Elsevier

Medical Hypotheses

Volume 121, December 2018, Pages 91-94
Medical Hypotheses

Eosinophilic inflammation in spontaneous coronary artery dissection: A potential therapeutic target?

https://doi.org/10.1016/j.mehy.2018.09.039Get rights and content

Abstract

Spontaneous coronary artery dissection (SCAD), defined as non-traumatic, non-iatrogenic dissociation of coronary vessel wall resulting from intimal disruption or intramural hemorrhage, represents an important cause of sudden death and myocardial infarction among young or middle-aged women without conventional risk factors for atherosclerosis. On histopathological examination, SCAD is featured by prominent eosinophilic infiltration of the adventitia or periadventitial layer of coronary artery. It has been estimated that approximately 15–30% of SCAD patients experience recurrent episodes of dissection despite medical therapy. Preliminary evidence suggests that injury to the vascular endothelium and myocytes in the arterial wall may be explained by cytotoxic products released from eosinophils in response to inflammatory mediators. In addition, neovascularization of vasa vasorum and dilatation of intimal capillaries may be stimulated by localized eosinophils. Newly formed fragile vasa vasorum may disrupt due to high intraluminal pressure from the interconnected capillary network, leading to the expansion of intramural hemorrhage. It is hypothesized that anti-inflammatory therapy targeting eosinophilic coronary periarteritis would be effective in preventing the recurrence of SCAD by promoting the healing of dissection. The article delineates the biological plausibility, empirical data, and future perspective regarding eosinophilic inflammation as a potential therapeutic target for SCAD.

Section snippets

Background

Spontaneous coronary artery dissection (SCAD) is defined as non-traumatic, non-iatrogenic dissociation of coronary vessel wall resulting from intimal disruption or intramural hemorrhage. The first report of SCAD was in 1931, which describes a 42-year-old woman died unexpectedly due to rupture of a dissecting atheromatous aneurysm in the right coronary artery following repetitive retching and vomiting [1]. Since then more than 1500 cases have been reported in the literature, and SCAD has been

The hypothesis

It is hypothesized that anti-inflammatory therapy targeting eosinophilic coronary periarteritis would be effective in preventing the recurrence of SCAD by promoting the clearance of eosinophils and healing of the dissection.

The unmet need for effective management strategies for SCAD recurrence

The absence of premonitory symptoms in patients makes prompt diagnosis and treatment difficult in cases of SCAD [10]. In addition, several studies have disclosed a high incidence of recurrent SCAD events despite medical therapy [23], [24], [25]. However, the optimal management strategy for SCAD recurrence remains unsettled. Current clinical practice is based upon expert opinions, results from observational studies, or extrapolation of ACS treatment guidelines [26]. Till date, there are no

Disclosure/conflict of interest

The work is not funded and the authors declare no conflict of interest.

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