Carotid endarterectomy continues to be the safest technique for emergency revascularization. However, 48 hours after index event, different strategy outcomes will become comparable. Multiple advances in device development have brought promising results for carotid revascularization patients with symptomatic stenosis. Regardless these developments, optimal revascularization timing after index event remains unclear. This study included patients with<a href="https://solaci.org/en/2022/01/11/symptomatic-carotid-arteries-early-or-late-emergency-revascularization/" title="Read more" >...</a>
Complete Revascularization after Pharmacoinvasive Strategy
Patients initially receiving pharmacoinvasive strategy for ST elevation myocardial infarction (STEMI) also presenting multivessel disease consistently benefit from complete revascularization. This benefit is similar to that of primary PCI. The COMPLETE showed that staged non-culprit lesion percutaneous coronary intervention (PCI) reduced major cardiovascular events in STEMI patients with multivessel coronary artery disease. This benefit was<a href="https://solaci.org/en/2021/08/25/complete-revascularization-after-pharmacoinvasive-strategy/" title="Read more" >...</a>
Best Revascularization Strategy in Patients with Left Ventricular Deterioration
Multivessel disease associated to ventricular function deterioration is challenging in terms of risk, when choosing a revascularization strategy. According to this recent analysis of the SCAAR registry published in the European Heart Journal, long term followup seems to justify taking a higher risk initially, higher risk being myocardial revascularization surgery (CABG). The study looked at<a href="https://solaci.org/en/2021/08/11/best-revascularization-strategy-in-patients-with-left-ventricular-deterioration/" title="Read more" >...</a>
FLOWER-MI: FFR vs. Angiography for Complete Revascularization in Infarction
Functional assessment with fractional flow reserve (FFR) was not better than conventional angiography to guide complete revascularization in patients with multivessel lesions in a setting of ST-segment elevation myocardial infarction and successful primary angioplasty. These results were published in the New England Journal of Medicine (NEJM) and presented during the American College of Cardiology (ACC)<a href="https://solaci.org/en/2021/06/07/flower-mi-ffr-vs-angiography-for-complete-revascularization-in-infarction/" title="Read more" >...</a>
Should Total Occlusion Influence on Revascularization Strategy?
Success or failure of total occlusion (TO) revascularization does not affect mortality at 10 years, and this does not depend on revascularization strategy (PCI vs surgery) or location. The long-term clinical benefit of recanalization and PCI or TO artery bypass graft remains nuclear. This is a sub-study of the SYNTAXES (Synergy Between PCI With Taxus<a href="https://solaci.org/en/2021/03/19/should-total-occlusion-influence-on-revascularization-strategy/" title="Read more" >...</a>
Contralateral Occluded Carotid Defines Revascularization Strategy
A significative lesion to the carotid artery in addition to contralateral carotid occlusion is an obvious factor of high risk for a revascularization procedure. However, this might be true for surgery but not for carotid artery stenting according to this recent publication in JACC. The presence of contralateral carotid occlusion has been established as high<a href="https://solaci.org/en/2021/03/11/contralateral-occluded-carotid-defines-revascularization-strategy/" title="Read more" >...</a>
Revascularization Is Needed Before TAVR
Disease prevalence in patients with severe aortic stenosis is highly variable: from 80% in inoperable patients to only 15% according to the most recent research including low-risk patients. Given the high mortality observed in patients with heart disease, guidelines suggest considering coronary bypass revascularization in those in need of a valve replacement. This experience with<a href="https://solaci.org/en/2021/03/08/revascularization-is-needed-before-tavr/" title="Read more" >...</a>
AHA 2020 | Effect of Evolocumab in Complex Coronary Revascularization
Evolocumab, a PCSK9 inhibitor, has shown significant reduction of complex coronary disease requiring revascularization (be it PCI or CABG). Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors induce plaque regression and could eventually reduce the risk of coronary revascularization, especially complex revascularization. The FOURIER study randomized 27564 patients with stable CAD already on statins to evolocumab<a href="https://solaci.org/en/2020/11/25/aha-2020-effect-of-evolocumab-in-complex-coronary-revascularization/" title="Read more" >...</a>
Visual Assessment for Non-Culprit Lesion Revascularization
There is evidence in favor of complete revascularization in the context of ST elevation MI with multivessel disease where primary PCI has been successful. However, the small print in these studies should be read carefully. Should revascularization be completed during index intervention, index hospitalization or after discharge? Should complete revascularization be based on visual assessment,<a href="https://solaci.org/en/2020/09/22/visual-assessment-for-non-culprit-lesion-revascularization/" title="Read more" >...</a>
ESC 2020 | Revascularization Strategies: Ventricular Dysfunction Might Tilt the Scales
Patients included in the ISCHEMIA trial who had a history of cardiac failure or ventricular function deterioration will benefit from revascularization vs. optimal medical treatment. This is a pre-specified analysis of the paradigmatic ISCHEMIA trial. The ISCHEMIA was published in March 2020 in NEJM and went somewhat unnoticed due to the COVID-19 pandemic. At the<a href="https://solaci.org/en/2020/09/08/esc-2020-revascularization-strategies-ventricular-dysfunction-might-tilt-the-scales/" title="Read more" >...</a>