Multiple studies support the use of an early invasive approach in high risk patients with non-ST elevation acute coronary syndrome (NST ACS). This benefit of an invasive strategy over the expected management has been shown in randomized studies and meta-analysis. Patients with a history of cardiac artery bypass graft (CABG) represent approximately 10% of ACS...
The hyperemic stenosis resistance index (HSR) was introduced as a more complete hemodynamic severity indicator of a coronary lesion. HSR combines both pressure drop across a lesion and the flow through it, therefore overcoming the limitations of traditional indices such as fractional flow reserve (FFR) and coronary flow reserve (CFR). The aim of this multicenter...
Onyx is a zotarolimus-eluting stent (ZES), designed with thin struts and a platinum core that enhances its radiological visibility. This can be beneficial in complex situations with limited visibility, such as in patients who are obese or present severe calcification, two particularly frequent characteristics in diabetic or elderly patients. The BIONYX study was a randomized...
The retrograde technique has significantly improved the success of percutaneous treatment of chronic total occlusions (CTO). After crossing a collateral channel, creating a connection between the anterograde and retrograde systems is key. The most common technique for this is reverse controlled antegrade and retrograde subintimal tracking (reverse CART). This technique involves inflating a balloon over...
Coronary Microvascular Dysfunction (CMD) is being increasingly considered a common consequence of STEMI. Its presence partly explains the persistence of angina symptoms in over 50% of patients after PCI, despite successful epicardial artery reperfusion. Also, CMD has been independently associated with worse left ventricular ejection fraction recovery, which leads to worse prognosis, including recurrent events,...
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,...
Coronary calcifications pose a complex challenge with a high incidence (25% of all angioplasties), thus implying difficult management and adverse long-term outcomes, such as an increased risk of events, especially the need for repeat revascularization. The main mechanisms of long-term failure include stent underexpansion and, in particular, minimal post-deployment stent area. Intravascular lithotripsy (IVL) has...
TAVR’s significant advance has driven the development of valve technology, which is currently in its third generation. Even though outcomes have improved, randomized studies are yet to compared balloon-expandable (BEV) vs self-expanding (SEV) valves in randomized studies, and we only have information from different analysis with contradicting conclusions. This was a meta-analysis of 16 studies...
Stent related adverse events after the first year see a constant 2-3% annual increase, reaching 20% by year 5 and 50% by year 10. BIOADAPTADOR RCT outcomes at 12 months have shown the safety and efficacy of DynamX Bioadaptor, establishing new reference parameters in arterial viability restoration. The aim of this study was to report...
Many of the studies comparing TAVR against SAVR in low risk patients included patients between 70-75 years, excluding those with tricuspid valves. This study included low surgical risk patients with severe aortic stenosis and symptoms, 75 years or younger. Participants were randomized 1:1 to receiving TAVR or SAVR, stratified according to sex, need for new...