Severe persistent calcification of the coronary arteries has been associated with different factors, such as advanced age, hypertension, dyslipidemia, smoking, and kidney failure, among others, and continues to be one of the challenges to stent implantation because of it impact on device advancing, drug release and adequate positioning. Intravascular lithotripsy (IVL) is a technique that...
Dissection and Re-Entry Technique in Chronic Total Occlusions: Data from the PROGRESS-CTO Registry
The antegrade dissection and re-entry (ADR) technique is considered essential for the management of chronic total occlusions (CTO). It serves as the primary option in some protocols for complex and extensive lesions or as a backup strategy in case of failure with other initial strategies. Dissection techniques include guided methods such as scratch and go,...
Is Complete Revascularization Really Necessary after AMI in the Elderly?
The population over 75 is growing gradually, which entails an increase in acute myocardial infarction (AMI) in this group. As we all know, it is fairly common for AMI to present with multivessel disease. It has been shown that younger patients will benefit from complete revascularization vs. a simple resolution of the culprit vessel. However,...
Aortic Stenosis and Cardiogenic Shock: Is TAVR an Option?
Cardiogenic shock (CS) in a setting of aortic stenosis is associated with high mortality rates. In consequence, surgery is generally not a possibility for this patient group, and they usually undergo aortic valvuloplasty, resulting in a mortality rate of 33%-50% at 30 days, 70% at one year, and 90% at two years. While transcatheter aortic...
Drug Coated Balloons: Link between Femoropopliteal Lesion Calcification Grade and Clinical Outcomes
At present, the use of drug coated balloons (DCB) in femoropopliteal territory is more and more frequent. However, when it comes to treating moderate to severe calcification, the evidence is still limited. Using a peripheral artery calcification scoring system (PACSS) has been associated to clinical outcomes after DCB angioplasty for femoropopliteal lesions. The system categorizes...
BASILICA: a Complex Strategy, Yet Safe
Coronary artery obstruction (CAO) after TAVR is rare, but it entails extremely high mortality (50% or more), especially after valve-in-valve (V-in-V) or when the coronary ostia are is too close to the valve annulus. This is why the BASILICA technique was developed (Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction)....
CTO: Length’s Impact on Success
The rise of chronic total occlusions (CTO) percutaneous coronary interventions (PCI) goes hand in hand with technological development, through still posing a great challenge, one not exactly exempt from complications. An important criterion to successful CTO PCI is length: ≥20 mm lesions lower the odds, according to J-CTO Score. However, increasing operator experience and the...
Long-Term Evolution of Hybrid Coronary Revascularization
Currently, myocardial revascularization surgery (MRS) and percutaneous coronary intervention (PCI) are the available strategies for multivessel coronary artery disease. However, an alternative strategy has long been developed, called hybrid coronary revascularization (HCR), where the anterior descending artery is bypassed with a graft from the mammary artery and the rest of the lesions are treated by...
Non-Cardiac Surgery After TAVR Is Safe
There are increasingly more patients who have undergone transcatheter aortic valve replacement (TAVR) and require a non-cardiac intervention, or patients with other diseases who need surgery and are diagnosed with aortic stenosis. In addition, on many occasions, surgery must be performed as soon as possible (as in cases of cancer) or is an emergency procedure....
Same Day Discharge in NSTE-ACS: Is It Possible?
At present, percutaneous coronary intervention (PCI) is the most common coronary revascularization strategy. One of its benefits is that patients can be safely discharged when procedures are programed, which helps decompress hospital capacity. However, this strategy has not been validated for acute coronary syndromes; the evidence gathered for non-ST elevation ACS is far from robust,...