This large cohort of patients undergoing PCI for chronic total occlusion has shown suboptimal recanalization is associated with cardiac death and myocardial infarction at long term compared against procedural failure. The link between acute outcomes and long-term events in recanalizations has been overlooked. Mainly when it comes to suboptimal results, is doing something more trouble...
01- Ticagrelor or Prasugrel in ST Elevation MI In patients undergoing ST elevation acute myocardial infarction (STEMI) receiving primary PCI, no significative differences between prasugrel and ticagrelor were found. However, the latter was associated to a significantly higher number of repeat MI when considered separately. Read more HERE 02- Number of Hours of Sleep and...
The best strategy to treat in stent restenosis continues to be a dilemma. A new drug eluting stent (DES) seems to be the simplest treatment, even though it adds metal layers that will make it harder and harder to retreat. Drug coated balloons might be a viable alternative seeing as it seems to enable retreatment,...
Should elderly patients stick to clopidogrel? The first large study on prasugrel showed an unacceptable increase of bleeding in elderly patients, suggesting the use of 5 mg (although the sample size was small, which hindered the determination of dose efficacy). Later, ticagrelor showed better efficacy than clopidogrel without apparent safety concerns. However, specific evidence on elderly...
At present, there is more than one dual layered stent in the market offering additional protection in carotid PCI. Therefore we saw fit to look at these devices to compare class benefits and find any specific differences. This study assessed the safety and efficacy of two dual layered mesh covered stents especially designed for carotid...
Ticagrelor monotherapy after 3 months of dual antiplatelet therapy in patients who experienced ST-segment elevation infarction significantly reduces major bleeding without increasing ischemic risk. This pre-specified analysis of the TICO study shows that ticagrelor monotherapy is safe even in patients with higher ischemic risk. Interrupting aspirin use after 3 months of dual antiplatelet therapy and continuing treatment...
Intravascular coronary lithotripsy shows promise for the improvement of angioplasty in severely calcified lesions, according to data from the DISRUPT CAD III study, published in JACC and simultaneously presented at the TCT 2020 Congress. Calcification in all patients enrolled was highly severe, with an average length of 48 mm, and side-branch involvement in 30% of cases. Lithotripsy,...
Following with aspirin alone after a short period of dual antiaggregation therapy (DAPT), 1 to 3 months, did not increase ischemic events in patients receiving a Xience stent while significantly reducing bleeding. This study endorses the safety of short DAPT with contemporary drug eluting stents (DES) in patients presenting high bleeding risk. The XIENCE Short...
Patients who undergo coronary angioplasty after acute coronary syndrome could de-escalate dual antiplatelet therapy with prasugrel to maintain the protection against ischemic events while lowering their hemorrhagic risk. The HOST-REDUCE-POLYTECH-ACS study (recently published in The Lancet) included 2338 patients who underwent coronary angioplasty in a setting of acute coronary syndrome. Patients were randomized to a year-long...
The IN.PACT AV Access study, recently published in the New England Journal of Medicine (NEJM), showed that drug-coated balloons are superior for the treatment of stenotic lesions in arteriovenous fistulas for dialysis compared with conventional balloons. Dialysis fistulas are an unknown territory for paclitaxel-eluting balloons, since the formal recommendation in the guidelines is conventional angioplasty...