Recent randomized studies have shown that the rates of combined peri-procedural events for carotid artery stenting and carotid endarterectomy are similar. While the final numbers are similar, the actual events are different: more infarction events for endarterectomy and more stroke (particularly minor stroke) events for carotid artery stenting. The reduction of these rates of stroke has been the aim of...
So far, the main controlled randomized studies have almost exclusively been aimed at comparing the efficacy and safety of carotid artery stenting vs. endarterectomy. Almost all of them have left at operator discretion the choice of the devices to be used during the procedure, which is why there is few direct information to help us...
The NIPPON trial (Nobori Dual Antiplatelet Therapy as Appropriate Duration) was a randomized study comparing a short dual antiplatelet therapy scheme (6 months) vs. a prolonged scheme (18 months) in patients receiving the Nobori drug eluting stent (Terumo, Tokyo, Japan) with a biodegradable abluminal polymer. It included 3,773 patients with chronic stable angina or acute coronary...
The association between glycemic control after coronary angioplasty and outcomes of the latter is controversial in many studies. We have come to think that the risk lies in suffering from diabetes, as if it was an unmodifiable factor. We have also come to believe that glycemic control can impact microvascular complications while it cannot do...
There is little information comparing contemporary drug eluting stents (DES) against bare metal stents (BMS), for PCI in saphenous vein grafts in patients receiving (CABG). This study aimed to assess clinical outcomes after PCI in saphenous vein grafts in patients receiving BMS, first generation DES, and new generation DES between 2006 and 2013. The study...
Courtesy of Dr. Carlos Fava. The prevalence of cardiogenic shock in acute myocardial infarction (MI) is 7%-10%, and it is associated with high mortality rates. Unfortunately, 0.7% of these cases are a consequence of unprotected left main coronary artery (ULMCA) as MI-culprit lesion. Its evolution is generally disastrous. Ventricular assist device support and its implementation time may...
Courtesy of Dr. Carlos Fava. It has been proved that in a setting of acute myocardial infarction with multivessel lesions, only the culprit vessel must be treated (if there is no hemodynamic compromise) at first, and other severe lesions are to be treated during a second session. However, proper conduct in cases with presence of chronic...
Courtesy of SBHCI. The PRISON IV trial compared the sirolimus eluting stent with ultra-thin struts and biodegradable polymer vs. the second-generation everolimus-eluting stent with thin struts and durable polymer in successfully recanalized chronic total occlusions. This is a sub-study with optical coherence tomography (OCT). The study included 330 patients, 85% angiographically followed up at...
Complex vascular anatomy could increase the risk of periprocedural stroke during carotid artery stenting (CAS). However, no randomize study has provided evidence showing this potential difficulty should inform the choice between carotid stenting and endarterectomy. This study included 184 patients with symptomatic lesions of the internal carotid randomized to CAS vs. endarterectomy in the context...
The safety of physiology-based coronary revascularisation has been supported by evidence for years now. DEFER (1998-2001) was one of the first related studies. However, major changes in device and medical treatment safety and efficacy have taken place since then. This could affect clinical results, particularly as regards acute coronary syndromes (ACS). Several studies have cast...