Since the last version of the European guidelines on the diagnosis and treatment of peripheral arterial disease in 2011, there have been many trials and registries that warrant guideline adjustments in many aspects. The first novelty is the teamwork that gave way to these guidelines, which were written in collaboration with the European Society of Vascular Surgery. The result was a document that balances the opinions of the best general practitioners, surgeons, and interventional cardiologists.
Critical ischemia is the most advanced form of peripheral arterial disease, and it is characterized by ischemic rest pain and ulcers or gangrene. Revascularization is obviously positioned as the first-line treatment, and guidelines recommend both possible strategies (surgery or angioplasty) largely based on the findings of the BASIL trial (British Angioplasty versus Surgery in Ischemic Legs).
After several trials with neutral outcomes, renal denervation had been demoted for some time. However, this new study presented at EuroPCR 2018 and simultaneously published in the LANCET brings back the technique with improved devices that seem to yield improved outcomes.
Patients eligible for this study suffered from hypertension, had been treated with up to 2 drugs, and presented a daytime ambulatory blood pressure ≥135/85 mmHg and less than 170/105 mmHg after a 4-week washout period.
Should the Antithrombotic/antiplatelet therapy following 10.0 by 60 mm stent implantation to the subclavian vein of a chronic kidney patient be the same as one following a 3.0 by 18 mm stent implantation to the second segment of the left anterior descending artery of this same patient? The daily practice of many interventional cardiologists performing these procedures says it should. However, this new consensus brings up completely deferent data that is worth looking into.
While the endovascular repair of aortic aneurysms has steadily become the number one option for aneurysms in which necks are adequate and which meet the specifications of device manufacturers. New technologies have arisen. These advancements allowed the expansion of this indication to more complex anatomies, such as those involving a short neck, no neck, or visceral branches.
This study shows the benefit of reducing waiting time between acute events and intervention in patients with severe symptomatic carotid stenosis. Its outcomes support the efforts to reduce patient management. Moreover, it could be used as an indicator of clinical practice quality.
The prevalence of peripheral arterial disease is between 15% and 20% of patients older than 65 years and its severity is greatly underestimated. In fact, annual mortality is higher in patients with peripheral arterial disease (8.2%) than in those after acute myocardial infarction (6.3%). Despite the above, medical advice and efforts to modify risk factors are far below those observed in those with coronary heart disease or stroke.
9- TCT 2018 | IMPERIAL: First Study Comparing Drug-Eluting Stents in Patients with Femoropopliteal Disease
The IMPERIAL trial compared the safety and efficacy of a nitinol self-expanding polymer-free placlitaxel-eluting stent (Zilver PTX, Cook Medical, already approved by the US Food and Drug Administration [FDA]) and a nitinol self-expanding polymer-coating placlitaxel-eluting stent (Eluvia, Boston Scientific).
Endovascular revascularization has become the main strategy for symptomatic patients with peripheral arterial disease in femoropopliteal territory. Conventional balloon angioplasty is effective in gaining lumen but has a restenosis rate to up 60% at 12 months. Implantation of conventional stents reduced restenosis to almost half, but presented problems such as thrombosis, stent fracture and difficulty in treating areas of flexion.
This four-year retrospective analyzis has shown that contrast enhanced ultrasound based follow up protocol post endovascular aortic repair is safe and effective. Aneurysm related mortality, reintervention rate, sac retraction and endoleak detection resulted similar to that of CT based follow up protocols.
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