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...
Invasive coronary angiography (ICA) has become the gold standard for the assessment of patients with chronic coronary syndrome (CCS) for obstructive coronary artery disease. However, its ability to detect this condition is limited and it does not detect non-obstructive myocardial ischemia, which can be overlooked. To address these limitations, a prospective, observational, multicenter study was...
Bicuspid aortic valve (BAV) disease affects 1%-2% of the population and manifests with severe aortic stenosis in the middle-aged. It characterizes for a very different anatomy with more calcification than the tricuspid aortic valve. At present, surgical aortic valve replacement (SAVR) is the first treatment indication. TAVR in this scenario has shown, in different studies,...
For years, treating dyslipidemia mainly focused on reducing LDL cholesterol (LDL-C) with statins, which had shown benefits in reducing atherosclerotic cardiovascular disease (ASCVD). Lipoprotein(a) [Lp(a)] is a form of apoB-containing lipoprotein bound to a hydrophilic, highly glycosylated protein called apolipoprotein(a) [apo(a)]. Circulating levels of Lp(a) are genetically determined, and are hardly affected by eating habits...
Chronic total occlusion (CTO) affect up to 20% of patients undergoing angiographic diagnostic tests. During the last two decades, recanalization technique refinement, the development of specific devices and operator skill improvement have elevated procedural success rate up to 90%. However, there are still particular complications such as collateral perforation and access site complications. This is...
Extracranial carotid artery disease represents 15 to 20% of all strokes. Carotid revascularization plays a role in primary and secondary prevention of cerebrovascular events. Outcomes of two common revascularization strategies, Carotid endarterectomy (CAE) and carotid artery stenting (CAS), have been studied and compared. In recent years, complications associated to CAS have dropped thanks to technical...
Regardless of whether it is attempted through percutaneous coronary intervention (PCI) or myocardial revascularization surgery (MRS), complete revascularization (CR) is not always achieved. Overall, it is more frequent with surgery than with percutaneous treatment. Additionally, incomplete revascularization (IR) has proven to be associated with worse outcomes compared to CR. Researchers conducted an analysis of the...
Transcatheter aortic valve intervention (TAVI) has been shown beneficial over the years. However, a significant subgroup of patients with small aortic annulus, which make approximately one third of cases and have a higher incidence in women, face additional challenge, such as higher incidence of mismatch, reduced exercise capacity and shorter durability. Self-expanding and balloon expandable...