What diagnostic w/u should patients with SCAD receive?
The first article I read was this research summary from AHA, where I I learned that more than 50% of patients with SCAD are found to have FMD when they undergo complete evaluation of their vascular beds, and that more than 50% of patients with FMD have involvement of more than one artery.
I appreciated this graph showing some of the overlap between risk factors for SCAD and FMD.
Figure 2. Demographics and cardiovascular risk factors of patients included in studies of fibromuscular dysplasia (FMD) and spontaneous coronary artery dissection (SCAD).
But then that review paper got into the weeds of genetics, which is not what I was looking for. So, back to PubMed, and I found the attached review article - in my mind, Dr. Saw is basically synonymous with SCAD, so, bingo!
This paper shares that while FMD is far and away the strongest association with SCAD, that it can also be associated with other diseases of connective tissue and systemic inflammation as well as pregnancy and other hormone-affected states. While it's an excellent review of SCAD - truly, really good review - I still did not have my answer. I did learn that SCAD associated with pregnancy has worse morbidity than cases outside this context.
I called it and went to Up To Date and read about FMD: they recommended CT evaluation of the renal, carotid, and vertebral arteries. They said ultrasound is a viable initial assessment in high volume centers with lots of experience but that otherwise CT > MRA. And, they said that on initial presentation, these patients should have comprehensive head --> pelvic imaging.
I share my approach with hope that it encourages you to utilize the primary literature more, even when the path to the answer isn't straightforward. Thanks for sticking with me!
Kim ESH, Saw J, Kadian-Dodov D, Wood M, Ganesh SK. FMD and SCAD: Sex-Biased Arterial Diseases With Clinical and Genetic Pleiotropy. Circulation Research. 2021;128(12):1958-1972. doi:https://doi.org/10.1161/circresaha.121.318300
Offen S, Yang C, Saw J. Spontaneous coronary artery dissection (SCAD): A contemporary review. Clinical Cardiology. 2024;47(6). doi:https://doi.org/10.1002/clc.24236
