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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I read with great interest the single-center experience on spontaneous coronary artery dissection &#40;SCAD&#41; recently published by Abreu and colleagues in this journal&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> The authors reported a case series consisting of 27 patients&#44; admitted to the cardiology department between January 2010 and December 2016&#44; with a diagnosis of acute coronary syndrome &#40;ACS&#41; due to ongoing SCAD&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence of SCAD was 0&#46;5&#37; among patients who underwent catheterization for suspected ACS &#40;15 NSTEMI&#44; 10 STEMI and two sudden cardiac arrest&#41;&#46; Most were women &#40;22 F&#58;5 M&#41; and the cohort&#39;s median age was 56&#177;11 years&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Patient characteristics and clinical presentation with predisposing factors were reported in Table 1 of the article&#46; They were managed mainly in a conservative manner &#40;15 medical therapy vs&#46; 12 PCI&#41;&#46; It is not insignificant that four of the 15 patients managed conservatively had a myocardial infarction on follow-up and in two of these the initial treatment was modified&#44; requiring a switch to coronary angioplasty&#44; with no cases of stent thrombosis at follow-up&#46; A close clinical follow-up with optical coherence tomography &#40;OCT&#41; for PCI-managed cases was recommended&#46; Prognosis was good despite the high prevalence of reinfarction in-hospital or during follow-up&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Considering the high level of interest in this subject&#44; the European Society of Cardiology&#44; in partnership with the Acute Cardiovascular Care Association&#44; has established a European SCAD registry as a platform for collaborative research with the aim of improving awareness of the condition for better management&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Here I would like to put forward some food for thought that could be useful and interesting for the <span class="elsevierStyleItalic">Journal</span>&#39;s readers&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Of note&#44; Abreu et al&#46; remarked that SCAD is still an underestimated entity due to the challenging diagnosis&#44; in which a high degree of clinical suspicion plays a key role&#46; In this regard&#44; I would like to underline that emerging evidence shows that this underestimation is mainly due to the absence of the classic angiographic hallmarks&#44; which are lacking in &#62;70&#37; of angiographies<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> and may be discovered only by intravascular imaging&#44; namely OCT and intravascular ultrasound &#40;IVUS&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Considering the high rate of misdiagnosed SCAD&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#8211;6</span></a> an interesting and useful score system &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41; was previously published and tested<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6&#8211;8</span></a> allowing interventionists to select suspected cases in which intravascular imaging&#44; particularly OCT&#44; as the first choice&#44; thanks to its higher spatial resolution &#40;about 10 times greater than IVUS&#44; which represents the second line&#41; could identify the presence of SCAD&#44; thus reducing the time to obtain the correct diagnosis and initiate appropriate therapy&#46; The score is in the process of statistical validation on a larger cohort&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Moreover&#44; SCAD management remains challenging because of the lack of evidence supporting standard medical therapy&#44; and the role of percutaneous or surgical revascularization is strongly debated&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">4&#44;5&#44;9</span></a> Abreu et al&#46; state that&#44; when necessary&#44; a long stent or two stents were implanted&#44; preventing the extension of intramural hematoma caused by stent compression against the vessel wall&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Conservative management &#40;medical therapy&#41; with aspirin&#44; P2Y<span class="elsevierStyleInf">12</span> inhibitors&#44; beta-blockers and statins is the preferred option according to a recently published experience-based survey&#46; Alternatively&#44; our group suggested invasive treatment with implantation of a drug-eluting stent or a bioresorbable scaffold &#40;BRS&#41; in cases of dissection involving vessels of &#8805;3 mm diameter or proximal vessel segments&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In my opinion&#44; and following our experience<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6&#8211;8&#44;10&#44;11</span></a> and the recent literature&#44;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">12&#44;13</span></a> these patients are eligible for bioresorbable scaffolding that allows vessel sealing&#44; in consideration of the typical absence of atherosclerotic plaque rupture and the young age of most subjects affected&#44; as in the cases reported&#44; thus avoiding a permanent metal prosthesis&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion&#44; our clinical-angiographic score could have helped provide the correct diagnosis&#44; especially in challenging cases&#44; thus allowing effective therapy that in my opinion should have been invasive&#44; preferably with BRS implantation&#44; considering the clinical presentation of ACS and for lesions longer than 3 mm or involving the proximal segment of coronary arteries&#44; in view of the risk of potentially life-threatening complications that could have occurred in young people like the patients of the case series reported&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Letter to the Editor
Focus on spontaneous coronary artery dissection: Where are we now?
Foco na disseção espontânea da artéria coronária: Onde estamos agora?
Dario Buccheri
Interventional Cardiology, “S. Antonio Abate” Hospital, Via Cosenza, 80, 91016 Erice (TP), Italy
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              "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Panel A&#58;</span> Coronary angiography from patient 8 &#8211; spontaneous coronary artery dissection &#40;SCAD&#41; type 1&#44; extending from left main coronary artery to left anterior descending artery &#40;LAD&#41;&#46; <span class="elsevierStyleBold">Panel B&#58;</span> Coronary angiography from patient 8 showing the result obtained after guidewire advancement to the true LAD lumen&#46; <span class="elsevierStyleBold">Panel C&#58;</span> Coronary angiography from patient 11 showing diffuse lumen narrowing involving the proximal and mid segments of right coronary artery &#8211; SCAD type 2&#46; <span class="elsevierStyleBold">Panel D&#58;</span> Coronary angiography from patient 11 showing the angiographic result after stent implantation&#46; <span class="elsevierStyleBold">Panels E-F</span>&#58; Optical coherence tomography from patient 22 of distal segment of right coronary artery&#44; depicting intramural hematoma &#40;asterisk&#41;&#46; <span class="elsevierStyleBold">Panels G-H&#58;</span> Cross-sectional intravenous ultrasound views from patient 9 depicting intramural hematoma &#40;asterisk&#41; causing luminal stenosis in the mid-LAD&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flowchart for the diagnosis and management of spontaneous coronary artery dissection&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a></p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I read with great interest the single-center experience on spontaneous coronary artery dissection &#40;SCAD&#41; recently published by Abreu and colleagues in this journal&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> The authors reported a case series consisting of 27 patients&#44; admitted to the cardiology department between January 2010 and December 2016&#44; with a diagnosis of acute coronary syndrome &#40;ACS&#41; due to ongoing SCAD&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence of SCAD was 0&#46;5&#37; among patients who underwent catheterization for suspected ACS &#40;15 NSTEMI&#44; 10 STEMI and two sudden cardiac arrest&#41;&#46; Most were women &#40;22 F&#58;5 M&#41; and the cohort&#39;s median age was 56&#177;11 years&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Patient characteristics and clinical presentation with predisposing factors were reported in Table 1 of the article&#46; They were managed mainly in a conservative manner &#40;15 medical therapy vs&#46; 12 PCI&#41;&#46; It is not insignificant that four of the 15 patients managed conservatively had a myocardial infarction on follow-up and in two of these the initial treatment was modified&#44; requiring a switch to coronary angioplasty&#44; with no cases of stent thrombosis at follow-up&#46; A close clinical follow-up with optical coherence tomography &#40;OCT&#41; for PCI-managed cases was recommended&#46; Prognosis was good despite the high prevalence of reinfarction in-hospital or during follow-up&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Considering the high level of interest in this subject&#44; the European Society of Cardiology&#44; in partnership with the Acute Cardiovascular Care Association&#44; has established a European SCAD registry as a platform for collaborative research with the aim of improving awareness of the condition for better management&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Here I would like to put forward some food for thought that could be useful and interesting for the <span class="elsevierStyleItalic">Journal</span>&#39;s readers&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Of note&#44; Abreu et al&#46; remarked that SCAD is still an underestimated entity due to the challenging diagnosis&#44; in which a high degree of clinical suspicion plays a key role&#46; In this regard&#44; I would like to underline that emerging evidence shows that this underestimation is mainly due to the absence of the classic angiographic hallmarks&#44; which are lacking in &#62;70&#37; of angiographies<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> and may be discovered only by intravascular imaging&#44; namely OCT and intravascular ultrasound &#40;IVUS&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Considering the high rate of misdiagnosed SCAD&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#8211;6</span></a> an interesting and useful score system &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41; was previously published and tested<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6&#8211;8</span></a> allowing interventionists to select suspected cases in which intravascular imaging&#44; particularly OCT&#44; as the first choice&#44; thanks to its higher spatial resolution &#40;about 10 times greater than IVUS&#44; which represents the second line&#41; could identify the presence of SCAD&#44; thus reducing the time to obtain the correct diagnosis and initiate appropriate therapy&#46; The score is in the process of statistical validation on a larger cohort&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Moreover&#44; SCAD management remains challenging because of the lack of evidence supporting standard medical therapy&#44; and the role of percutaneous or surgical revascularization is strongly debated&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">4&#44;5&#44;9</span></a> Abreu et al&#46; state that&#44; when necessary&#44; a long stent or two stents were implanted&#44; preventing the extension of intramural hematoma caused by stent compression against the vessel wall&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Conservative management &#40;medical therapy&#41; with aspirin&#44; P2Y<span class="elsevierStyleInf">12</span> inhibitors&#44; beta-blockers and statins is the preferred option according to a recently published experience-based survey&#46; Alternatively&#44; our group suggested invasive treatment with implantation of a drug-eluting stent or a bioresorbable scaffold &#40;BRS&#41; in cases of dissection involving vessels of &#8805;3 mm diameter or proximal vessel segments&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In my opinion&#44; and following our experience<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6&#8211;8&#44;10&#44;11</span></a> and the recent literature&#44;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">12&#44;13</span></a> these patients are eligible for bioresorbable scaffolding that allows vessel sealing&#44; in consideration of the typical absence of atherosclerotic plaque rupture and the young age of most subjects affected&#44; as in the cases reported&#44; thus avoiding a permanent metal prosthesis&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion&#44; our clinical-angiographic score could have helped provide the correct diagnosis&#44; especially in challenging cases&#44; thus allowing effective therapy that in my opinion should have been invasive&#44; preferably with BRS implantation&#44; considering the clinical presentation of ACS and for lesions longer than 3 mm or involving the proximal segment of coronary arteries&#44; in view of the risk of potentially life-threatening complications that could have occurred in young people like the patients of the case series reported&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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ISSN: 08702551
Idioma original: Inglês
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2021 Setembro 29 31 60
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2021 Julho 16 20 36
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2021 Maio 34 26 60
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2021 Fevereiro 50 15 65
2021 Janeiro 27 10 37
2020 Dezembro 30 6 36
2020 Novembro 14 21 35
2020 Outubro 17 10 27
2020 Setembro 15 14 29
2020 Agosto 13 6 19
2020 Julho 27 18 45
2020 Junho 22 9 31
2020 Maio 19 7 26
2020 Abril 20 26 46
2020 Maro 19 10 29
2020 Fevereiro 81 19 100
2020 Janeiro 20 12 32
2019 Dezembro 45 9 54
2019 Novembro 16 6 22
2019 Outubro 18 3 21
2019 Setembro 96 10 106
2019 Agosto 10 3 13
2019 Julho 19 12 31
2019 Junho 18 9 27
2019 Maio 15 9 24
2019 Abril 15 10 25
2019 Maro 12 11 23
2019 Fevereiro 12 9 21
2019 Janeiro 26 12 38
2018 Dezembro 45 33 78
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