was not date-restricted but was updated through July 2026. Priority was given to guideline documents, consensus statements, registries, systematic reviews, and original cohort studies. The review highlights the angiographic recognition of SCAD patterns and the selective use of intravascular imaging in ambiguous cases. A conservative management strategy is preferred in hemodynamically stable patients with preserved distal coronary flow and no objective evidence of ongoing ischemia, given the high rates of spontaneous healing and the risk of iatrogenic dissection. Revascularization may be considered in selected high-risk patients with ongoing ischemia or hemodynamic compromise. Long-term care includes individualized antiplatelet therapy, beta-blockers, extracoronary arteriopathy screening, rehabilitation, and counseling regarding pregnancy and trigger avoidance. This review provides a clinically applicable framework for SCAD diagnosis and management while highlighting persistent evidence gaps in antithrombotic strategies, recurrence prediction, and extracoronary screening.

Keywords: Coronary angiography, fibromuscular dysplasia, intravascular imaging, revascularization, spontaneous coronary artery dissection.