Individual randomized studies have shown variable results regarding the mortality risk following treatment of left main coronary artery disease (LMCAD), either through percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). However, upon assessment of the latest meta-analyses (with matched data), similar risks of all-cause and cardiovascular mortality have been reported for both groups.…
ISCHEMIA Outcomes: Does Sex Have Any Impact?
We are well aware of CAD physiopathological disparities and how it manifests differently in men and women. The ISCHEMIA study (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) has revealed that during 3.2 years no differences were seen in the incidence of ischemic events when comparing an invasive strategy (INV) vs a…
Use of IVL in Calcified Coronary Lesions in a Real World Population
The presence of calcification in coronary arteries (CAC) remains a challenge for the percutaneous treatment of these lesions. Several studies have established the link between CAC and poor long term results. Intravascular lithotripsy (IVL) has surged as a tool to induce calcified plaque fracture. Even though studies on this strategy are not randomized, they have…
Lithotripsy in the Left Main Coronary Artery
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…
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…
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…
Should We Use Ultrasound Routinely to Guide Transfemoral Access?
Currently, transfemoral access (TFA) is used in large-caliber procedures and when transradial access fails. The introduction of ultrasound (US) to guide access has emerged as a technique that allows for precise channeling, avoiding accesses above or below the inguinal ligament. However, evidence regarding the use of this tool has shown diverse results. Two surveys conducted…
Recurrent Revascularization at 10 Years after Percutaneous Treatment of DES In-Stent Restenosis
In stent restenosis (ISR) continues to be the main limitation to the percutaneous treatment of coronary artery disease, with 5 to 10% prevalence after new generation DES stenting. Guideline recommendations for this intervention include new DES stenting and the use of drug coated balloons (DCB). Recurrent ISR stenting rate ranges between 10 and 40%, and…