Achieving rapid and maximum inhibition of platelet aggregation can reduce complications related to scheduled percutaneous coronary intervention (PCI) in chronic coronary syndromes (CCS). Over the last few decades, the optimal timing for initiating P2Y12 inhibitors and their appropriate dosage have been the subject of numerous studies; however, they have not been clearly established yet. Higher…
Long Term Outcomes of Hyperemic Stenosis Resistance Index (HSR) in Patients with Stable Chronic Angina
The hyperemic stenosis resistance index (HSR) was introduced as a more complete hemodynamic severity indicator of a coronary lesion. HSR combines both pressure drop across a lesion and the flow through it, therefore overcoming the limitations of traditional indices such as fractional flow reserve (FFR) and coronary flow reserve (CFR). The aim of this multicenter…
Pre-Catheterization Fast
It has been generally established that coronary procedures with local anesthesia and moderate sedation minimally require a 6 hour fast for solids and 2 hours for liquids (according to SCAI guidelines 2021). However, complications requiring emergency orotracheal intubation are extremely rare. Prolonged fasting can have adverse effects such as hypoglycemia, insulin resistance, acute renal failure…
REPLICA-EPICA 18 Registry: Using IVL in Calcified Coronary Lesions
The presence of calcification in the coronary arteries (CAC) remains the main challenge in the percutaneous treatment of these lesions. Various studies have demonstrated the association of CAC with unfavorable long-term outcomes. Intravascular lithotripsy (IVL) has emerged as an effective tool for fracturing calcified plaques. Studies evaluating this strategy have shown high device success rates,…
Is Intravascular Lithotripsy Equally Effective in All Coronary Calcification Patterns?
Coronary calcifications pose a complex challenge with a high incidence (25% of all angioplasties), thus implying difficult management and adverse long-term outcomes, such as an increased risk of events, especially the need for repeat revascularization. The main mechanisms of long-term failure include stent underexpansion and, in particular, minimal post-deployment stent area. Intravascular lithotripsy (IVL) has…
EuroPCR 2024 | CALIPSO: CTO vs Angiography Guided Treatment of Calcified Lesions
The presence of calcified lesions worsens percutaneous coronary intervention prognosis, presenting more restenosis, thrombosis and need for new revascularization. The aim of this study was to assess the superiority of CTO with a prespecified management algorithm on a conventional angiography treatment, in addition to assessing CTO safety. A superiority randomized study was carried out including…
EuroPCR 2024 | Influence and Effect of CAD Physiopathological Patterns in the Safety and Efficacy of PCI
Coronary revascularization aims at improving coronary flow. However, after successful percutaneous coronary intervention (PCI) a significant number of patients might experience suboptimal coronary physiology. It has been observed that low fractional flow reserve (FFR) after PCI is associated to poor prognosis. Also, improved FFR after procedure directly correlates with improved angina symptoms. Pullback pressure during…
ACC 2024 | PREVENT Study
The use of intravascular imaging to identify vulnerable plaque (VP) has proven to be very useful, as such plaque is associated with an increase in major adverse cardiac events. Optimal medical treatment is currently considered the standard strategy to stabilize VP. However, the safety and effectiveness of preventive treatment with percutaneous coronary intervention (PCI) in…
Lithotripsy in the “Real World”: REPLICA EPIC-18 Study
Severe persistent calcification of the coronary arteries has been associated with different factors, such as advanced age, hypertension, dyslipidemia, smoking, and kidney failure, among others, and continues to be one of the challenges to stent implantation because of it impact on device advancing, drug release and adequate positioning. Intravascular lithotripsy (IVL) is a technique that…
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…