A new diagnostic tool might change the classical abdominal aortic aneurysm (AAA) cutoff thresholds of 5.5 and 5 cm for men and women, respectively. The new ultrasound speckle tracking technology can study AAA wall motion in real time and has the potential to become the new standard for diagnostic and therapeutic decisions. This study looked...
In 2020, the European Society of Cardiology guidelines for the management of patients with acute coronary syndromes without ST-segment elevation (Non-ST-Segment Elevation Myocardial Infarction, NSTEMI) were presented. This document went somewhat unnoticed in the context of the COVID-19 pandemic, so this seems a good time to review it and set out some practical “commandments” (something...
Invasive functional measurement of intermediate lesions has become the gold standard to define revascularization. Due to its favorable long-term prognostic value, fractional flow reserve (FFR) is the reference used to compare all others. Recently, new nonhyperemic indexes, measured in a specific diastolic period, have emerged. Among them, the one with the most accumulated evidence is...
Watch again the 7° ProEducar Educational Meeting on Extracardiac Interventions on our Youtube channel. In this video you will learn about: How to perform a carotid angioplasty and avoid complications? Educational Case. Step by Step – Dr. Estêvão Carvalho de Campos Martins (BRA). ntervention in lower limbs critical ischemia – Dr. Larry Díaz Sandoval (USA).
The benefits of intravascular ultrasound (IVUS) guidance in all angioplasties with second-generation drug-eluting stents (DES) persist through 3 years of follow-up. These data derive from the extended follow-up of the ULTIMATE study, presented virtually at TCT 2020 and published simultaneously in JACC Intv. At 3 years, target-vessel failure remained lower in patients whose angioplasty was guided by...
Symptomatic patients undergoing PCI with no residual ischemia confirmed by iFR have superior symptom improvement at one year vs. patients who did not receive the optimization. In addition to symptoms, patients receiving iFR optimization (final value ≥ 0.95) presented lower cardiac mortality, spontaneous MI or clinically justified revascularization vs. patients with <0.95 final value. ...
Optical coherence tomography (OCT) has proven useful in diabetic patients, even those with negative FFR. These findings make us rethink the ischemia and functional revascularization paradigm vs. the anatomical findings of vulnerable plaque. Diabetic patients with lesions that might be deferred base don FFR might benefit from OCT to find in these plaques certain risk...
Patients who undergo coronary angioplasty after acute coronary syndrome could de-escalate dual antiplatelet therapy with prasugrel to maintain the protection against ischemic events while lowering their hemorrhagic risk. The HOST-REDUCE-POLYTECH-ACS study (recently published in The Lancet) included 2338 patients who underwent coronary angioplasty in a setting of acute coronary syndrome. Patients were randomized to a year-long...
Patients with a bigger number of complex anatomical characteristics that increase PCI complexity have worse results at one-year followup. These data come from a large multicenter study (e-Ultimaster) recently published in EuroIntervention. The more complex the characteristics, the greater the increase in events. It is important to see past the obvious anatomical challenges (bifurcations, calcification,...
Patients with documented spasm to the coronary arteries present increased risk of myocardial infarction (MI) and repeat angiography, while patients with microvascular spasm are associated to recurrent angina. Globally, the prognosis of all these patients continues to be favourable, even though acetylcholine testing might help distinguish one-another. Coronary spasm shows in up to 60% of...