There are controversies regarding transcatheter aortic valve implantation (TAVI) in cases of challenging anatomical complexity, such as horizontal aorta (HA). This is primarily because aortic angulation (AA) impacts the procedure differently depending on the valve type used. As previously studied, angulation complicates crossing, implantation, and coaxial positioning with commissural alignment. In the study presented by...
The octogenarian population has already reached 137 million and continues to grow. It is estimated to triple by 2050. This increase represents a big challenge, seeing as these patients are often more fragile, present more complex coronary artery disease and multiple comorbidities. This generally requires two or more procedures and more experience both from operators...
One of the limitations of aortic bioprostheses is their durability. When these devices fail, percutaneous valve implantation is a valid strategy. However, it has been shown that there may be high gradients involved. This gradient increase has been associated with worse outcomes and higher mortality rates, as observed in the PARTNER 2 study at 12 months....
Achieving rapid and maximum inhibition of platelet aggregation can reduce complications related to scheduled percutaneous coronary intervention (PCI) in chronic coronary syndromes (CCS). Over the last few decades, the optimal timing for initiating P2Y12 inhibitors and their appropriate dosage have been the subject of numerous studies; however, they have not been clearly established yet. Higher...
Drug-eluting balloons (DEB) with paclitaxel have shown efficacy and safety in the treatment of femoropopliteal disease. Sirolimus-eluting balloons (DEB S) are currently being introduced. This new drug acts during the cellular resting phase (G0) and is considered potentially more effective than paclitaxel, which is a cytostatic drug. However, there is no conclusive evidence in this...
Onyx is a zotarolimus-eluting stent (ZES), designed with thin struts and a platinum core that enhances its radiological visibility. This can be beneficial in complex situations with limited visibility, such as in patients who are obese or present severe calcification, two particularly frequent characteristics in diabetic or elderly patients. The BIONYX study was a randomized...
It has been generally established that coronary procedures with local anesthesia and moderate sedation minimally require a 6 hour fast for solids and 2 hours for liquids (according to SCAI guidelines 2021). However, complications requiring emergency orotracheal intubation are extremely rare. Prolonged fasting can have adverse effects such as hypoglycemia, insulin resistance, acute renal failure...
The retrograde technique has significantly improved the success of percutaneous treatment of chronic total occlusions (CTO). After crossing a collateral channel, creating a connection between the anterograde and retrograde systems is key. The most common technique for this is reverse controlled antegrade and retrograde subintimal tracking (reverse CART). This technique involves inflating a balloon over...
The presence of calcification in the coronary arteries (CAC) remains the main challenge in the percutaneous treatment of these lesions. Various studies have demonstrated the association of CAC with unfavorable long-term outcomes. Intravascular lithotripsy (IVL) has emerged as an effective tool for fracturing calcified plaques. Studies evaluating this strategy have shown high device success rates,...
Coronary calcifications pose a complex challenge with a high incidence (25% of all angioplasties), thus implying difficult management and adverse long-term outcomes, such as an increased risk of events, especially the need for repeat revascularization. The main mechanisms of long-term failure include stent underexpansion and, in particular, minimal post-deployment stent area. Intravascular lithotripsy (IVL) has...