Current models are not reliable when it comes to predicting events after carotid revascularization in acute patients. Peri-procedural events seem to be particularly hard to predict. The development of models that can be externally validated is essential for the decision-making process in patients with high event rates, both during the procedure or while the case...
The Dangerous Combination of Complex Angioplasty and High Bleeding Risk Seems to Have a Solution
The LEADERS FREE trial demonstrated that a polymer-free Biolimus A9-coated stent (BioFreedom™DCS; Biosensors Europe, Morges, Switzerland) is superior to a conventional stent (bare metal stent, BMS) in patients with high bleeding risk treated with only one month of dual antiplatelet therapy. Now, is this global study outcome applicable in cases of complex lesions with several...
Post Carotid Stenting Cerebral Hyperperfusion: a Preventable Complication
This syndrome, which can be reverted, is also one of the causes of preventable stroke, at least in the context of carotid endarterectomy. At present, there is little information on the incidence of this condition in the context of carotid stenting, which is the purpose of this study, in addition to providing tips to prevent it....
Left Main PCI: Despite Auspicious Long-Term Outcomes, Optimal Strategy Still under Discussion
Left main coronary artery bifurcation interventions have shown very good results at long term, especially with new generation DES. The one-stent strategy has seen better results than the two-stent strategy, according to this registry recently published in J Am Coll Cardiol Intv. However, how does this registry of the daily practice between the years 2002 and...
EXCEL Sub-Study: The Site of the Left Main Coronary Artery Lesion Does Not Alter History
The EXCEL study, originally presented at TCT 2016 and published simultaneously in the New England Journal of Medicine (NEJM), showed that angioplasty and surgery in patients with left main coronary artery disease have similar rates of mortality, infarction, and stroke at 3 years. This sub-study, recently published in J Am Coll Cardiol Intv, adds that the...
New Ultra-Thin-Strut DES: Do They Outperform Second-Generation DES?
The new drug-eluting stents (DES) equipped with ultra-thin struts are showing a lower risk of target lesion failure as a result of lower rates of acute myocardial infarction and similar rates of revascularization, according to this meta-analysis soon to be published in Circulation. Such a difference is evidenced at a 1-year follow-up when compared with...
First Results for Ticagrelor in Elective Coronary Angioplasty
This is one of the first studies on the use of ticagrelor in patients with stable coronary arteries who undergo elective angioplasty. Although its number of patients is low and its endpoints are soft, this work at least provides some support to what is already happening in daily clinical practice. Many patients admitted for a...
The Largest Registry on the ACURATE neo Valve
Transcatheter aortic valve replacement (TAVR) using the ACURATE neo device depends, largely, on correct patient selection and appropriate oversizing. The individual anatomy of each patient, namely periannular and aortic root calcification, must be taken into account. The ACURATE neo valve (Symetis/Boston, Ecublens, Switzerland) is a new-generation self-expanding valve characterized by a stent design shaped as an X...
Renal Impairment: How Does It Affect Angioplasty and Surgery?
Courtesy of Dr. Carlos Fava. The incidence of kidney disease is increasing. In its final stage, this pathology is related with coronary disease and increased mortality. Furthermore, we know that, in many occasions, it is associated with diabetes. Nowadays, the evidence comparing the progress of patients with impaired kidney function who have undergone left main...
EuroPCR 2018 | SYNTAX II: Results at 2 Years for Best Angioplasty vs. Surgery in Multivessel Disease
Since the publication of the original SYNTAX trial, there have been great technical advancements that have influenced the results of angioplasty: New tools for risk stratification using the SYNTAX II score which integrate clinical and anatomical variables to the team’s decision-making process. Functional revascularization (hybrid use of fractional flow reserve or instantaneous wave-free ratio). Optimization of...