“The scaffolding must be removed once the house is built”—spontaneous coronary artery dissection and the potential of bioresorbable scaffolds

Spontaneous coronary artery dissection (SCAD) is defined as the separation in any of the three layers of the coronary artery wall that is not iatrogenic or caused by trauma (1). Although SCAD is often asymptomatic, it is increasingly recognized as the underlying etiology in acute coronary syndromes (ACS) (2). SCAD mainly affects women (>90% of cases), most commonly between 44 to 55 years-of-age (3-6). SCAD may result from an intimal disruption or “tear” with formation of an intramural hematoma (IMH), or spontaneous intramural bleeding, likely due to the rupture of vasa vasorum (7). SCAD resulting from either mechanism results in blood accumulation within the newly formed false lumen, which may compress the true lumen to varying degrees (1), thus presenting as myocardial ischemia, ACS, cardiogenic shock or sudden cardiac death (4,8,9). SCAD may extensively propagate in anterograde and/or retrograde fashion, with the mean length of dissection typically >45 mm
on quantitative coronary angiography (10).