By Erika Gondim Gurgel Ramalho Lima.
Plaque Erosion with No Stenting in Acute Coronary Syndrome: Are There Event Predictors to Avoid This Strategy?
Event predictors in patients with plaque erosion and no stenting. A third of all acute coronary syndrome (ACS) cases are caused by plaque erosion. In the initial EROSION study, it was shown that patients with plaque erosion (as evidenced by OCT, with stenosis <70%, TIMI III flow, and asymptomatic) were stabilized without stent implantation (no...
Resistant Obstructive Hypertrophic Cardiomyopathy: Myomectomy or Septal Ablation?
Approximately 70% of hypertrophic cardiomyopathies (HCM) are associated to a left ventricular outflow tract (LVOT) obstruction and mitral valve failure leading to dyspnea and cardiac failure in a high number of patients. Even though at present there are effective drug treatments combined with pacemaker implantation, surgery (septal myomectomy (SM) continues to be the first choice...
Is Rehospitalization a Relevant Factor after Aortic Valve Replacement?
Patients with severe symptomatic aortic stenosis treated with aortic valve replacement might still present cardiac failure, even after successful procedures. According to some reports, the incidence of cardiac failure after TAVR varies between 9% and 24%. The prognostic relevance of rehospitalization in these patients has not been studied yet; in fact, it remains unclear whether...
Trans-Stent Gradient as a Predictor of Adverse Events at Followup
Stenting a coronary lesion should not present a drop in pressure when measuring the treated segment with fractional flow reserve (FFR). FFR based trans-stent gradient should involve a segment of the sub-expanded vessel or instent obstruction as plaque prolapse or thrombus. The link between post-stenting physiology and long-term outcomes have been looked at in several...
Safety of Atherectomy in Femoropopliteal Disease
Peripheral artery disease hinders patient quality of life extensively. In advanced stages, such as critical lower limbs ischemia (CLLI), it could yield an increased risk in major cardiovascular events, as well as limb-related events (amputation or repeat revascularization), making treatment with revascularization paramount in these cases. Calcification is a predictor of revascularization failure, which is...
Drug Coated Balloons in Femoropopliteal Territory: Predictors of Failed Patency
Endovascular treatment in femoropopliteal territory has become the strategy of choice over time, with diverse devices; among others, drug coated balloons (DCB). DBS are meant to provide the antiproliferation effect of drugs while reducing exposure of a specific artery segment to a strange body. Even though the number of studies on DCB effectiveness has been...
Stent Thrombosis: Clinical Characteristics and Event Predictors in a Contemporary Cohort
Stent thrombosis (ST) is a serious complication of coronary PCI. However, its incidence across registries is low. It has been classified according to onset into acute (less than 24 hrs.), subacute (between 24 and 30 days), late (between 30 and 365 days) and very late (later than 365 days). The estimated incidence of ST is...
Calcified Lesions: CTO Strategies for Plaque Preparation
Vascular calcification is a predictor of difficult stent positioning and expansion, which increases the chance of device failure (even with last generation stents). Calcium modifying strategies are being developed to reduce these difficulties. Two recent randomized studies compare different calcium preparation devices. The PREPARE-CALC compares rotational atherectomy (RA) against plaque modifying balloons (PMB = cutting...
Primary vs Secondary Retrograde Approach in CTO: Differences
Successful chronic total occlusion procedures are on the rise, especially in high volume centers, seeing as they count on more sophisticated materials and different techniques, such the retrograde approach. However, the significant increase of success rate with this technique has also brought along an increase in associated complications. The aim of this study was to...