Controlling stent expansion with optical coherence tomography (OCT) based on an external elastic membrane–based protocol for stent sizing resulted non-inferior to the control group which used intravascular ultrasound (IVUS) and superior the angiography only group. Based on these study outcomes and the prior outcomes, we should use IVUS imaging if available. There are no specific algorithms...
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...
Complex angioplasties require not only experience and patience but also technology. Imaging–guided pre-dilation, stent sizing, and post-dilation reduced the cardiovascular events after a 3-year follow-up in patients who received drug-eluting stents in complex angioplasties. This paper, recently published in JACC Interventions, compared the 3-year outcome of the complex angioplasty optimization technique with intravascular imaging to...
Courtesy of Dr. Carlos Fava. Bifurcation lesions account for about 25% of all angioplasties and it is a challenge for which there is no single treatment strategy. Intravascular ultrasound (IVUS) has proven its usefulness, improving outcomes by reducing mortality in unprotected left main coronary artery (LMCA) angioplasty. A new strategy consists in conducting an IVUS after...
Technique advancements in left main coronary artery angioplasty have turned this procedure into a reasonable alternative to surgery, particularly in patients with a low or intermediate Syntax score and, obviously, those in whom surgery was contraindicated. Results can be credited to a refinement in technique, better drug-eluting stents, better patient selection, and frequent use of...
Courtesy of SBHCI. The aim of this work, which was presented during the TCT 2019 Scientific Session and simultaneously published in JACC Intv, was to prove the benefit of intravascular ultrasound (IVUS) in angioplasty. The IVUS-XPL trial randomized 1400 patients with long coronary lesions (≥28 mm) to IVUS-guided angioplasty (n = 700) vs. angiography-guided angioplasty (n = 700). All procedures were...
Intravascular Ultrasound (IVUS) guided drug eluting stent (DES) implantation is associated with less adverse events compared against angiography guided stenting. This is especially clear for certain populations (with left main PCI as paradigmatic) but not so clear when dealing with all comers. 1448 all comer patients requiring DES stenting were randomized 1:1 to IVUS guided...
In patients with 3-vessel disease, surgery obtained better outcomes than angioplasty, according to results from the SYNTAX and FREEDOM trials, which used first-generation drug-eluting stents. Even in the BEST trial, which used new-generation stents, surgery still offered far better outcomes. Nobody is surprised by the fact that, whenever angioplasty evolves due to a new device...
Courtesy of Dr. Carlos Fava. Currently, chronic total occlusions (CTO) are one of the obstacles that coronary angioplasties must overcome, particularly with the development of drug-eluting stents (DES) and new devices and strategies for these challenging lesions. However, there is little information on the safety, efficacy, and real clinical benefit of implanting stents of over 60 mm (known as full metal jackets, FMJ)....
Courtesy of Dr. Gustavo Leiva. Coronary Artery Bypass Graft (CABG) has traditionally been the procedure of choice in patients with left main coronary artery disease. However, the use of percutaneous techniques in this kind of lesions has been on the rise, partly due to recent research showing similar outcomes with both procedures. Unprotected left main...