Introduction Chronic total occlusion (CTO) represents the most challenging setting for percutaneous coronary intervention (PCI) and multivessel coronary disease (MCD) is often treated in a staggered manner and in a deferred procedure. Although transfemoral is one of the common access site, the transradial access (TRA) has been used with similar procedural success [1]. The distal…
Lower Mortality with Rechanneling vs. Medical Therapy
We had to wait for it, but we have finally seen a benefit in hard endpoints—such as mortality—derived from rechanneling. Patients with chronic total occlusion (CTO) in whom rechanneling was used as initial strategy showed higher survival rated compared with those receiving medical therapy. As initial treatment strategy, rechanneling a CTO did not show any…
Should Total Occlusion Influence on Revascularization Strategy?
Success or failure of total occlusion (TO) revascularization does not affect mortality at 10 years, and this does not depend on revascularization strategy (PCI vs surgery) or location. The long-term clinical benefit of recanalization and PCI or TO artery bypass graft remains nuclear. This is a sub-study of the SYNTAXES (Synergy Between PCI With Taxus…
03/03 | SOLACI Webinar – Left Main PCI and Bifurcations: LATAM Bif Registry
We invite you to participate in the first free SOLACI virtual event of 2021. It is carried out with the support of Abbott, Boston Scientific, Medtronic and Terumo Interventional Systems and will have the participation of prestigious hemodynamicists from Latin America and the world. The title of the event is: “Left Main PCI and Bifurcations:…
Suboptimal Recanalization Results Worse than Procedural Failure
This large cohort of patients undergoing PCI for chronic total occlusion has shown suboptimal recanalization is associated with cardiac death and myocardial infarction at long term compared against procedural failure. The link between acute outcomes and long-term events in recanalizations has been overlooked. Mainly when it comes to suboptimal results, is doing something more trouble…
Is the Paradigm for Bifurcation Lesions Changing Once More?
Four years ago, we published a summary of the SMART-STRATEGY Study saying that, with bifurcation lesions, “less is more.” Last month, the DEFINITION Study published in the European Heart Journal suggested that things were about to change. Today, the DK-crush technique seems to have rendered both title and article obsolete. According to this recent analysis…
Webinar SOLACI Research | Left-Main Disease Controversy After EXCEL 5 years
We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.
Two-Stent Strategy is Safer in True Bifurcation Lesions
Courtesy of Dr. Carlos Fava. DES have improved PCI outcomes, but one of its biggest challenges continues to be bifurcations (especially when we have to use two stents, since it’s been associated to higher restenosis and stent thrombosis rates). Left main coronary artery true bifurcation lesions are the ones that generate the greatest challenge and…
Ideal Area for Unprotected Left Main PCI
Courtesy of Dr. Carlos Fava. Unprotected left main PCI (PCI-UPLMS) is an acceptable and comparable strategy vs CABG, although the use of IVUS is advisable, since it has shown better evolution and mortality. However, the adequate stent expansion remains unclear. Researchers carried out a sub-analyzis of the NOBLE trial. Of the total 603 patients receiving…
IVUS in Unprotected LMCA Angioplasty: Should We Change the Way We Use It?
Courtesy of Dr. Carlos Fava. Bifurcation lesions account for about 25% of all angioplasties and it is a challenge for which there is no single treatment strategy. Intravascular ultrasound (IVUS) has proven its usefulness, improving outcomes by reducing mortality in unprotected left main coronary artery (LMCA) angioplasty. A new strategy consists in conducting an IVUS after…
Is the Use of iFR for the Deferral of Left Main Coronary Artery Lesions Safe?
Deferral of left main coronary artery lesions using instantaneous wave-free ratio (iFR) seems to be safe. At the least, patients with deferred lesions had similar long-term prognosis to that of patients who underwent revascularization based on that same indicator. Left main coronary artery lesions were universally excluded from studies including medical treatment among the therapeutic…