A lesion ≥50% in the left main coronary artery (LMCA) is considered severe, according to various scientific societies, regardless of the presence of symptoms or ischemia, due to the extent of myocardium at risk. In such cases, revascularization is indicated. In many patients, lesions in this section of the coronary artery have severe calcification, which…
IN.PACT Outcomes at 5 Years
Over time, percutaneous coronary intervention (PCI) with drug coated balloons (DCB) have been shown more beneficial than conventional PCI. However, in many cases, stenting is required to treat suboptimal results. Even though several studies have looked into this scenario, long term durability still calls for research. This was a 5 year thorough analysis of the…
ERCTO Registry: Current Results for Percutaneous Treatment of Chronic Total Occlusions
Chronic total occlusions (CTO) occur in up to 20% of patients undergoing diagnostic angiographic studies. Over the past two decades, the optimization of recanalization techniques, the development of new specialized devices, and improvement in operator skill have contributed to an increased procedural success rate, reaching 90%. However, specific complications such as collateral perforation and access…
Tricuspid Valve Transcatheter Edge-to-Edge Repair in the “Real World”
Tricuspid valve transcatheter edge-to-edge repair (T-TEER) is currently under development, with an increasing number of conducted procedures. While the TRILUMINATE Study did not reveal benefit regarding major events, it did show improvements in quality of life. In the real world, we encounter numerous patients who do not meet the study criteria but still experience symptoms…
Proximal Optimization Technique in Unprotected LMCA
Proximal optimization technique (POT) has been recommended as a standard strategy in bifurcation lesions because it facilitates proper stent implantation and apposition in the proximal main vessel, according to the European Bifurcation Club. Percutaneous coronary intervention (PCI) of the unprotected left main coronary artery (LMCA) has specific characteristics, and the long-term impact of this strategy…
Use of Transjugular Echocardiography in TAVR
TAVR is a well-established course of treatment, increasingly indicated in lower risk populations. However, one of the challenges associated with self-expanding TAVR, compared against balloon expandable TAVR and SAVR, is the frequent need for definite permanent pacemaker implantation (PPI). High implantation, also known as cusp overlapping (COT), has been shown to reduce the need for…
Post TAVR Long Term Outcomes in Patients with Chronic Inflammatory Disease
Patients suffering from immune-mediated chronic inflammatory disease (CID) face a high risk of developing heart disease, including aortic valve disease. Inflammatory vascular disease when triggered by an autoimmune condition, can prompt a harmful response leading to valve degeneration, with increased calcification and fibrosis, and the associated progression of stenosis, failure or both. Prior research has…
Treatment of Femoropopliteal Lesions with Low-Dose vs. High-Dose Drug-Coated Balloons
The use of drug-covered balloons (DCBs) has increased significantly for the endovascular treatment of femoropopliteal arterial disease. Previous studies on first-generation high-dose DCB (HD-DCB) have validated its benefits, thus supporting its recommendation in current clinical guidelines. However, there have been reports of adverse effects associated with paclitaxel and its excipients. Second-generation, lower-dose DCBs (LD-DCB) have…
Network Meta-Analysis of Complementary Imaging (IVUS/OCT + Conventional Angiography) for Coronary Stenting
Complementary imaging allows for the identification of numerous scenarios not visible with conventional angiography (ICA), both for the assessment of differential diagnoses and the improvement of percutaneous coronary intervention (PCI) outcomes. Advantages include assessment of plaque characteristics, vessel plaque burden, stent edge dissection, vessel diameter, and correct apposition, among others. While intravascular ultrasound (IVUS) was…
Use of Intravascular Lithotripsy in Left Main
The Left main coronary artery supplies circulation to roughly 70% of myocardium, and left main disease requires a high risk intervention with significant impact on patient prognosis. The current guidelines have set the threshold for intervention in LM disease at ≥50% stenosis, irrespective of the presence of symptoms or ischemic burden. LM calcification is an…