Most randomized studies on decision-making in coronary artery disease revascularization exclude left main coronary artery disease (LMCAD), as did the ISCHEMIA Study. On the other hand, the benefits of functionally assessing lesions, proven in studies such as FAME, emphasize the importance of this tool in guiding revascularization decisions. However, there is still little understanding of…
Can Ultrasound Treat Aortic Stenosis?
Severe calcified aortic stenosis is a common condition that can currently be effectively treated with SAVR or TAVR. However, some patients, given comorbidities or anatomical characteristics, are not good candidates for these therapeutic alternatives. The non-invasive ultrasound therapy (NIUT) has surged as viable alternative. It claims ultrasound might act on calcified valves, and mobilize tissue…
Is AS Only Important When Severe?
Aortic stenosis (AS) is a progressive disease associated with morbidity and mortality, especially in severe cases. However, recent studies have revealed that moderate stenosis can also have unfavorable consequences in the course of the disease. One of the challenges lies in that determining its severity is sometimes difficult due to discrepancies between valve area, gradient,…
Low Gradient, Normal Flow Aortic Stenosis: Changes in Quality of Life with TAVR
There is no question as regards the recommended treatment for symptomatic severe aortic stenosis, seeing as both transcatheter and surgical aortic valve replacement (TAVR and SAVR) have shown to significantly improve prognosis. This is despite the fact that there is still certain ambiguity around its characterization, which looks to define it according to hemodynamic severity…
ROTACUT Study: Rotational Atherectomy with Cutting Balloon for Stent Expansion Optimization
Approximately 30% of patients undergoing percutaneous coronary intervention (PCI) present moderate to severe calcified lesions, which presents a significant challenge involving a high incidence of major adverse cardiovascular events (MACE). Rotational atherectomy (RA) is used to modify these calcified lesions and facilitate balloon angioplasty followed by stent implantation. The combination of RA with other plaque…
Drug-Coated Balloons (DCB): Sirolimus vs. Paclitaxel in De Novo Lesions in Small Vessels
The use of drug-coated balloons (DCB) offers the advantage of avoiding permanent stent implants, thus reducing the incidence of in-stent restenosis (ISR), neoatherosclerosis, and late in-stent thrombosis. Additionally, the use of DCB reduces the duration of dual antiplatelet therapy. Current evidence supports the use of DCB for ISR treatment (Class I) compared with drug-eluting stents…
Cilostazol in Diabetic Patients with Endovascular Peripheral Revascularization: One Step Beyond Symptom Improvement
In patients with peripheral vascular disease (PVD), the presence of diabetes has been significantly associated with increased failure of critical lower limb ischemia (CLI) treatment, and higher incidence of amputation. This relationship has been attributed mainly to comorbidities and patient characteristics, concomitant peripheral neuropathy and marked microvascular alteration. Also, a high proportion of these patients…
Is Coronary Lithotripsy as Effective as Rotational Atherectomy?
Severely calcified lesions currently pose a significant challenge, as they require adequate preparation through non-compliant balloons or cutting balloons to achieve effective stent expansion. Another option is the use of orbital or rotational atherectomy (RA), but this carries the risk of complications such as slow/no reflow, perforations, dissections, peri-procedural infarction, or guidewire rupture. Despite the…
Optimal Duration of DAPT with Oral Anticoagulation After PCI?: 1 Month vs. 3 Months
While the benefits of dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor are recognized, its primary complication is the occurrence of bleeding events, which negatively impact patient morbidity and mortality. Additionally, about 10% of patients undergoing percutaneous coronary intervention (PCI) are on oral anticoagulant therapy, which significantly increases the risk of bleeding when…
Stentless Strategy in ACS: Perfusion and Drug Coated Balloons
The initial strategy for the treatment of patients at high risk of bleeding (HBR) after percutaneous coronary intervention (PCI) has consisted of a short dual antiaggregation therapy (DAPT). Stents continue to improve, which has allowed the reduction of DAPT schemes and therefore the incidence of bleeding. However, researchers are also looking into another strategy to…