Courtesy of Dr. Carlos Fava. The current population of frail and elderly patients is increasing, and while non-ST-segment acute coronary syndrome (NSTEACS) guidelines recommend early invasive treatment, this group has been excluded from most studies on the subject. Current information on its efficacy is controversial but agrees with the notion that this is a higher-risk group...
The benefits of transcatheter aortic valve replacement (TAVR) for high-risk, prohibitive-risk (class I) or intermediate-risk (class IIa) patients have already been proven, but there is a growing population of patients with a history of myocardial revascularization surgery (MRS) who experience severe aortic stenosis. Decision-making in these cases is anything but simple, mainly due to the presence of...
Long-term follow-up of patients under 50 with multivessel coronary artery disease suggests surgery outcomes are significantly better than angioplasty outcomes. This study, presented at the Society of Thoracic Surgeons’ (STS) Annual Meeting, concludes that surgery should continue as plan A when it comes to young patients with three-vessel disease. Surgeons complain that many patients never actually...
Ulcers that do not heal, thus threatening the integrity of a lower limb in patients with critical ischemia, is a main concern. Sometimes, despite successful revascularization, major amputation cannot be prevented. The anatomical description of angiosomes started in the 70s as a way of optimizing tissue grafts. Angiosomes are basically blocks of tissue that include...
Endovascular revascularization has become the main strategy for symptomatic patients with peripheral arterial disease in femoropopliteal territory. Conventional balloon angioplasty is effective in gaining lumen but has a restenosis rate to up 60% at 12 months. Implantation of conventional stents reduced restenosis to almost half, but presented problems such as thrombosis, stent fracture and difficulty...
Critical ischemia is the most advanced form of peripheral arterial disease, and it is characterized by ischemic rest pain and ulcers or gangrene. Revascularization is obviously positioned as the first-line treatment, and guidelines recommend both possible strategies (surgery or angioplasty) largely based on the findings of the BASIL trial (British Angioplasty versus Surgery in Ischemic...
Courtesy of Dr. Carlos Fava. In most randomized or observational studies, women comprise more than 50% of patients undergoing TAVR, and they have showed better evolution, compared against surgery. The main differences between men and women with severe aortic stenosis are that women have smaller annular dimension, shorter distance to coronary ostia, smaller peripheral arteries, and...
The presence of inducible ischemia is an essential prerequisite to obtain clinical benefits from revascularization through angioplasty. In that sense, the measurement of fractional flow reserve (FFR) is the gold standard as regards invasive methods assessing the functional significance of epicardial artery stenosis. As opposed to FFR, the measurement of the instantaneous wave-free ratio (iFR)...
1) Balloon Angioplasty: A Reasonable Plan B for Chronic Thromboembolic Hypertension Thromboembolic pulmonary hypertension is caused by pulmonary artery stenosis caused by organized thrombi. The only treatment potentially healing for this disease is surgical thrombectomy. However, patients with lesions in very peripheral branches or high surgical risk patients with comorbidities might benefit from a plan B,...
Thromboembolic pulmonary hypertension is caused by pulmonary artery stenosis caused by organized thrombi. The only treatment potentially healing for this disease is surgical thrombectomy. However, patients with lesions in very peripheral branches or high surgical risk patients with comorbidities might benefit from a plan B, such as balloon pulmonary angioplasty. The percentage of patients with chronic...