Coronary revascularization with drug-eluting stents (DES) is very frequent, especially in acute coronary syndromes, but these metallic stents are permanent foreign bodies that activate the entire inflammatory system. Using bioresorbable stents (BRS) emerged as an alternative to this challenge. Although the initial results of the ABSORB study were not as expected (probably due to a…
Revascularization Using DES in Infrapopliteal Disease: Meta-Analysis and Change of Paradigm?
Peripheral vascular disease (PVD) has been under-studied and under-recognized in comparison with ischemic heart disease and stroke, despite its well-known impact on quality of life and its associated morbidity and mortality. According to a systematic review, it was estimated that in 2015 about 238 million people globally had PVD. This number is on the rise.…
Coronary Angioplasty Evolution According to Syntax II: 5-Year Followup
It has been long since the SYNTAX (NEJM 2009) came out comparing percutaneous coronary intervention (PCI) against coronary artery bypass grafting (CABG). That emblematic study associated PCI with first generation drug eluting stents (Taxus) with increased major cardiac and cerebrovascular events (all-cause mortality, AMI, stroke, or any revascularization – MACCE) vs. CABG, at 5 years,…
IVUS-Guided Coronary Angioplasty: Promising Results at 3-Year Follow-Up
Intravascular ultrasound (IVUS) to guide drug-eluting stent (DES) implantation has been evaluated in several studies. Two randomized studies, IVUS-XPL (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions) and ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in All-Comers Coronary Lesions), have shown fewer repeat revascularizations compared with angiography-guided…
Drug Eluting Stents: Does Strut Size Matter?
The benefit of first-generation Drug-Eluting Stents (DES) over Bare Metal Stents (BMS) is largely known. Moreover, technological developments have led to reduced strut size, biodegradable polymers, and new scaffolds, which in turn have led to improved outcomes. These are known as ultrathin stents, and its struts measure between 70 and 100 microns, which contributes to…
Clnical Practice Dissociated from Study Outcomes: Bad News for Our Patients?
Differences in patient characteristics, changes in treatment algorithms, and advances in device technology, together or separately, might limit the applicability of older randomized trials to contemporary clinical practice. In this case, we look at patients and devices used in the contemporary clinical practice vs. those in the EXTEND DAPT. These differences were associated with attenuated…
TCT 2021 | SUGAR Trial: Polymer-Free Stent in Diabetes
In CAD patients with diabetes the polymer-free amphilimus-eluting stent resulted non-inferior to the polymer-based zotarolimus-eluting Resolute Onyx. This new device, in addition to ultrathin struts, has already been found non-inferior to the Resolute Integrity in the general population at 3-year followup. Researchers believe that the new amphiphilic carrier might be especially useful in diabetic patients…
Drug-Eluting Balloons Find Their Niche
According to this large European registry, drug-eluting balloons (DEBs) are competing with drug-eluting stents (DES) to treat in-stent restenosis. Drug-eluting balloons seem to work equally well for the treatment of long-term in-stent restenosis compared with new stent implantation (for the thin-strut DES registry). If DEBs can compete with DES—adding to the advantage of avoiding a…
SOLACI-CACI 2021 | Overcoming Challenges of the BALLOON EXPANDABLE TAVI Cases – EDWARDS Symposium
✔️ Watch again the Edwards Lifesciences Symposium in the SOLACI-CACI 2021 Virtual Congress.✔️ Topic: Overcoming Challenges of the BALLOON EXPANDABLE TAVI Cases. 👨🏫 Program: 00:05 – Opening – Dr. José Mangione (BRA). 02:20 – Aortic VinV in small annuli: Does the final gradient matter? – Dr. Adolfo Ferrero (ARG). 21:14 – Small Annuli and…
The Long Marathon of Ultrathin vs. 2nd Generation Thin-Strut DES
After 2.5 years of non-stop racing, ultrathin-strut drug-eluting stents (DES) reached the finish line before 2nd generation thin-strut DES. The advantage was in terms of clinically justified lesion revascularization, while rates of infarction, stent thrombosis, cardiac death, and all-cause death were similar. After failure at trying to create new generations of DES based on drugs…
Novel DES Technology Promises to Become the Next DES Generation
The novel technology of drug-eluting stent Supreme was designed to synchronize antiproliferative drug release and leave a base behind to promote healing. Accelerated endothelial healing after antiproliferative drug release may limit the long-term inflammatory response. This multicenter, single-blind study included 1600 patients who were randomized 2:1 to receive drug-eluting stent Supreme vs. a classic permanent-polymer everolimus-eluting…