Compartilhar
Informação da revista
Vol. 37. Núm. 11.
Páginas 873-960 (Novembro 2018)
Compartilhar
Compartilhar
Baixar PDF
Mais opções do artigo
Vol. 37. Núm. 11.
Páginas 873-960 (Novembro 2018)
Letter to the Editor
DOI: 10.1016/j.repc.2018.10.006
Open Access
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?»
Visitas
267
Glória Abreu
Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
Conteúdo relacionado
Rev Port Cardiol 2018;37:953-510.1016/j.repc.2018.08.005
Dario Buccheri
Este item recebeu
267
Visitas

Under a Creative Commons license
Informação do artigo
Texto Completo
Bibliografia
Baixar PDF
Estatísticas
Texto Completo
Dear Editor,

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”.1

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.

As the author pointed out, SCAD remains an underdiagnosed entity.2 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.

We analyzed with great interest the scoring system proposed and tested by Buccheri et al.,3,4 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.5,6 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.7,8 Indeed, technical failure of percutaneous coronary intervention may occur in up to half of patients with SCAD.9 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,10 and thus they would probably require longer clinical follow-up and intracoronary imaging control to assess vascular repair and device failure.

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.9,11–13 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.9,12,14 In stable patients, i.e. those in whom revascularization is not required, a conservative strategy is generally accepted.15,16 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.

Conflicts of interest

The author has no conflicts of interest to declare.

References
[1]
G. Abreu, C. Galvão Braga, J. Costa, et al.
Spontaneous coronary artery dissection: a single-center case series and literature review.
Rev Port Cardiol, 37 (2018), pp. 707-713
[2]
M.S. Tweet, R. Gulati, S.N. Hayes.
Spontaneous coronary artery dissection.
Curr Cardiol Rep, 18 (2016), pp. 60
[3]
D. Buccheri, D. Piraino, G. Andolina.
Score system approach to diagnose and manage spontaneous coronary artery dissection.
Rev Esp Cardiol, 69 (2016), pp. 878-879
[4]
D. Buccheri, D. Piraino, B. Cortese.
Intravascular imaging as a tool for definite diagnosis of acute coronary syndrome caused by spontaneous coronary artery dissection.
Int J Cardiol, 214 (2016), pp. 43-45
[5]
A. Ielasi, B. Cortese, G. Tarantini, et al.
Sealing spontaneous coronary artery dissection with bioresorbable vascular scaffold implantation: data from the prospective “Registro Absorb Italiano” (RAI Registry).
Int J Cardiol, 212 (2016), pp. 44-46
[6]
B. Cortese, P. Silva Orrego, P. Agostoni, et al.
Effect of drug-coated balloons in native coronary artery disease left with a dissection.
JACC Cardiovasc Interv, 8 (2015), pp. 2003-2009
[7]
D. Adlam, F. Afonso, A. Maas, et al.
European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection.
Eur Heart J, 39 (2018), pp. 3353-3368
[8]
S.N. Hayes, E.S.H. Kim, J. Saw, et al.
Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association.
Circulation, 137 (2018), pp. e523-e557
[9]
M.S. Tweet, M.F. Eleid, P.J. Best, et al.
Spontaneous coronary artery dissection: revascularization versus conservative therapy.
Circ Cardiovasc Interv, 7 (2014), pp. 777-786
[10]
R. Pavasini, M. Serenelli, F. Gallo, et al.
Effectiveness and safety of the ABSORB bioresorbable vascular scaffold for the treatment of coronary artery disease: systematic review and meta-analysis of randomized clinical trials.
J Thorac Dis, 9 (2017), pp. S887-S897
[11]
J. Saw, E. Aymong, T. Sedlak, et al.
Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes.
Circ Cardiovasc Interv, 7 (2014), pp. 645-655
[12]
S. Rogowski, M.T. Maeder, D. Weilenmann, et al.
Spontaneous coronary artery dissection: angiographic follow-up and long-term clinical outcome in a predominantly medically treated population.
Catheter Cardiovasc Interv, 89 (2017), pp. 59-68
[13]
F. Alfonso, M. Paulo, V. Lennie, et al.
Spontaneous coronary artery dissection: long-term follow-up of a large series of patients prospectively managed with a “conservative” therapeutic strategy.
JACC Cardiovasc Interv, 5 (2012), pp. 1062-1070
[14]
C. Lettieri, D. Zavalloni, R. Rossini, et al.
Management and long-term prognosis of spontaneous coronary artery dissection.
Am J Cardiol, 116 (2015), pp. 66-73
[15]
J. Saw, G.B. Mancini, K.H. Humphries.
Contemporary review on spontaneous coronary artery dissection.
J Am Coll Cardiol, 68 (2016), pp. 297-312
[16]
A. Al-Hussaini, D. Adlam.
Spontaneous coronary artery dissection.
Heart, 103 (2017), pp. 1043-1051
Copyright © 2018. Sociedade Portuguesa de Cardiologia
Idiomas
Revista Portuguesa de Cardiologia

Receba a nossa Newsletter

Opções de artigo
Ferramentas
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.