Spontaneous coronary artery dissection: novel insights on diagnosis and management.

Spontaneous coronary artery dissection (SCAD) remains an elusive and challenging clinical entity 8 decades after its initial description. Very recently, our understanding of this rare condition has been enriched by data from large series of patients prospectively studied and systematically followed. In addition, intracoronary diagnostic techniques have provided a new window into the diagnosis of this elusive condition of special value in patients presenting with the phenotype of intramural hematoma. Spontaneous healing has been demonstrated in most patients during long-term follow-up. The large list of associated conditions has been recently updated with the novel description of concomitant fibromuscular dysplasia (FMD) in large arteries in many of these patients, leading to the suggestion of a potential causal link between both conditions. Finally, data from large series of patients suggest that, whenever possible, a conservative initial management strategy ("watchful waiting"), is indicated in most patients with this challenging clinical entity.