About 25% of patients with multivessel disease undergoing myocardial revascularization surgery or PCI have diabetes. In this subgroup, the benefit of surgery in terms of mortality has long been shown: in the BARI study (Bypass Angioplasty Revascularization Investigation) patients undergoing PCI had close to double the mortality rate at 5 years compared to those...
The higher rate of restenosis in the diabetic population is historic and has been reproduced in all studies and with all kinds of stents, but it was only after the FREEDOM trial when we found out about the higher infarction rate with PCI compared to surgery. This is why 50% of patients undergoing CABG are diabetic. Apart from the above...
Courtesy of Dr. Carlos Fava. Currently, chronic total occlusions (CTO) are one of the obstacles that coronary angioplasties must overcome, particularly with the development of drug-eluting stents (DES) and new devices and strategies for these challenging lesions. However, there is little information on the safety, efficacy, and real clinical benefit of implanting stents of over 60 mm (known as full metal jackets, FMJ)....
The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, which included patients with 3-vessel or left main coronary artery lesions, showed that myocardial revascularization surgery (MRS) turned out to be superior to angioplasty with drug-eluting stents (DES), mainly due to differences in acute myocardial infarction and repeat revascularization. Up to this work, patient sensations (which can be...
Although chronic total occlusion (CTO) is a common finding, there is little consensus as to when such lesions should be treated routinely with angioplasty. Benefits of successful rechanneling include relief of symptoms, resolution of ischemia, improvement in ventricular function, and avoidance of myocardial revascularization surgery. Unsuccessful rechanneling is common and may be associated with several adverse events,...
Courtesy of Dr. Carlos Fava. Nowadays, chronic total occlusions (CTO) due to in-stent restenosis (ISR) represent 5%-25% of all coronary angioplasties. These lesions pose a new and true challenge, since CTOs are often associated with stent-related problems (fractures, lack of expansion, overlapping, deformation), extreme tortuosity, severe calcification, tandem lesions after CTO, and aorto-ostial lesions, with little...
Courtesy of Dr. Carlos Fava. Nowadays, the number of coronary angioplasties carried out on patients with chronic total occlusion (CTO) is increasing due to many studies showing that it improves ventricular function, reduces symptoms, and improves survival. However, most of these works do not include patients of over 75 years old due to their frailty and...
Courtesy of Dr. Guillermo Migliaro. Drug eluting stents (DES) represented the greatest technological advance in the treatment of instent restenosis from conventional metallic stents (BMS), especially cobalt chromium everolimus eluting stents (CoCr EES), which have shown an excellent profile, and are mostly safer, compared to first generation DES. Indeed, several randomized studies and meta-analyzis have...
Courtesy of Dr. Carlos Fava. The presence of chronic total occlusions (CTO) in coronary angiograms varies between 5% and 30%, depending of the different analyzis. Likewise, they have been associated to higher mortality rate and the need for myocardial revascularization surgery. The frequency of CTO PCI is low across the different series (3.8%), though...
Courtesy of Dr. Carlos Fava. The presence of chronic obstructive pulmonary disease (COPD) is a criterion for which patients are ruled out for surgery and proposed as candidates for its current alternative, transcatheter aortic valve replacement (TAVR). A minimalist strategy could benefit this patient group, given the use of conscious sedation instead of general anesthesia. ...