Aspiration thrombectomy (AT) in patients with high thrombotic burden could pathophysiologically reduce thrombus burden, decrease distal embolization, reduce no-reflow phenomenon, and improve microvascular perfusion. However, its usefulness has not been shown in the large, randomized trials (TASTE and TOTAL) that compared routine use of AT in primary angioplasty in patients with ST-segment elevation acute coronary...
Lecture by Dr. Hector García García – LM-PCI: IVUS and FFR/IFR? Dr. Hector García delivered an excellent presentation on whether we should use intravascular ultrasound (IVUS) or fractional flow reserve (FFR)/instantaneous wave-free ratio (iFR) in the left main coronary artery (LMCA) to consider severe obstruction, since there is significant interobserver variability with angiography. Although the...
Coronary physiology, FFR and iFR, has been shown safe to defer lesions and effective to save stents by different randomized studies and registries. However, patients with chronic kidney disease have not been thoroughly analyzed yet, which brings us to the question about what to do in the face of their negative evolution, when atherosclerosis develops...
In the last few years, we have seen significant growth of chronic total occlusion (CTO) percutaneous intervention, which has also been considered for patients with viable territory that remain symptomatic. Experienced centers present successful CTO intervention rates close to 90%, especially with a hybrid approach. However, it is still a complex procedure, and target vessel...
New revascularization after coronary artery bypass graft (CABG) is often needed, be it because of severe bridge lesion, intimal hyperplasia, thrombosis, atherosclerosis, or native vessel lesion progression. We therefore need to determine the best revascularization strategy, namely native or graft percutaneous intervention, venous or arterial, or repeat surgery, with the risk it entails. There is...
The benefit of the transradial approach in percutaneous interventions is well known. Its main limitation is radial artery occlusion (RAO) which would compromise the artery for future use in percutaneous procedures. Even though it is clinically silent, reported cases might reach 33%. More recently, the distal radial access (DRA) has surged as an alternative to...
In the last decade, the interest in atheroma plaque morphology and its role in clinical events has been on the rise. Several studies have shown the use of IVUS to sort out plaque into lipidic rich (LRP) and thin cap fibroatheromas (TCFA). These morphologies have been associated with major cardiovascular events at followup. At...
It has been long since the SYNTAX (NEJM 2009) came out comparing percutaneous coronary intervention (PCI) against coronary artery bypass grafting (CABG). That emblematic study associated PCI with first generation drug eluting stents (Taxus) with increased major cardiac and cerebrovascular events (all-cause mortality, AMI, stroke, or any revascularization – MACCE) vs. CABG, at 5 years,...
Coronary microvascular disfunction (CMD) is an important long-term prognosis predictor. CMD treatment can be an effective therapeutic strategy for patients with acute coronary syndrome (ACS). Nevertheless, more studies are needed to assess different strategies. In the PLATO (Study of Platelet Inhibition and Patient Outcomes) study, ticagrelor vs. clopidogrel reduced ischemic events and overall mortality in...
Fractional flow reserve (FFR) proved to be very useful and safe in the FAME study, but its trade-off was using adenosine (which has a short half-life) and adverse reactions, which fortunately were rare. Subsequently, two large studies—the iFR-SWEDEHEART and DEFINE-FLAIR—demonstrated that instantaneous wave-free ratio (iFR) offered comparable results to FFR in the short term, avoiding...