Courtesy of Dr. Carlos Fava. Critical limb ischemia is the final stage of peripheral vascular disease and is associated to pain at rest, trophic lesions, and gangrene. It is also associated to amputation and reduced mobility. When it happens in frail patients, it presents a challenge. This population is on the rise and there is...
Invasive Strategy in Frail Patients Is Safe
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...
Access the Scientific Program for the SOLACI-SOCIME 2018 Congress
We hereby present the complete scientific program for the SOLACI-SOCIME Congress that will take place from August 1st to 3rd, 2018, at the Expo Santa Fe International Convention Center in Mexico City. You will also find the list of activities for the 9th edition of the Interventional Trainees Pre-Congress Course, “José Gabay,” which will take...
TAVR with Prior MRS: A New Challenge
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...
Diastolic Dysfunction Should Be Considered in TAVR
Aortic stenosis increases afterload creating hypertrophy as a compensation mechanism to maintain minute volume. This leads to left ventricular diastolic dysfunction (LVDD). More than half of patients presenting aortic stenosis have LVDD and myocardial fibrosis, which is a mortality predictor in surgery. At present, there is contradicting evidence in TAVR. The study looked...
Surgery Seems Superior to Angioplasty in Young Patients
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...
Lesion Targeting Seems to Be the Secret in Critical Ischemia
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...
The diagnostic performance of the iFR makes the FFR tremble
Despite the evidence, most stable patients continue to be managed based on coronary angiography and, worse, often without a prior non-invasive functional study. With the introduction of the FFR, we left the “anatomical” era for the “functional” era in the catheterization room, which has been proven to improve patients prognosis and, as if that were...
Who Lives Longer After TAVR, Men or Women?
Courtesy of Dr. Carlos Fava. Currently, some small observational studies and a meta-analysis suggest that women experience more short-term complications after TAVR (due to higher rates of bleeding, vascular complications, and stroke), as well as less 1-year mortality. However, results are still conflicting. This work analyzed 17 studies including 8 different registries, with a total 23,303 women and 23,885 men....
The 10 Commandments of ESC’s New STEMI Guidelines
The authors have given an entertaining account of the most relevant points and differences between the new STEMI guidelines and the prior ones, from 2014. The article features 10 points resembling the ten commandments, which makes it easy to read, compared to the tedious task of reading the complete guidelines. 1) The emergency systems should help...