In patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (primary PCI), multivessel disease is observed in up to 40% of cases. The optimal timing for revascularizing non-culprit lesions in these patients without cardiogenic shock remains a controversial issue. European guidelines recommend completing revascularization during the initial procedure or within 45 days…
ULTIMATE III: Use of IVUS for Coronary De Novo Lesion Drug Coated Balloon Angioplasty
Percutaneous coronary intervention (PCI) with drug eluting stents (DES) can present limitations, especially in the form of stent thrombosis or instent restenosis (ISR). These findings have furthered the development of drub coated balloons (DCB). The safety and efficacy of DCB have already been shown in the context of ISR and de novo small vessel coronary…
Intravascular Lithotripsy: Outcomes and Trends in the Treatment of Calcified Coronary Lesions
Lately, the complexity of percutaneous coronary artery interventions (PCI) has seen an increase, mainly driven by the increasing prevalence of coronary lesion calcification, which represents a significant challenge for interventionists. Untreated calcification might result in insufficient stent expansion, a high risk factor of thrombosis and instent restenosis. Historically, several devices have been used to treat…
Predictors of DCB Failure in De Novo Lesions
Percutaneous coronary intervention (PCI) with drug coated balloons (DCB) is a viable alternative, especially in patients at high risk of bleeding, side-branch lesions in coronary bifurcation, or in small coronary segments. De novo heart disease treated with DCB has been shown non-inferior to conventional DES stenting, according to the PICCOLETO-II trial. However, these interventions are…
Antiplatelet Treatment with Ticagrelor vs. Clopidogrel in Patients with Chronic Coronary Syndrome
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…