In 1992, Kiemeneij performed the first transradial coronary procedure, following Campeau’s description of that access in 1989. It’s been 30 years since that milestone in interventional cardiology. Over time, the number of procedures conducted with this approach has increased exponentially, and it is the main approach in most centers in different clinical scenarios. Historically, the...
CTO: Trials vs. Real-World
Percutaneous coronary intervention of chronic total occlusions (CTO) is currently indicated for symptom improvement, as studies have inadequate randomization of data which hinders the assessment of hard outcomes. However, patient inclusion in randomized controlled trials has been challenging, especially for highly symptomatic and higher risk patients. This causes a selection bias in randomized studies on...
Progress-CTO Score: A Key New Tool to Plan CTO
Intervention of chronic total occlusions (CTO) through angioplasty (PCI) can cause complications, even in highly experienced centers. Plenty has been written on the probability of success for the treatment of CTOs using scores such as CL-SCORE, J-CTO, ORA, E-CTO, CASTLE-CTO, etc. (some of which are usually used when preparing these cases). However, besides estimating success...
Intermittent Claudication: Invasive Treatment Superior to Pharmacological Treatment?
Peripheral vascular disease is strongly associated to cardiovascular events and a negative impact on health status and quality of life. However, researchers are yet to determine the benefit of early intervention in patients presenting intermittent claudication, and whether it improves quality of life. At present, there is little information in this regard (CLEVER trial), and...
Post-MitraClip Mitral Valve Stenosis: Bad Prognosis
The EVEREST II trial has shown the MitraClip has similar mortality rate to that of surgery and, on the other hand, we are well aware that residual mitral regurgitation (MR) is associated with a strong negative impact. However, research has shown little about transvalvular gradient after MitraClip and what it entails. 268 patients receiving MitraClip were...
EuroPCR 2022 | TriCLASP, Evolution at 30 Days
Tricuspid regurgitation (TR) is difficult to manage and is a mortality predictor. At present, surgery is recommended, even though its mortality rate is not low. Endovascular intervention of this entity is currently being developed and according to the European guidelines, it has evidence level IIb C in symptomatic inoperable patients. The TriCLASP included 74 patients...
Transcatheter Edge-To-Edge Repair Is Favorable for Elderly Patients at High Surgical Risk
Mitral valve prolapse is the most frequent cause of mitral valve regurgitation and is associated to hospitalization for cardiac failure and mortality. At present, the preferred treatment for operable patients is mitral valve surgical repair. Transcatheter edge to edge repair (TEER) has shown great benefit patients at high surgical risk; however, it has not been...
Avatar Trial: Is It Time to Use Surgical Aortic Valve Replacement in Asymptomatic Patients?
It is still unclear whether surgical aortic valve replacement (SAVR) is beneficial in asymptomatic patients with severe aortic stenosis (AS) and conserved left ventricular function (C1 indication according to AHA guidelines). The European American guidelines only recommend intervention in asymptomatic patient when there is ventricular compromise (ejection fraction <50%, class I indication) or with a...
In Multivessel Disease, When Should Renal Impairment Be Considered?
Cardiovascular disease is one of the main causes of morbidity and mortality in patients with advanced chronic kidney disease (CKD), and vice-versa. Both diseases share risk factors, including, but not limited to, diabetes, high blood pressure, smoking, dyslipidemia, and old age. As kidney disease develops, its severity grade has been linked to more thrombotic events...
ACC 2022 | VALOR-HCM: Mavacamten in Adults with Symptomatic Obstructive HCM Eligible for Septal Reduction Therapy
Roughly 50% of hypertrophic cardiomyopathies (HCM) are obstructive, and of this percentage, most of symptoms can be attributed to this condition. Historically, it has been treated with non-specific drugs such as betablockers or calcium blockers. There is an alternative treatment, septal reduction therapy (SRT), done either by surgery myectomy and alcohol septal ablation, both normally done in...