Infiltrative diseases (ID) consist of a heterogeneous series of genetic conditions that cause infiltration and extracellular deposits which alter the diverse systems and organs affected. Amyloidosis, sarcoidosis and hemochromatosis affect the heart, altering the myocardium and the conduction system. PCI is often used at present to treat heart disease, and some of these patients present…
KODRA Registry: Distal Radial Access as First Choice in Coronary Procedures
The first experiences with distal radial access (DRA) have revealed significant benefits compared against the transradial approach (TRA), showing reduced bleeding events and better puncture site occlusion rate. Even the spectrum of diseases treated with DRA has grown, and now includes chronic total occlusion (CTO) though 7Fr inductors, such as Terumo’s Glidesheath Slender. The aim…
Sub-Analysis of the REVIVED-BCIS2: Myocardial Viability Changes Prognosis in Ischemic Cardiomyopathy Revascularization?
The purpose of myocardial viability testing is to identify patients that might benefit from revascularization by diagnosing three types of myocardium: normal, viable or hibernating, and scarred (non-viable). Non-randomized studies have shown recovery of a viable ventricle after myocardial revascularization surgery (CABG) and improved survival. However, a sub-analysis of the main study on viability testing,…
Preparation Before Elective Coronary Angiography: Is Prolonged Fasting the Only Option?
When scheduling a coronary angiography, patients are usually instructed to fast for at least 8 hours (no oral intake after dinner). However, this strategy can lead to negative effects such as discomfort, irritability, dehydration, and even hypoglycemia in some cases. Previous studies have not shown significant differences in gastric complications between patients fasting only 2 hours before…
Contemporary Outcomes of CTO PCI in Europe: The ERCTO Registry
Roughly 20% or coronary angiographies show some form of chronic total occlusion (CTO), and this figure is twice as high for diabetic patients or those with cardiac failure and reduced ejection fraction (EF). CTO percutaneous intervention (PCI) has experienced a significant growth thanks to the development of new techniques and dedicated material. However, a considerable…
Should We Treat Obstructive Coronary Artery Disease in TAVI?
Coronary artery disease, both obstructive and non-obstructive, often coexists with significant aortic stenosis. Therapeutic decision-making in this scenario remains controversial, not only regarding the need for treatment, but also about when it should be addressed, considering its pros and cons. Various analyses have yielded contradictory data, as most lesions are chronic and stable. Currently, the…
Events According to Revascularization Modality in the ISCHEMIA Trial
The main studies carried out on patients with chronic coronary syndromes (CCS), such as the MASS II, COURAGE, BARI 2D and FAME-2, failed to show benefits in terms of mortality with the invasive approach. The ISCHEMIA, a large randomized study including patients with moderate to severe ischemia, with without left main disease and with acceptable…
Coronary Artery Disease in TAVR: Unsolved Dilemma
Aortic stenosis shares risk factors with coronary artery disease (CAD), and its prevalence varies according to age, reaching approximately 50% or more in some registries. Deciding when to treat and the need for percutaneous intervention presents a challenge. It has been established that epicardial stenosis at proximal level, or the medial segment, requires intervention, especially…
Clopidogrel Monotherapy Beyond 12 months: Long Term Analysis of the STOPDAPT-2
Short dual antiplatelet therapy (DAPT) has shown benefits in patients receiving drug eluting stents (DES), reducing bleeding with no concomitant increase in major adverse cardiovascular events (MACE). Traditionally, the therapeutic window was limited to monotherapy with P2Y12 inhibitors during the first year and there are few data on short DAPT followed by long term monotherapy…
Relationship of Radial Wall Strain with Functional and Morphological Assessment of Coronary Artery Lesions
Radial wall strain (RWS) has been recently linked with plaque vulnerability and has been identified as a predictor of lesion progression and clinical outcomes. However, RWS should be assessed together with physiological indices and plaque characteristics. The aim of this post hoc analysis of the CCTA-FFR registry was to look into the link between RWS…
Use of Intravascular Lithotripsy vs. Rotational Atherectomy for Severely Calcified Coronary Lesions
Severely calcified coronary stenosis poses a significant challenge for coronary angioplasty procedures. Modifying plaque before stenting is crucial to a successful intervention, since it will prevent the sub expansion associated to worse clinical outcomes at followup. The tools employed to assess complex lesions include specialized balloons such as cutting, scoring, or high pressure balloons, as…