Several cases have shown an association between patent foramen ovale and cryptogenic shock, particularly in patients under 55 and in those with atrial septal aneurysm or a significant right-to-left shunt. Using PFO closure for stroke prevention has been controversial and, so far, no randomized studies have shown the superiority of this strategy compared to anti-thrombotic...
Courtesy of Dr. José Álvarez. This is a multicenter randomized study on patients with patent foramen ovale (PFO) and a first episode of cryptogenic stroke. It only included patients with moderate to large shunt based on the number of bubbles observed in the left atrium within the first three beats after being noticed in the...
Courtesy of Dr. José Álvarez. The RESPECT trial is a multicenter randomized trial with blinded adjudication of end-point events. It randomly assigned patients from 18 to 60 years of age who had a patent foramen ovale (PFO) and a history of cryptogenic ischemic stroke to undergo closure of the PFO with the Amplatzer device plus medical...
This new meta-analysis did not manage to prove whether permanent pacemaker implantation after transcatheter aortic valve replacement (TAVR) raises the rates of mortality, infarction, or stroke. Implantation could only be associated to a lesser recovery of ventricular function after the procedure, something that had already been observed in previous studies. Patients who required a pacemaker undoubtedly...
Courtesy of Dr. Agustín Vecchia. As TAVR is expanded to lower risk patients, complications become more relevant. As regards stroke, the PARTNER 2 and SURTAVI one year outcomes are 8.0% and 8.2% respectively. The mechanisms behind this complication have not yet been clarified and, therefore, neither have guideline recommendations in this regard (as we can tell...
Recent randomized studies have shown that the rates of combined peri-procedural events for carotid artery stenting and carotid endarterectomy are similar. While the final numbers are similar, the actual events are different: more infarction events for endarterectomy and more stroke (particularly minor stroke) events for carotid artery stenting. The reduction of these rates of stroke has been the aim of...
Spinal Cord infarction represents roughly 1% of all strokes and can lead to severe impairment, like paraplegia or quadriplegia. Aortic endovascular and surgical repair of aortic aneurysms or dissections could result in spinal cord infarction, because the vascular supply of the spinal cord largely originates directly from the aorta. Spinal cord ischemia (SCI) rate in patients undergoing aortic repair varies depending on the...
The association between glycemic control after coronary angioplasty and outcomes of the latter is controversial in many studies. We have come to think that the risk lies in suffering from diabetes, as if it was an unmodifiable factor. We have also come to believe that glycemic control can impact microvascular complications while it cannot do...
Courtesy of Dr. Carlos Fava. Moderate/severe paravalvular regurgitation (PVR) after TAVR is present in 10%-14% of all cases, according to different series. The treatment of choice is post-dilation, generally effective in most cases. However, this strategy carries a risk of stroke. The true impact of this conduct is still unclear. This review analyzed 6 studies that included 5007 patients; 889 of...
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...