Courtesy of Dr. Carlos Fava. One of the questions around drug-eluting stents (DES) is whether the development of biodegradable polymers would derive in better outcomes than the performance of durable polymers as regards the presence of events. In consequence, the COMPARE II trial was carried out with the aim of testing them in “real-world” patients. This...
Patients with symptomatic stenosis of the internal carotid artery benefit from early intervention. The challenge lies in what intervention to choose. Most studies comparing endarterectomy to carotid stenting are fairly heterogeneous as regards timing of intervention. This element is key to comparing between procedures, since there is no doubt timing will directly affect results. ...
Courtesy of the SBHCI. Guidelines recommend dual antiplatelet therapy for a year in patients admitted with coronary acute syndrome. However, patients at high risk for bleeding who receive coronary angioplasty have been historically excluded from studies. The new polymer-free stent BioFreedom allows for the reduction of dual antiplatelet therapy time, due to rapid drug elution...
Complex vascular anatomy could increase the risk of periprocedural stroke during carotid artery stenting (CAS). However, no randomize study has provided evidence showing this potential difficulty should inform the choice between carotid stenting and endarterectomy. This study included 184 patients with symptomatic lesions of the internal carotid randomized to CAS vs. endarterectomy in the context...
Courtesy of SBHCI Diabetic patients have worse evolution after coronary PCI. Drug eluting stents with bioresorbable polymers were designed to facilitate arterial healing, and reduce inflammation and late and very late thrombosis risk. This sub-study of diabetic EVOLVE II patients presents the 3 year outcomes of the SYNERGY stent. The EVOLVE II included...
The MiStent device is made of cobalt-chromium, with struts of up to 64 µm thick. It is coated with a completely absorbable polymer that contains a microcrystalline form of sirolimus that embeds directly into the vessel wall. The drug is eluted continuously for up to 9 months. This was a multicenter noninferiority study that randomized patients...
Courtesy of Dr. Carlos Fava. Carotid artery stenting (CAS) has proven to be effective in high-risk patients. Nowadays, when performed by trained operators, its results are similar to those of surgery. This study seeks to clarify the incidence and prognosis of plaque protrusion through the stent (as observed in both control angiography and intravascular ultrasound [IVUS])...
There have been several studies offering contradictory data on the relative effectiveness of carotid artery stenting and carotid artery endarterectomy for the prevention of stroke due to carotid artery stenosis. The authors of this study performed a meta-analysis assessing the efficacy of these techniques, given recently published clinical trial data. They selected randomized...
Courtesy of Dr. Carlos Fava. Chronic Total Occlusions (CTO) are truly challenging and different technologies are being developed to treat them, but currently our most pressing questions about them are whether in-stent CTO present the same success rate as de novo CTO, and what their prognosis is. The present trial analyzed 899 CTO: 111(12.3%)...
Courtesy of Dr. Carlos Fava Bivalirudin has been shown to reduce bleeding in carotid stenting and maintain its efficacy. Even though carotid stenting has shown benefits, these remain unclear. With this in mind, four studies were analyzed (one randomized) including 7,784 patients undergoing carotid stenting with unfractioned heparin vs. bivalirudin. No difference was...