5-year followup of bioresorbable scaffolds in selected and better prepared lesions (ABSORB IV). Historically, when comparing previously used therapies, such as conventional balloon angioplasty (BA) against bare metal stent (BMS) and later against drug eluting stent (DES) implantation, we see significantly improved outcomes. These advances have shown reduced recoil and more effective restenosis inhibition, compared…
Post PCI Functional Assessment for Focal Lesion and Stent Underexpansion Detection
The use of fractional flow reserve (FFR) and non-hyperemic pressure indices (NHPRs) have become essential for intermediate lesion revascularization. A linear inverse correlation has been recently shown between the use of post PCI physiology and cardiovascular events at followup. However, its adoption has been limited so far, seeing the wide variety of algorithms used in…
5 Year Evolution of PCI vs CABG in Large Randomized Studies on Acute and Chronic Coronary Syndrome
Left main lesions in acute coronary syndrome (ACS) represent a major risk and, at present, the best revascularization strategy is a matter of debate. Though many studies and registries have excluded this group of patients, there is data on the pros and cons of both percutaneous coronary intervention (PCI) and cardiac artery bypass graft (CABG). …
Minimal Stent Area: New IVUS Parameter?
Intravascular Ultrasound (IVUS) has shown, in several studies, its great benefits for both restenosis and mortality reduction. Even though several variables have been studied, so far minimal stent area (MSA) has been disregarded as important. The OPTIVUS-Complex PCI looked at 961 patients with 1,957 lesions, and found 1.6% TLR incidence (30 lesions). There were no…
Diffuse Coronary Artery Disease: One-Year 48mm XIENCE Skypoint Outcomes
Long 48mm Stent XIENCE Skypoint in the treatment of diffuse CAD Long coronary artery lesions often involve complex decision making since they can be treated either with a long stent or with shorter overlapping stents. Both in registries and meta-analysis, the overlapping technique has been associated to increased target vessel revascularization and increased radioscopy time,…
Provisional Stenting vs. Culotte: 5-Year Results of EBC TWO
The optimal treatment of true bifurcation lesions not affecting the left main coronary artery is widely debated. Results from randomized studies have shown neutral or worse outcomes with the two-stent technique. Regarding these studies, researchers used first-generation stents and the secondary branches were small. The EBC TWO study compared the provisional stenting strategy against the…
EuroPCR 2023 | Provisional Stenting is Still the First Choice
The EBC TWO in Non-LM study randomized 200 patients with bifurcation lesions not affecting the left main coronary artery (LCA) to receive provisional stenting vs. culotte (Norobi stent). The secondary branch had to have a diameter ≥2.5 mm and a lesion length >5 mm. The crossover of those who received provisional stenting to the two-stent strategy was 16%.…
EuroPCR 2023 | Left Main Coronary Artery Angioplasty: One or Two Stents?
The EBC MAIN LM study randomized 467 patients with severe left main coronary artery (LCA) lesions to receive provisional stenting or a two-sent strategy (Resolute or Onix stent). The two-stent strategy was decided by the operator (culotte, DK-minicrush, T/TAP). The crossover rate from those randomized to provisional stenting was 22%. After a 3-year follow-up, the composite…
PICCOLETO-II: Drug-Coated Balloons in Small Vessels
Use of drug-coated balloons vs. drug-eluting stents in small caliber vessels. The constant advancements in coronary device technology have significantly reduced complication rates (such as that of restenosis). However, there are gaps where a high number of undesirable events prevail, such as small vessel disease (SVD), for which, in previous studies up, the rate of…
Comparative Study of Two Drug Coated Balloons: Angiographic and Clinical Outcomes
The incidence of in-stent restenosis (ISR) requiring repeat revascularization ranges between 5% and 10% of PCI patients receiving new generation drug eluting stents (DES). This is why the current European guidelines on myocardial revascularization recommend treating ISR with drug coated balloons (DCB) with class I recommendation, level of evidence A. DCB are mostly coated with…
Drug-Eluting Balloon in STEACS: Leaving No Trace is Beneficial?
Using drug-eluting balloons in patients with ST-segment elevation acute coronary syndrome. The benefits of early reperfusion in ST-segment elevation acute coronary syndromes (STEACS) have not been discussed; compared with fibrinolysis, primary percutaneous coronary intervention (pPCI) has shown benefits in terms of mortality. Despite the constant advancements in stent technology and design, these devices are not…