Coronary microvascular dysfunction (CMD) is a paramount factor involved in the development of anginal syndromes. Among patients with angina and nonobstructive coronary artery disease with CMD, two patterns have been identified using minimal microvascular resistance: structural CMD, and functional CMD. Structural CMD is characterized by decreased coronary flow reserve (CFR) in the presence of increased…
Hand Function after Distal Radial Access: Is it Safe?
The benefit of the transradial approach in percutaneous interventions is well known. Its main limitation is radial artery occlusion (RAO) which would compromise the artery for future use in percutaneous procedures. Even though it is clinically silent, reported cases might reach 33%. More recently, the distal radial access (DRA) has surged as an alternative to…
FFR and IFR: Are We Talking About the Same Thing?
To evaluate borderline coronary lesions (a 40% to 70% obstruction), determining associated ischemia is paramount. For this purpose, pressure gradients are measured across the stenosis. These measurements can be hyperemic, such as the fractional flow reserve (FFR), or taken at rest, such as the instantaneous wave-free ratio (iFR). According to the iFR-SWEDEHEART 5-year follow-up outcomes,…
Improved Ventricular Function Post Revascularization: Fewer Events across Subgroups?
According to the STITCH and STITCHES trials, in patients with coronary artery disease and deteriorated left ventricular ejection fraction (EF), revascularization of a viable heart might reverse left ventricular systolic dysfunction. In these patients, improved EF after coronary revascularization appears to increase long term survival, particularly after cardiac artery bypass grafting (CABG), compared against medical…
Can the Use of Intra Arterial Vasodilators Prevent Radial Artery Occlusion?
The incidence of post procedure radial occlusion (RAO) ranges from 1% to 12 % according to some studies. Different strategies to reduce RAO include the use of small caliber catheters, adequate anticoagulation and punction site care after procedure. Vasodilators are used to prevent radial spasm during procedure. However, using it after procedure should increase flow,…
In Multivessel Disease, When Should Renal Impairment Be Considered?
Cardiovascular disease is one of the main causes of morbidity and mortality in patients with advanced chronic kidney disease (CKD), and vice-versa. Both diseases share risk factors, including, but not limited to, diabetes, high blood pressure, smoking, dyslipidemia, and old age. As kidney disease develops, its severity grade has been linked to more thrombotic events…
CRUNCH Registry: An Option for Underexpanded Stents
Coronary calcification hinders both stent transfer and implantation, and has been associated with a higher risk of complications. Coronary perforation is the worst of them. In turn, these calcifications affect the preparation of coronary plaque, resulting in an underexpanded stent (US), which is a strong predictor of restenosis and early thrombosis. For the management of…
Women Present Lower Risk of Sport Related Sudden Death Compared to Men
According to this recent analysis published in Eur Heart J, women would have a far lower chances of dying suddenly for physical exertion during sports compared against men. Women seem to be better protected against this event, which rises the following question: what the value of screening? The risk of sports related sudden death is…
The FDA Approves Intravascular Lithotripsy for Calcified Lesions
The US Food and Drug Administration (FDA) has cleared the shockwave lithotripsy system to treat severely calcified plaque lesions. The device uses a balloon to release pressure sound waves capable of passing through the softest material, and possibly rupture calcified plaque and optimize stent implantation. As such, it has the potential to replace or, at…
AFIRE Study | Hidden Risks After Bleeding in Coronary Disease and Atrial Fibrillation
Patients with atrial fibrillation (AF) and stable coronary disease who suffer from major bleeding present an extremely high risk of subsequent cardiovascular events. Preventing bleeding is necessary, and so is preventing the risk of subsequent cardiovascular events and death. The association between coronary angioplasty, early bleeding, and an increase in death and infarction rates after…
Provisional vs Dual Stenting in Left Main: An Endless Discussion?
True left main stem bifurcation patients have shown fewer adverse events with stepwise provisional stenting vs systematic dual stenting as first strategy, even though the difference was not significant. Usually, for any other vessel, the preferred technique is provisional stenting. However, when it comes to the left main, there is a randomized, dedicated, well designed…