Atherosclerosis & SCAD
Accounts for 22-28% of SCAD
Hering et al. (IVUS used frequently) identified 35/42 cases where some
CAD was visualized
More common in males > females as the cause for SCAD
Patients tend to be older with more risk factors for CAD
De Maio et al. Am J Cardiol 1989;64:
Peripartum SCAD 
Peripartum SCAD accounts for 30% of 
SCAD in women
SCAD accounts for 30% of AMI during pregnancy
22% of peripartum SCAD occurs during pregnancy
78% occur postpartum
Most < 2 weeks after delivery but can be up to 12 weeks
30% of peripartum SCAD patients have atherosclerotic risk factors
Koul et al. Cath & CV Interv 2001;5
Peripartum SCAD
Pregnancy
Hemodynamic changes |
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specially during delivery) Estrogen/Progesterone |
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Changes in elastic & |
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Shear stress |
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collagen fibers in media |
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Spontaneous Dissection
Hayes et al. Angiology 2007;58:
Peripartum SCAD
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1952-1999 |
2000-2008 |
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# of cases |
58 |
25 |
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Average |
33 |
32 |
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age |
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Parity |
2.4 |
1.6 |
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LAD |
78% |
80% |
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LM/MV |
24%/40% |
20% |
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Mortality |
38% |
0% |
Koul et al. Cath & CV Interv 2001;5 Appleby et al. Exp Clin Cardiol 2009;1
Peripartum SCAD
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Kamineni et al. Cardiology in Review 2002;10
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Khan et al. Acute Cardiac Care 2006;8
Underlying Risk Factors
Hereditary
Marfan’s, Ehler-Danlos
Vasculitis
SLE, PAN, APA
Medications
OCPs, cyclosporine, 5-FU, fenfluramine, cocaine
Hyperdynamic state
Exercise, intercourse, retching, HTN
Fibromuscular dysplasia
Khan et al. Acute Cardiac Care 2006;8:
Pathogensis
Three theories surrounding the pathogenesis of SCAD:
Cystic Medial Necrosis
Peri-Adventitial Eosinophillic
Infiltrate
Plaque Rupture
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Cystic Medial Necrosis
Accounts for up to 37 % of SCAD cases on pathology
Breakdown of the intima-media or media-adventitia interface
Focal fragmentation of elastic fibers
Loss of smooth muscle cells of the media
Deposition of acid mucopolysaccharides
Often found in Marfan’s and cocaine- induced SCAD
Maehara et al. Am J Cardiol 2002;89:
Eosinophilic
Inflammation
Eosinophils have been found on autopsy specimens in the media of SCAD arteries
May account for up to 43% of SCAD cases
Eosinophils:
release enzymes leading to lysis of media and damage to collagen/elastin in the artery wall
cause artery spasm leading to shear stress and SCAD
Often found in Peripardum and vasculitis- induced SCAD
Robinowitz et al. Am J Med 1982;72: