After rechanneling occluded superficial femoro-popliteal arteries, interventional physicians are left with the question of how to proceed with infrapopliteal disease. This work (soon to be published in Eur J Vasc Endovasc Surg) shows us the importance of achieving patency in tibial arteries so as to obtain better mid-term outcomes. The gist is that, after an…
MR CLEAN Registry: “Time is Brain” is a Far More Accurate than “Time is Heart”
Time to endovascular treatment after ischemic stroke is strongly associated to functional outcomes. This association could be even stronger than previously suggested in more select populations of controlled studies. These findings emphasize that functional outcomes after endovascular treatment could be improved significantly by reducing onset to treatment times. Randomized studies in select acute…
Exercise Programs in Peripheral Artery Disease
Programmed exercises are recommended as initial management strategy for patients with peripheral artery disease (PAD). Most exercise programs include supervised treadmill walking twice or three times a week in a strategic facility (such as a gym). PAD patients often give up on these programs seeing as they might find it difficult to keep to a…
Effect of More Expedited Carotid Intervention on Recurrent Events
This study shows the benefit of reducing waiting time between acute events and intervention in patients with severe symptomatic carotid stenosis. Its outcomes support the efforts to reduce patient management. Moreover, it could be used as an indicator of clinical practice quality. The risk of recurrent events after an ischemic event is significantly higher in…
Safety of Early Carotid Artery Stenting in Symptomatic Patients
This work shows the safety of carotid artery stenting within 14 days of a stroke and, so far, this is the largest series of symptomatic patients published by an institution. The exact moment to conduct this procedure after an acute stroke is still controversial, although most publications so far have favored early endarterectomy over early angioplasty.…
The 10 most read articles of September
1- High-Sensitivity Troponins Turned All Events into Infarctions; the 4th Universal Definition Clarifies Things Myocardial infarction or myocardial injury? The Fourth Universal Definition of Myocardial Infarction (an update of the 2012 version) is here to clarify that not all cases of elevated cardiac troponin values are acute myocardial infarctions. Read more 2- A Simple…
TCT 2018 | PADN-5: Pulmonary Artery Denervation in Pre- and Post-Capillary Pulmonary Hypertension
This work included 98 patients with pre- and post-capillary pulmonary hypertension defined as mean pulmonary arterial pressures ≥25 mmHg, pulmonary capillary wedge pressures >15 mmHg, and pulmonary vascular resistance >3.0 Wood units. These subjects were randomized to pulmonary artery denervation vs. sildenafil plus sham pulmonary artery denervation. The medical treatment for heart failure was administered to all patients. The…
TCT 2018 | RADIOSOUND-HTN: Testing Different Renal Ablation Techniques and Devices
The clinical efficacy of renal endothelial sympathetic denervation using both radiofrequency and ultrasound endoscopy in the treatment of hypertension has already been proven. This is the first work comparing different techniques and technologies used to this end, which warranted its publication in Circulation. Patients with resistant hypertension were randomized 1:1:1 to: 1) radiofrequency denervation of…
TCT 2018 | IMPERIAL: First Study Comparing Drug-Eluting Stents in Patients with Femoropopliteal Disease
The IMPERIAL trial compared the safety and efficacy of a nitinol self-expanding polymer-free placlitaxel-eluting stent (Zilver PTX, Cook Medical, already approved by the US Food and Drug Administration [FDA]) and a nitinol self-expanding polymer-coating placlitaxel-eluting stent (Eluvia, Boston Scientific). This was a single-blind randomized trial in patients with symptomatic intermittent claudication (Rutherford categories 2, 3, or…
Frailty: What Happens When We Are Too Late in Critical Lower Limb Ischemia
This condition, now “trending” among patients undergoing transcatheter aortic valve replacement (TAVR), has expanded to almost all patients we treat, always with the same outcome: the prognosis is bad, so bad that it might warrant making the difficult decision of not going forward. The association between frailty and bad prognosis is easy to see and…
HIV and Peripheral Artery Disease: Acknowledging the Association
The role of human immunodeficiency virus (HIV) in the development of vascular disease (specifically peripheral artery disease) remains unclear. Is the virus per se the direct cause of this disease or is it a consequence of dyslipidemia, one of the adverse effects of antiretrovirals? This study looked into the effect of HIV infection on peripheral…
