Rotational atherectomy is a very important tool in the treatment of heavily calcified and non-dilatable lesions. Historically, transfemoral access has been the gold standard due to a perceived need for large-bore guidewire catheters in order to use spheroids for proper debulking. Nowadays, rotational atherectomy has evolved towards a technique that aims to modify plaque for...
In the subgroup of patients with ST-segment elevation myocardial infarction who fail thrombolysis, transradial access reduces both bleeding and mortality, according to the results of this new study recently published in JACC Cardiovascular Interventions. Overall, transradial access following failed thrombolysis was associated with a 70% reduction in vascular complications, a 28% reduction in combined in-hospital...
For TAVR eligible patients (transcatheter aortic valve replacement) with femoral access counterindication, a new access site, extra thoracic yet percutaneous, may offer an alternative. This consists of reaching the abdominal aorta through the vena cava. With this technique the operator enters the abdominal aorta through the vena cava by electrifying a guidewire, advancing a...
Courtesy of Dr. Guillermo Migliaro. Coronary angiography and angioplasty via transradial approach are associated with a significant reduction in access site complications, compared with transfemoral and transbrachial access. Moreover, a significant reduction in mortality has been reported for procedures performed via transradial approach vs. transfemoral approach in primary angioplasty. There is a limited number...
Courtesy of Dr. Carlos Fava. Transfemoral access is the first choice for transcatheter aortic valve replacement (TAVR). However, this approach is not feasible for a progressively larger number of patients, which establishes the need to search for alternative accesses. Between 2009 and 2014, this study enrolled 174 patients who underwent TAVR and were unsuitable for transfemoral...
Courtesy of Dr. Carlos Fava. The femoral approach has been the gold standard for the transcatheter aortic valve replacement procedure (TAVR); however, it is anatomically unsuitable for an important number of patients, and these require a different approach. At present, there is little evidence in support of the transapical or transaortic access sites as...
Original title: Clinical outcomes and safety of transfemoral aortic valve implantation under general versus local anesthesia: subanalysis of the French Aortic National CoreValve and Edwards 2 registry. Reference: Oguri A et al. CircCardiovascInterv. 2014; 7:602-610. Transcatheter aortic valve replacement (TAVI) performed under local anesthesia is becoming an increasingly common procedure. This study compared clinical outcomes in patients...
Original title: Full conversion from transfemoral to transradial approach for percutaneous coronary interventions results in a similar success rate and a rapid reduction of in-hospital cardiac and vascular major events. Reference: Vincent Dangoisse et al. EuroIntervention 2013;9:345-352. Although the transfemoral approach has clear disadvantages when it comes to bleeding complications, it continues to be the preferred approach...
Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) have demonstrated similar outcomes in symptomatic aortic stenosis patients (at high or intermediate risk) in terms of 5-year survival. When evaluating the quality of life (QoL) of these two treatment strategies in patients with high surgical risk, there were no significant differences at 5...
Currently, the number of transcatheter aortic valve replacement (TAVR) procedures is increasing as it expands towards a lower-risk younger population. Therefore, continuous technological advancement is imperative to reduce post-procedural complications. The Food and Drug Administration (FDA) has approved the SavyWire, a preformed 0.035-gauge guidewire that can perform three essential functions: 1) it facilitates prosthesis transportation...