1- What’s New in the European Guidelines on Peripheral Arterial Disease Since the last version of the European guidelines on the diagnosis and treatment of peripheral arterial disease in 2011, there have been many trials and registries that warrant guideline adjustments in many aspects. The first novelty is the teamwork that gave way to these...
The Most Relevant Articles of 2018 in Pharmacology and Clinical Cardiology – Part 2
1- What Antiplatelet Therapy Should We Use in Patients with Stroke/TIA? Interesting Results for the POINT Trial The New England Journal of Medicine (NEJM) recently published an article about the POINT trial (simultaneously presented at the European Stroke Organisation Conference), a long-awaited randomized clinical trial to assess the efficacy and safety of dual antiplatelet therapy...
Cautious Administration of Supplemental 02, Especially in Acute Stroke or MI
Recent studies show the potential damaging effect of supplemental oxygen in the context of acute stroke and myocardial infarction. Experts now say that it should not be used in patients with >92% oxygen saturation. These guidelines have looked into the most recent studies, including the DET02X-AMI, which suggest supplemental oxygen therapy could increase mortality in...
Differences in Stroke between TAVR and SAVR in Intermediate Risk Patients
Transcatheter aortic valve replacement (TAVR) is more and more frequent in lower risk populations that had previously been treated with surgical valve replacement (SAVR). A small difference in neurological events could have significant consequences when it comes to deciding a course of action. This study is a sub-analysis of the randomized study SURTAVI (Surgical Replacement...
TAVR in Low-Risk Patients with “Zero” Mortality and “Zero” Stroke
Transcatheter aortic valve replacement (TAVR) is now the standard of care for patients with symptomatic severe aortic stenosis who are at extreme, high, or intermediate risk for surgery. This multicenter, prospective study (Feasibility of Transcatheter Aortic Valve Replacement in Low-Risk Patients With Symptomatic, Severe Aortic Stenosis) included low-risk patients and was approved by the United...
MR CLEAN Registry: “Time is Brain” is a Far More Accurate than “Time is Heart”
Time to endovascular treatment after ischemic stroke is strongly associated to functional outcomes. This association could be even stronger than previously suggested in more select populations of controlled studies. These findings emphasize that functional outcomes after endovascular treatment could be improved significantly by reducing onset to treatment times. Randomized studies in select acute...
TAVR Post-dilation Is Safe
Courtesy of Dr. Carlos Fava. Numerous studies have shown that the presence of aortic regurgitation after TAVR is associated with worse evolution, and that balloon post-dilation (BPD) is the adequate strategy to correct this. However, a few reports using first generation valves have associated BPD to complications such as stroke, annulus rupture and valve displacement,...
ESC 2018 | ART: Disappointment with Bilateral Internal-Thoracic Artery Grafts After a 10-Year Follow-Up
Published 5-year results had been neutral for bilateral vs. single internal-thoracic artery grafts, but, at the time, surgeons argued that the time period analyzed was not enough and that a difference would be observed after 10 years of follow-up, once the trial finished. Such follow-up was presented at the European Society of Cardiology (ESC) Congress 2018...
How to Predict Events in Order to Decide Whether to Revascularize Symptomatic Carotid Artery Stenosis
Current models are not reliable when it comes to predicting events after carotid revascularization in acute patients. Peri-procedural events seem to be particularly hard to predict. The development of models that can be externally validated is essential for the decision-making process in patients with high event rates, both during the procedure or while the case...
Post Carotid Stenting Cerebral Hyperperfusion: a Preventable Complication
This syndrome, which can be reverted, is also one of the causes of preventable stroke, at least in the context of carotid endarterectomy. At present, there is little information on the incidence of this condition in the context of carotid stenting, which is the purpose of this study, in addition to providing tips to prevent it....