Clinical practice guidelines are usually tedious and, frankly, while a lot of people make an enormous effort to write them, they are ultimately read in full by just a few. These new European Guidelines on the Management of Lower Limb Acute Ischemia represent a special team effort, since they include physicians, cardiologists, surgeons, and interventionists,…
Felling Reassured with Paclitaxel Coated Devices in Peripheral Artery Disease
This big analysis shows rapid absorption of paclitaxel coated devices for PCI in femoropopliteal territory, which reassures us about its alleged association to increased mortality. In fact, survival, amputation-free survival and cardiovascular events rate resulted better with paclitaxel coated devices in the treatment of chronic limb ischemia. This study emphasizes the difference that might exist…
Drug-Coated Balloons vs. Conventional Angioplasty Below the Knee
This meta-analysis is an update on the role of drug-coated balloons in the treatment of infrapopliteal arterial disease, a difficult pathology for all strategies. The primary endpoint of this meta-analysis was treated lower limb salvage at 12 months. The secondary endpoints included survival at 12 months, amputation free survival, restenosis, and target lesion repeat revascularization rate. This…
Crest-2 Registry: Carotid PCI Presents Low Rates of Death and Stroke
Courtesy of Dr. Carlos Fava. In modern studies, carotid artery stenting (CAS) has been shown equal to surgery in terms of the composite end point of periprocedural stroke, death, acute myocardial infarction and late ipsilateral stroke. This was tested in different groups and by trained operators. In the CREST-2 Registry (C2R) 2141 patients were included,…
Angioplasty in Long Femoropopliteal Lesions Offers Reasonable Results
Courtesy of Dr. Carlos Fava. Around half the treated lesions in peripheral disease are femoropopliteal lesions. Long lesions are among the challenges faced: they are associated with higher mortality and morbidity, and revascularization in that setting always entails some degree of difficulty. Nowadays, with the development of nitinol stents and more operator experience, angioplasty is becoming…
Medical vs. Endovascular Treatment in Uncomplicated Type B Aortic Dissection
Under much debate, the treatment of uncomplicated type B aortic dissection is still uncertain. Several studies with methodological limitations have shown that endovascular treatment plus optimal medical treatment might be beneficial, compared with medical treatment alone. This meta-analysis sought to define more clearly the treatment strategy in patients with acute and subacute uncomplicated type B…
We Should Indicate More than 6 Months of DAPT in Lower Limb Disease
Courtesy of Dr. Carlos Fava. Advanced peripheral vascular disease is frequently associated with cardiovascular events and amputation. It has been proven that mono-antiplatelet therapy (MAPT) offers some benefit (with either aspirin or clopidogrel), but there are scarce data on the role of dual antiplatelet therapy (DAPT) in these patients. Researchers analyzed 404 patients who received MAPT for…
Consensus on How to Conduct Follow-Up in Peripheral Vascular Disease
Peripheral vascular disease involves multiple areas and, therefore, can have very different presentations (from complete lack of symptoms to disabling symptoms). Depending on clinical presentation, general condition, anatomical localization, and lesion extension, revascularization can be indicated alongside optimal medical treatment. In 2017, guidelines with indications for revascularization were published; however, maintaining long-term patency can be…
AHA 2019 | Treat Stroke to Target: Post-Stroke Aggressive Therapy with Statins
Indicating statins to reach more aggressive LDL goals in patients that have suffered transient ischemic attack or ischemic stroke driven by atherosclerosis significantly reduces major cardiovascular events according to this study presented in the AHA 2019 scientific sessions simultaneously published in NEJM. The study was prematurely ended because of lack of funding, but its outcomes…
SYMPLICITY Registry: Renal Denervation Struggles Not to Be Forgotten
Long-term data from this registry account for the largest cohort of hypertensive patients who received renal denervation in a real-world clinical setting. This study, recently published by the European Heart Journal, confirms both the safety and efficacy of the procedure with significant and sustained reductions in both office and ambulatory blood pressure. The Global SYMPLICITY…
Safety of Paclitaxel-Coated Balloons in Peripheral Vascular Disease
Everybody keeps wondering whether drug-coated balloons can actually increase mortality. If that is the case, there is an even harder question in need of an answer: what would be the physiopathology for such increase in mortality? As a lukewarm message, the US Food and Drug Administration recommended a special informed consent form when these devices…