Letter to the Editor
Reply to Letter to the Editor “Focus on spontaneous coronary artery dissection: Where are we now?”
Resposta à Carta ao Editor «Foco na disseção espontânea da artéria coronária: Onde estamos agora?»
Glória Abreu
Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
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"tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "953" "paginaFinal" => "955" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Foco na disseção espontânea da artéria coronária: Onde estamos agora?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2589 "Ancho" => 3000 "Tamanyo" => 604470 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flowchart for the diagnosis and management of spontaneous coronary artery dissection.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a></p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Dario Buccheri" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Dario" "apellidos" => "Buccheri" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918303969?idApp=UINPBA00004E" "url" => "/21742049/0000003700000011/v1_201812150634/S2174204918303969/v1_201812150634/en/main.assets" ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Reply to Letter to the Editor “Focus on spontaneous coronary artery dissection: Where are we now?”" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "957" "paginaFinal" => "958" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Glória Abreu" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Glória" "apellidos" => "Abreu" "email" => array:1 [ 0 => "gloriappabreu@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Hospital de Braga, Braga, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Resposta à Carta ao Editor «Foco na disseção espontânea da artéria coronária: Onde estamos agora?»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We would like to thank Dario Buccheri for the interest shown in our article “Spontaneous coronary artery dissection: a single-center case series and literature review”.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We reported an interesting case series of spontaneous coronary artery dissection (SCAD) from our center, in which we presented the prevalence of SCAD in our cohort, its form of presentation, patient characteristics, how we managed the condition and its prognosis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">As the author pointed out, SCAD remains an underdiagnosed entity.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a> Therefore, it is crucial to have a high level of clinical suspicion, recognize some particular features characteristic of this entity, be familiar with all angiographic patterns and systematically use intracoronary imaging.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We analyzed with great interest the scoring system proposed and tested by Buccheri et al.,<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">3,4</span></a> which scores clinical and angiographic variables that raise the suspicion of SCAD and favors the use of optical coherence tomography or intravascular ultrasound to confirm the diagnosis. We think that it could be a useful and practical tool for diagnosis, although it still needs statistical validation in a larger cohort. Although invasive treatment is suggested in the score and in the letter, this kind of strategy is based on case reports and experience in short case series.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">5,6</span></a> Percutaneous treatment of SCAD may carry non-negligible risks, such as secondary iatrogenic dissection, guidewire passage into the false lumen, proximal or distal false lumen propagation during stent deployment, persistent distal dissection, major side branch occlusion or flow limitation, and subacute or late stent malapposition due to intramural hematoma reabsorption.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">7,8</span></a> Indeed, technical failure of percutaneous coronary intervention may occur in up to half of patients with SCAD.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> Dr. Buccheri proposed that in this setting, bioresorbable vascular scaffolds (BVS) might be an interesting therapeutic tool because they allow for SCAD sealing and healing, theoretically with subsequent restoration of the morphological and functional characteristics of the coronary segment treated. This option could be of great importance in cases of long SCAD requiring multiple overlapping permanent stents, which are associated with a high rate of adverse events at follow-up. However, compared with newer drug-eluting stents, BVS are associated with higher risk of device thrombosis and target lesion failure,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a> and thus they would probably require longer clinical follow-up and intracoronary imaging control to assess vascular repair and device failure.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In fact, the optimal treatment strategy remains controversial and undetermined, as no randomized trials comparing conservative with revascularization strategies have been carried out. Nevertheless, there is good evidence that the majority of SCAD will first stabilize and then heal completely over time, if managed conservatively.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">9,11–13</span></a> It is recognized that revascularization in SCAD is challenging, because of the presence of an underlying disrupted and friable vessel wall, not infrequently leading to a suboptimal outcome.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">9,12,14</span></a> In stable patients, i.e. those in whom revascularization is not required, a conservative strategy is generally accepted.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">15,16</span></a> Given the current concern about this condition, the European Society of Cardiology has created a SCAD registry, which we expect will help us to improve our knowledge about this subject.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous coronary artery dissection: a single-center case series and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 8 | 13 |
| 2024 October | 25 | 27 | 52 |
| 2024 September | 37 | 25 | 62 |
| 2024 August | 21 | 28 | 49 |
| 2024 July | 26 | 25 | 51 |
| 2024 June | 21 | 17 | 38 |
| 2024 May | 19 | 22 | 41 |
| 2024 April | 18 | 26 | 44 |
| 2024 March | 19 | 22 | 41 |
| 2024 February | 13 | 32 | 45 |
| 2024 January | 24 | 33 | 57 |
| 2023 December | 14 | 18 | 32 |
| 2023 November | 23 | 26 | 49 |
| 2023 October | 14 | 15 | 29 |
| 2023 September | 11 | 23 | 34 |
| 2023 August | 13 | 13 | 26 |
| 2023 July | 10 | 14 | 24 |
| 2023 June | 11 | 11 | 22 |
| 2023 May | 20 | 24 | 44 |
| 2023 April | 17 | 2 | 19 |
| 2023 March | 22 | 17 | 39 |
| 2023 February | 19 | 13 | 32 |
| 2023 January | 15 | 18 | 33 |
| 2022 December | 25 | 27 | 52 |
| 2022 November | 22 | 27 | 49 |
| 2022 October | 28 | 15 | 43 |
| 2022 September | 16 | 30 | 46 |
| 2022 August | 20 | 25 | 45 |
| 2022 July | 17 | 33 | 50 |
| 2022 June | 15 | 20 | 35 |
| 2022 May | 18 | 32 | 50 |
| 2022 April | 32 | 29 | 61 |
| 2022 March | 20 | 33 | 53 |
| 2022 February | 13 | 26 | 39 |
| 2022 January | 12 | 22 | 34 |
| 2021 December | 14 | 22 | 36 |
| 2021 November | 16 | 38 | 54 |
| 2021 October | 19 | 35 | 54 |
| 2021 September | 22 | 23 | 45 |
| 2021 August | 12 | 28 | 40 |
| 2021 July | 10 | 24 | 34 |
| 2021 June | 19 | 17 | 36 |
| 2021 May | 19 | 39 | 58 |
| 2021 April | 24 | 36 | 60 |
| 2021 March | 36 | 15 | 51 |
| 2021 February | 38 | 10 | 48 |
| 2021 January | 21 | 11 | 32 |
| 2020 December | 26 | 9 | 35 |
| 2020 November | 13 | 13 | 26 |
| 2020 October | 12 | 15 | 27 |
| 2020 September | 14 | 6 | 20 |
| 2020 August | 11 | 11 | 22 |
| 2020 July | 14 | 17 | 31 |
| 2020 June | 10 | 22 | 32 |
| 2020 May | 10 | 12 | 22 |
| 2020 April | 7 | 8 | 15 |
| 2020 March | 12 | 20 | 32 |
| 2020 February | 15 | 20 | 35 |
| 2020 January | 15 | 5 | 20 |
| 2019 December | 17 | 9 | 26 |
| 2019 November | 15 | 10 | 25 |
| 2019 October | 7 | 4 | 11 |
| 2019 September | 7 | 7 | 14 |
| 2019 August | 8 | 6 | 14 |
| 2019 July | 6 | 7 | 13 |
| 2019 June | 16 | 13 | 29 |
| 2019 May | 15 | 4 | 19 |
| 2019 April | 16 | 13 | 29 |
| 2019 March | 11 | 12 | 23 |
| 2019 February | 15 | 8 | 23 |
| 2019 January | 17 | 6 | 23 |
| 2018 December | 9 | 13 | 22 |
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