Complementary imaging allows for the identification of numerous scenarios not visible with conventional angiography (ICA), both for the assessment of differential diagnoses and the improvement of percutaneous coronary intervention (PCI) outcomes. Advantages include assessment of plaque characteristics, vessel plaque burden, stent edge dissection, vessel diameter, and correct apposition, among others. While intravascular ultrasound (IVUS) was...
The antegrade dissection and re-entry (ADR) technique is considered essential for the management of chronic total occlusions (CTO). It serves as the primary option in some protocols for complex and extensive lesions or as a backup strategy in case of failure with other initial strategies. Dissection techniques include guided methods such as scratch and go,...
Drug coated balloon (DCB) angioplasty offers a novel strategy for treating coronary artery disease. Studies assessing this strategy have shown clinical outcomes comparable to drug-eluting stents’ (DES) in patients with in-stent restenosis and de novo disease in small vessels. However, evidence for the use of DCB in large coronary vessels is limited. This observational, retrospective study DCB...
Coronary calcification, whether concentric or eccentric, has always posed a challenge in percutaneous coronary intervention (PCI) due to difficulties in plaque preparation, device navigability, proper stent apposition, drug release, and potential complications during the procedure. This study analyzed 262 patients who participated in the four Disrupt CAD OCT Studies and underwent PCI using coronary lithotripsy followed...
Drug-coated balloon (DCB) angioplasty is emerging as a novel treatment for coronary artery disease. Studies evaluating this strategy have demonstrated clinically non-inferior outcomes compared with those of drug-eluting stent (DES) implantation in patients with in-stent restenosis and de novo disease in small vessels. However, evidence for the use of DCBs in large coronary vessels is...
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...
The new European guidelines on NON-ST-segment elevation acute coronary syndromes (NSTE ACS) were presented virtually during the European Society of Cardiology 2020 Congress (ESC 2020) and published in Eur Heart J. This document includes news regarding a more agile infarction diagnosis, the use of non-invasive imaging, the simplification of anticoagulant therapy, infarction with normal coronary arteries,...
Courtesy of Dr. Carlos Fava. Generally, coronary artery dissection (SCAD) is not very frequent in young women and presents better evolution with medical treatment. However, it is occasionally associated with ST segment elevation. In this scenario, PCI with stent implantation is quite challenging. The study looked at 4298 STEMI patients; 53 presented SCAD (1.23%). STEMI-SCAD...
The results of the FREEDOM (Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multi-vessel Disease) trial have shown a lower rate of events in patients with diabetes and stable multivessel disease who were randomized to undergo myocardial revascularization surgery, compared to those who underwent angioplasty. Surgery even showed a mortality reduction that...
Critical lower limb ischemia (CLLI) is associated with a major deterioration in quality of life and a significant increase in morbidity and mortality. Its estimated annual incidence is 220 to 3500 cases per million people, with an expected prevalence of 11% of patients with peripheral arterial disease. CLLI is the “terminal” stage of peripheral artery...