Severely calcified coronary lesions are found in 25% of patients undergoing PCI, and their presence has a negative impact in long term outcomes. These lesions difficult stent expansion and increase device failure rate, even when using the latest generation of drug eluting stents (DES). This is why there is an interest in lesion preparation strategies…
Should We Start Using Ultra-Thin Struts?
The benefits of DES are well known, as well as the benefits of more recent polymer-based DES versions (even those with no polymers). However, strut size is no small matter, and might even make the difference, seeing as thinner struts are associated to better deliverability, simpler crossing profile in bifurcations, better endothelization and healing. Besides,…
Calcified Lesions: CTO Strategies for Plaque Preparation
Vascular calcification is a predictor of difficult stent positioning and expansion, which increases the chance of device failure (even with last generation stents). Calcium modifying strategies are being developed to reduce these difficulties. Two recent randomized studies compare different calcium preparation devices. The PREPARE-CALC compares rotational atherectomy (RA) against plaque modifying balloons (PMB = cutting…
TCT 2022 | PCSK9 Inhibitor in Patients with STEMI to Lower LDL Cholesterol
In patients with ST-elevation myocardial infarction (STEMI), early treatment with statins —regardless of low-density lipoprotein (LDL) cholesterol levels — is routine around the world. Adding a potent LDL lowering agent, as a PCSK9 inhibitor, has proven clinical benefits in patients with a history of acute coronary syndrome or atherosclerosis, since treatment with statins have not…
TCT 2022 | Angioplasty vs. Surgery: The BEST Study Long-Term Results
The BEST study was a prospective, randomized study to compare percutaneous coronary intervention (PCI) with everolimus-eluting stents vs. myocardial revascularization surgery (MRS) in patients with multivessel disease. The analysis was interrupted early due to slow patient inclusion. The study included 880 patients, who were randomized 438 to the PCI arm and 442 to the MRS arm.…
TCT 2022 | FAME-3 Trial: post PCI FFR And IVUS in Patients with Three-Vessel Disease
We are well aware of the benefits of Fractional Flow Reserve (FFR) to assess coronary artery stenosis. FFR after PCI (post-PCI FFR) has been shown to have prognostic value; however, few studies have included patients with complex three-vessel disease. The impact of intravascular ultrasound (IVUS) or optical computer tomography (OCT) in this field has been…
TCT 2022 | BYPASS CTCA
Studies have shown that the use of computed tomography cardiac angiography (CTCA) prior invasive coronary angiography (ICA) in patients with prior cardiac artery bypass graft (CABG) might reduce procedural time and post procedure kidney injury. 1 out of 5 patients with ischemic cardiomyopathy and prior CABG need to be assessed with ICA within 3 years…
TCT 2022 | PROTECTED TAVR
Stroke is still a major complication of transcatheter aortic valve replacement (TAVR), with a 30-day mortality of 16.7%. Even in the absence of symptoms, most patients (68-93%) have some type of diffusion imaging defect after TAVR implantation. The Sentinel cerebral protection device (CPD) (Boston Scientific) received FDA approval for the capture of emboligenic material that…
TCT 2022 | CLASP II D TRIAL: Transcatheter Edge-to-Edge Repair for Mitral Regurgitation in Patients at Prohibitive Risk
The CLASP IID study was a prospective randomized study to assess the efficacy and effectiveness of the PASCAL transcatheter valve repair system compared with the MitraClip device for patients with degenerative mitral regurgitation (MR) at prohibitive surgical risk. The study included Patients at prohibitive surgical risk, candidates for both devices, with MR 3+ to 4+,…
TCT 2022 | AMULET IDE: Events at 3 Years Using the AMULET Appendage Closure Device
The aim of this study was to assess the 3-year efficacy for the endpoints of the AMULET Occluder (Abbott) left atrial appendage closure device compared with the Watchman 2.5 device. The evaluated endpoints were analyzed according to a “per protocol” population, assessing a composite of stroke, systemic embolism, or cardiovascular death. The secondary endpoints were…