Aortic stenosis is associated to significant coronary artery disease (CAD) in nearly 50% of cases. When we decide to treat aortic disease using surgery, it has been established we should also treat heart disease. However, when using transcatheter aortic valve replacement (TAVR), this is still unclear, given that in many occasions we see stable lesions…
Combined Calcified Lesion Preparation Strategy
Stent sub-expansion in coronary territory has been identified as one of the major predictors of stent failure at followup, which is why improving stent expansion will improve clinical and imaging outcomes. In percutaneous coronary interventions (PCI) of severely calcified lesions, calcified lesions present a major challenge since they impede stent delivery, causing stent under-expansion or…
Is Clopidogrel Monotherapy Safe After a Month of Dual Antiplatelet Therapy in Diabetic Patients?
Currently, many randomized studies have suggested that short-term dual antiplatelet therapy (DAPT) followed by monotherapy reduces bleeding without increasing major cardiovascular events after percutaneous coronary intervention (PCI). A meta-analysis of six randomized studies has shown this benefit using ticagrelor monotherapy after short DAPT. However, there is no data on the results of clopidogrel monotherapy. Researchers…
A Meta Analysis of Distal Transradial Access vs. Conventional Transradial
Transradial access is currently the preferred access for diagnostic and therapeutic interventions. However, about 7% of patients experience radial artery occlusion (RAO), which is not expressed by clinical symptoms. However, RAO is a limit for future interventions; it reduces the potential use of that artery as a conduit for aorto-coronary bypass and for the creation…
P2Y12 Inhibitor Monotherapy vs Aspirin: Results of a Network Meta-Analysis
Revascularization and antiaggregation guidelines have typically recommended aspirin (AAS) as first choice for secondary prevention of cardiovascular events after DES stenting. However, these past few years this strategy has been called into question, seeing as studies have shown the superiority of P2Y12 inhibitor monotherapy (IP2Y12) with clopidogrel or ticagrelor. There is little data comparing both…
Post PCI FFR
Much research has been done on the usefulness of functional testing such as fractional Flow reserve (FFR) after percutaneous coronary intervention (PCI), resulting in the correlation of pathological FFR values with major adverse events at 6 months, as shown by Pijls, et al. The impact of post PCI FFR on prognosis has not been studied…
Trans-Stent Gradient as a Predictor of Adverse Events at Followup
Stenting a coronary lesion should not present a drop in pressure when measuring the treated segment with fractional flow reserve (FFR). FFR based trans-stent gradient should involve a segment of the sub-expanded vessel or instent obstruction as plaque prolapse or thrombus. The link between post-stenting physiology and long-term outcomes have been looked at in several…
Patients with INOCA in the ISCHEMIA Trial
There has been an increase in the diagnosis of patients with proven ischemia who did not present obstructive coronary lesions (defined as the absence of stenosis ≥50%), called ischemia with non-obstructive coronary arteries (INOCA). These patients are at a higher risk for major adverse cardiac events (MACE) compared with the rest of the population. The…
Devices to Prepare Severely Calcified Lesions: Is There a Difference When Assessed by Intravascular Imaging?
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…
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 | 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.…