All over the world, functional lesion measurement remains underutilized due to the need for a hyperemic stimulus (which may be avoided with instantaneous wave-free ratio [iFR]) and, above all, the invasiveness of guidewire placement (crossing the intended lesion) for the measurement. These guidewires have improved a lot, but they still lack the navigating capacity of…
TCT 2018 | ULTIMATE: IVUS Guided DES Implantation for All Vessels, for All Lesions
Intravascular Ultrasound (IVUS) guided drug eluting stent (DES) implantation is associated with less adverse events compared against angiography guided stenting. This is especially clear for certain populations (with left main PCI as paradigmatic) but not so clear when dealing with all comers. 1448 all comer patients requiring DES stenting were randomized 1:1 to IVUS guided…
TCT 2018 | SYNTAXES: 10 Year Follow Up is ‘Trendy’
The SYNTAX trial had a 5-year follow-up, but the SYNTAXES (“ES” for extended survival) was specifically designed to find out comparative mortality of both treatments (PCI or surgery) at 10 years in patients with three vessel and/or left main lesions. This study retrospectively compared survival data at long term of 897 patients randomized to surgery…
TCT 2018 | PREPARE-CALC: Rotational Atherectomy vs. Cutting Balloon in Calcified Lesions
Compared against conventional predilation with balloon, rotational atherectomy is associated with higher procedural success rate in severely classified lesions. Balloons capable of modifying plaque such as the Flextome Cutting Balloon or the AngioSculpt Scoring Balloon -among others- could reach similar results to that of rotational atherectomy, though this has not been tested so far. 200…
Stroke Rate after CABG vs PCI in over 10,000 Patients
Repeat revascularization rate has historically been the weak spot of PCI when compared against CABG: we are still unable to compete with a well done internal mammary artery graft connected to the anterior descending artery. However, repeat revascularization is the soft of end points commonly assessed in trials, and even though several studies have shown…
A Simple Trick to Improve Our Transradial Punctures
Transradial access is here to stay; that much has been clear for some time now. However, some operators still resist change and the systematic use of this technique shows great geographical dispersion. Some of its limitations are a difficulty to obtain access and the somewhat frequent occurrence of radial artery occlusion after the procedure. This…
ESC 2018 | ART: Disappointment with Bilateral Internal-Thoracic Artery Grafts After a 10-Year Follow-Up
Published 5-year results had been neutral for bilateral vs. single internal-thoracic artery grafts, but, at the time, surgeons argued that the time period analyzed was not enough and that a difference would be observed after 10 years of follow-up, once the trial finished. Such follow-up was presented at the European Society of Cardiology (ESC) Congress 2018…
SOLACI-SOCIME 2018 | Usefulness of the functional evaluation with iFR and FFR in bifurcations to define PCI
Read articles on the main presentations of the first day of SOLACI-SOCIME 2018 Congress. See the presentation by Dr. Flavio Ribichini, entitled “Usefulness of the functional evaluation with iFR and FFR in bifurcations to define PCI”. We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.
ESC 2018 | FUTURE: A Thorn in FFR and More Questions than Answers
As observed at the preliminary analysis that motivated the FUTURE trial early termination, the use of fractional flow reserve (FFR) to guide revascularization in an unselected population with multivessel disease was associated to twice the mortality rate in one year, with no beneficial impact on other end points. Even though the combined end point of…
What Happens with Small Dissections and Imperfections Only Shown by OCT?
When we carry out an angioplasty guided by angiography alone, as we historically have, we are almost blind. Nowadays, optical coherence tomography (OCT) offers plenty of detail but also raises costs, procedure time, and contrast volume. The question that this study aimed to answer is whether becoming aware of all small defects and imperfections in…
The Dangerous Combination of Complex Angioplasty and High Bleeding Risk Seems to Have a Solution
The LEADERS FREE trial demonstrated that a polymer-free Biolimus A9-coated stent (BioFreedom™DCS; Biosensors Europe, Morges, Switzerland) is superior to a conventional stent (bare metal stent, BMS) in patients with high bleeding risk treated with only one month of dual antiplatelet therapy. Now, is this global study outcome applicable in cases of complex lesions with several…