Table 1.

Most common treatment modalities used for spontaneous coronary artery dissection

Treatment modalities	First line	Advantages	Disadvantages
Aspirin	Most commonly used for acute and long term SCAD treatment	Low side effect profile and bleeding risks and clear cut benefits in patients with ACS and secondary prevention of CAD	None
Aspirin + clopidogrel	Used in patients after PCI due to SCAD and sometimes in combination with aspirin even in patients without stents	Since SCAD involves intimal tear which is prothrombotic, dual antiplatelet therapy would be empirically beneficial to reduce false lumen thrombus burden and theoretically reduce true lumen compression	Higher risk of bleeding
Anticoagulation	Controversial, no clear cut guidelines	Initially administered on patients presenting with ACS	Risk of extension of dissection and extension of intramural haematoma
Beta blockers	Indicated	Reduce arterial wall stress	Should be avoided in severe asthma and COPD patients
ACE-inhibitors	Not first line	Only indicated in patients with significant LV dysfunction after MI (EF < 40%)
Statin	Not used	No previous studies showing benefit in patients with non-atherosclerotic SCAD	Should only be used in patients with pre-existing dyslipidaemia
PCI	Not routinely performed	Indicated in patients with ongoing or recurrent chest pain, haemodynamic or electrical instability or cardiogenic shock and or patients involving LM SCAD3	Potential risk of further dissection or inability to find true lumen
CABG	Not routinely performed	Indicated in high risk patients not amenable to PCI and patients with LM SCAD3	Higher risk of bleeding complications and inability to find true lumen for bypass anastomosis

ACS, acute coronary syndrome; CABG, coronary artery bypass graft; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; EF, ejection fraction; LM, left main; LV, left ventricular; PCI, percutaneous coronary intervention; SCAD, spontaneous coronary artery dissection.