The octogenarian population has already reached 137 million and continues to grow. It is estimated to triple by 2050. This increase represents a big challenge, seeing as these patients are often more fragile, present more complex coronary artery disease and multiple comorbidities. This generally requires two or more procedures and more experience both from operators...
One of the limitations of aortic bioprostheses is their durability. When these devices fail, percutaneous valve implantation is a valid strategy. However, it has been shown that there may be high gradients involved. This gradient increase has been associated with worse outcomes and higher mortality rates, as observed in the PARTNER 2 study at 12 months....
Achieving rapid and maximum inhibition of platelet aggregation can reduce complications related to scheduled percutaneous coronary intervention (PCI) in chronic coronary syndromes (CCS). Over the last few decades, the optimal timing for initiating P2Y12 inhibitors and their appropriate dosage have been the subject of numerous studies; however, they have not been clearly established yet. Higher...
Diabetic patients have twice as high a risk of developing coronary artery disease (CAD). Additionally, CAD increases mortality risk. Patients with a history of percutaneous coronary intervention (PCI) tend to need repeat revascularization, even with second generation stents. To date, there are few studies assessing the role of glycemic control in stent failure, stent thrombosis,...
At present, most percutaneous coronary intervention procedures (PCI) are done with drug eluting stents (DES). However, drug coated balloons (DCB) have shown benefits in restenosis and small vessel de novo lesions. Intravascular ultrasound (IVUS) has been shown effective in left main PCI and complex procedures, even though there is little infomration on its use for...
The hyperemic stenosis resistance index (HSR) was introduced as a more complete hemodynamic severity indicator of a coronary lesion. HSR combines both pressure drop across a lesion and the flow through it, therefore overcoming the limitations of traditional indices such as fractional flow reserve (FFR) and coronary flow reserve (CFR). The aim of this multicenter...
Onyx is a zotarolimus-eluting stent (ZES), designed with thin struts and a platinum core that enhances its radiological visibility. This can be beneficial in complex situations with limited visibility, such as in patients who are obese or present severe calcification, two particularly frequent characteristics in diabetic or elderly patients. The BIONYX study was a randomized...
The presence of calcification in the coronary arteries (CAC) remains the main challenge in the percutaneous treatment of these lesions. Various studies have demonstrated the association of CAC with unfavorable long-term outcomes. Intravascular lithotripsy (IVL) has emerged as an effective tool for fracturing calcified plaques. Studies evaluating this strategy have shown high device success rates,...
Nowadays, evidence from studies and meta-analyses has demonstrated the benefits of complete revascularization compared to culprit-vessel-only revascularization in patients with acute myocardial infarction (AMI). The identification and treatment of non-culprit lesions can be guided by conventional angiography, intracoronary imaging, or coronary physiology; the optimal modality, however, is still unclear. Quantitative flow ratio (QFR) is a...
Despite primary angioplasty, many patients with ST elevation acute myocardial infarction with (STEMI) show evidence of microvascular dysfunction. This dysfunction can be characterized by two main factors: A new specific index has recently been identified to assess microcirculation called microvascular resistance reserve (MRR), which allows measuring vasodilatory capacity independent of the epicardium. The purpose of...