In the first session of SOLACI-SOCIME 2022 on “Complex angioplasty guided by intravascular imaging”, Dr. Alejandro Diaz (MEX) reviewed the evidence on intravascular ultrasound (IVUS) in complex angioplasties. A meta-analysis indicated its use is associated with a significant decrease in the risk of death, acute myocardial infarction (AMI), and new target lesion revascularization (TLR) in...
Percutaneous coronary intervention of chronic total occlusions (CTO) is currently indicated for symptom improvement, as studies have inadequate randomization of data which hinders the assessment of hard outcomes. However, patient inclusion in randomized controlled trials has been challenging, especially for highly symptomatic and higher risk patients. This causes a selection bias in randomized studies on...
Peripheral arterial disease is a manifestation of systemic atherosclerotic disease with increasing prevalence. Moreover, this disease is associated with a high risk of mortality and cardiovascular events. Lipoprotein (a) (Lp a)—which has a proatherogenic, proinflammatory, and antifibrinolytic role—has been shown to be related to major cardiovascular events and peripheral vascular events after acute coronary syndromes...
Intervention of chronic total occlusions (CTO) through angioplasty (PCI) can cause complications, even in highly experienced centers. Plenty has been written on the probability of success for the treatment of CTOs using scores such as CL-SCORE, J-CTO, ORA, E-CTO, CASTLE-CTO, etc. (some of which are usually used when preparing these cases). However, besides estimating success...
Second generation drug-eluting stents have lower frequency of thrombotic complications and in-stent restenosis. While clinical results have significantly improved, having a 2-3% annual rate of these complications within the first year after angioplasty is still worrisome. This resulted in the development of stents with struts <70 µm (ultrathin), with bioresorbable polymer and abluminal cover. Stents...
The prevalence of coronary lesions with bifurcation involvement is about 20% in patients undergoing coronary angiography (CTA). While provisional stenting is overall the most accepted technique, the 2018 myocardial revascularization guidelines recommend the 2-stent technique for complex bifurcation lesions, defined as side branch with lesion >5mm, distal reference diameter of the side branch ≥2.75, or...
Percutaneous treatment of coronary lesions affecting bifurcations has increased in recent decades. Coronary angioplasty (percutaneous coronary intervention, PCI) in these cases is associated with an increased rate of adverse events in patients with multivessel disease and left main coronary artery lesions. The SYNTAX score, which is a predictor of total mortality, is used to evaluate...
The concepts of ischemia with non-obstructive coronary artery disease (INOCA) and myocardial infarction with non-obstructive coronary artery disease (MINOCA) have been established, widely spread, accepted, and included in the different guidelines that support our clinical practice. Among INOCA and MINOCA we find vasospastic angina (VSA) caused by epicardial vessel spasms and angina caused by microvascular...
The proportion of patients treated with coronary angioplasty who are at a high risk for bleeding is increasing. In this population, extended dual antithrombotic therapy increases the risk of bleeding. The 1-year randomized Onyx one study has demonstrated the non-inferiority of zotarolimus-eluting stents (ZES) vs. biolimus-coated polymer-free stent BioFreedom (DCS). Patients received dual-antiplatelet therapy (DAPT)...
In general, thrombus aspiration in acute myocardial infarction (AMI) has not been shown beneficial by large studies. It could even be prejudicial, since it has been associated with stroke. However, there are certain scenarios where the presence of a significant number of these prevents us from reaching adequate TIMI flow 3, or is associated with...