At two-year followup, primary end point continued to be significantly lower with Sapien 3 vs. conventional surgery, but the initial difference in death and stroke in favor of TAVR started to shrink. In addition, there was higher risk of valve thrombosis in TAVR patients. The PARTNER 3 (Safety and Effectiveness of the SAPIEN 3 Transcatheter<a href="https://solaci.org/en/2021/03/16/tavr-in-low-risk-patients-though-still-superior-with-diminished-advantage-after-2-years/" title="Read more" >...</a>
Should We Discontinue Anticoagulation Before TAVR?
Against what common sense dictates, continuing oral anticoagulation pre- and post- transcatheter aortic valve replacement (TAVR) is safe, according to this article soon to be published in JACC Interventions. There was no increase in hemorrhagic or vascular complications and, paradoxically, those who continued using anticoagulant agents received fewer transfusions that those who did not. A<a href="https://solaci.org/en/2021/02/02/should-we-discontinue-anticoagulation-before-tavr/" title="Read more" >...</a>
Current DES Performance: Is There Room for Improvement?
Head-to-head comparison of current drug-eluting stents (DES) showed contradictory results that led us to believe, for years, that we had reached a plateau. This feeling was also fostered by the disappointment caused by Absorb and bioresorbable-polymer stents. However, this recent article featured in JACC Interventions shows a light at the end of the tunnel with<a href="https://solaci.org/en/2021/02/02/current-des-performance-is-there-room-for-improvement/" title="Read more" >...</a>
Optimal Medical Treatment Under-used in Vascular Peripheral Disease
Less than half of patients undergoing endovascular revascularization for peripheral artery disease to their lower limbs are discharged with optimal medical treatment. Their traditional risk factors are predictors of a more comprehensive treatment; however, women, patients with higher risk of thrombosis, and those more likely to lose a lower limb, are far from being treated<a href="https://solaci.org/en/2021/01/28/optimal-medical-treatment-under-used-in-vascular-peripheral-disease/" title="Read more" >...</a>
Intravascular Imaging: A Universal Approach for Angioplasty Optimization
Despite robust information supporting the use of intravascular imaging during coronary angioplasty, its use in clinical practice remains low. This paper proposes using an algorithm for decision-making throughout the procedure to promote increased intravascular imaging use. Regardless of the many technologies that have been incorporated into strut design struts and polymer type, the rate of<a href="https://solaci.org/en/2021/01/04/intravascular-imaging-a-universal-approach-for-angioplasty-optimization/" title="Read more" >...</a>
AHA 2020 | RIVER: Rivaroxaban as Alternative to Warfarin in Patients with Atrial Fibrillation and Bioprosthetic Mitral Valve
Rivaroxaban seems to be a reasonable alternative to warfarin in patients with atrial fibrillation and bioprosthetic mitral valve. These results arise from the RIVER Study presented at the American Heart Association (AHA) 2020 Congress and simultaneously published in the New England Journal of Medicine (NEJM). After 5 years of follow-up, rivaroxaban reached the non-inferiority criterion<a href="https://solaci.org/en/2020/11/20/aha-2020-river-rivaroxaban-as-alternative-to-warfarin-in-patients-with-atrial-fibrillation-and-bioprosthetic-mitral-valve/" title="Read more" >...</a>
AHA 2020 | Clopidogrel Resists as the Best Option in Elective Patients
High risk patients undergoing elective PCI treated with a more potent antiplatelet scheme (ticagrelor) vs. the classic clopidogrel do not see a benefit in protection against periprocedural events and instead see increased costs and minor bleeding rate. These are the outcomes of the ALPHEUS study presented at AHA 2020 simultaneously published in the Lancet. Ticagrelor<a href="https://solaci.org/en/2020/11/20/aha-2020-clopidogrel-resists-as-the-best-option-in-elective-patients/" title="Read more" >...</a>
In-Stent Restenosis Treatment: Meta-Analysis of 10 Randomized Studies
The best strategy to treat in stent restenosis continues to be a dilemma. A new drug eluting stent (DES) seems to be the simplest treatment, even though it adds metal layers that will make it harder and harder to retreat. Drug coated balloons might be a viable alternative seeing as it seems to enable retreatment,<a href="https://solaci.org/en/2020/11/18/in-stent-restenosis-treatment-meta-analysis-of-10-randomized-studies/" title="Read more" >...</a>
Ticagrelor or Prasugrel in ST Elevation MI
In patients undergoing ST elevation acute myocardial infarction (STEMI) receiving primary PCI, no significative differences between prasugrel and ticagrelor were found. However, the latter was associated to a significantly higher number of repeat MI when considered separately. Few studies have compared the efficacy and safety of the two most potent oral P2Y12 receptor inhibitors in<a href="https://solaci.org/en/2020/11/12/ticagrelor-or-prasugrel-in-st-elevation-mi/" title="Read more" >...</a>
Angioplasty in Aspirin-Free Stable Patients with Prasugrel: Innovation Continues
Potent P2Y12 receptor inhibitors, such as prasugrel and ticagrelor, have been tested mainly in a setting of acute coronary syndromes. There is little evidence on stable patients, particularly for prasugrel. Designing a study with that purpose seemed challenging enough, but adding aspirin discontinuation in patients without a particularly high bleeding risk took this research to<a href="https://solaci.org/en/2020/11/10/angioplasty-in-aspirin-free-stable-patients-with-prasugrel-innovation-continues/" title="Read more" >...</a>