Patients with atrial fibrillation (AF) unsuitable for anticoagulation because of bleeding risk, require other strategies to prevent stroke. For some years, there have been in the market (limited to some places; not as part of the regular agenda of cardiologists and hematologists) devices to occlude the atrium that have been proved safe and effective. These...
Most certainly, as we read this title, we imagine the conclusion (as does the editor): patients with prior cerebrovascular disease (CEVD) benefit from a less invasive revascularization strategy, such as PCI. However, the EXCEL outcomes tell us that patients with left main coronary artery disease (LMCAD) and a history of CEVD will not benefit from...
Every operator keeps track of their cases. Have they reached their potential or are they still learning and improving their technique? After 1000 procedures, can we expect them to have better results than someone that has only done 500? Prior studies have reached conflictive results and consequently the relationship between learning curve and volume-outcomes remains...
This new “Paladin” system for post-dilation during carotid artery stenting was safe and may effectively reduce the number of particles that reach the brain, with a subsequent decreased risk for peri-procedural stroke. This study evaluated the safety and efficacy of the Paladin System, a novel post-dilation balloon with an integrated distal protection filter designed to...
Courtesy of Dr. Carlos Fava. Carotid artery stenting (CAS) with a cerebral protection system has emerged as an alternative to surgery, particularly for patients with high surgical risk. Nowadays, there are a considerable number of cerebral protection systems, but these may sometimes fail due to anatomical issues, the diameter of embolized particles, or placement difficulties (among...
Experts still won’t agree on whether to carry out randomized trial to put an end to this discussion, but it seems clear that balloon expandable TAVR is valid only for certain anatomies. TAVR in real world bicuspid valve populations is associated with similar outcomes at 30 days and one year when compared against cohorts...
This study was not able to show benefits in terms of mortality or bleeding when using radial vs. femoral approach in patients undergoing ST elevation myocardial Infarction. This small trial does not change things for “radialists” way past their learning curve who already feel confident with this technique. For them, there is no way back....
Courtesy of Dr. Carlos Fava. TAVR has largely been shown superior or non-inferior in high or intermediate risk patients. Indeed, the development of new technologies, the more simplified procedure and the increased experience of operators and team have allowed these groups to benefit from this strategy. However, there is little evidence available on low risk...
Courtesy of Dr. Carlos Fava. Self-expanding supraannular aortic valves have proved to be superior to surgery in high-risk patients and noninferior in intermediate-risk patients. However, the current challenge is posed by low-risk, generally younger, patients. In that sense, our purpose is to determine device effectiveness and safety in terms of mortality and stroke rates (which are...
The number of centers that are starting endovascular stroke therapy (EST) to treat acute stroke is growing fast, with a significant increase of cases in low volume centers. Interventional neurologists are not able to cover the high demand and interventional cardiologists are always ready to learn something new. Is this right? Should interventional cardiologists treat...