Aortic stenosis is associated to significant coronary artery disease (CAD) in nearly 50% of cases. When we decide to treat aortic disease using surgery, it has been established we should also treat heart disease. However, when using transcatheter aortic valve replacement (TAVR), this is still unclear, given that in many occasions we see stable lesions...
Stent sub-expansion in coronary territory has been identified as one of the major predictors of stent failure at followup, which is why improving stent expansion will improve clinical and imaging outcomes. In percutaneous coronary interventions (PCI) of severely calcified lesions, calcified lesions present a major challenge since they impede stent delivery, causing stent under-expansion or...
Currently, many randomized studies have suggested that short-term dual antiplatelet therapy (DAPT) followed by monotherapy reduces bleeding without increasing major cardiovascular events after percutaneous coronary intervention (PCI). A meta-analysis of six randomized studies has shown this benefit using ticagrelor monotherapy after short DAPT. However, there is no data on the results of clopidogrel monotherapy. Researchers...
Changes in fractional flow reserve (FFR) values after percutaneous coronary intervention (PCI) are associated with improvement in angina symptoms. The pattern of baseline coronary artery disease influences the degree of variation in FFR after stent implantation. Focal coronary artery disease leads to high post-PCI FFR values, while the improvement is not as marked in diffuse...
Revascularization and antiaggregation guidelines have typically recommended aspirin (AAS) as first choice for secondary prevention of cardiovascular events after DES stenting. However, these past few years this strategy has been called into question, seeing as studies have shown the superiority of P2Y12 inhibitor monotherapy (IP2Y12) with clopidogrel or ticagrelor. There is little data comparing both...
The degeneration of bioprostheses in aortic position occurs at approximately after 10 to 15 years. In this scenario, the treatment of choice used to be redo surgery, but with the evolution of transcatheter aortic valve replacement (TAVR), it became a valid alternative with a level IIa B evidence. While there are currently multiple analyses of...
At present, cardiogenic shock continues to present high mortality despite the new treatments and ventricular assistance devices available in some centers. In this group, the presence of severe mitral regurgitation (MR) is around 5% and, on many occasions, it cannot be treated with surgery because of hemodynamic conditions. Edge-to-edge repair has been looked at by...
The use of intravascular imaging such as intravascular ultrasound or optical coherence tomography (OCT) both for decision making optimization and percutaneous intervention planning have introduced changes in some scenarios, such as the left main, improving trial end points. There are ongoing studies set to deliver more evidence on its long term safety and efficacy (especially...
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...
Left main coronary artery (LMCA) intervention with significant lesions on both coronary angiography and intravascular ultrasound (IVUS), either through angioplasty (PCI) or myocardial revascularization surgery (MRS), is directly related to a decrease in long-term adverse clinical events. However, the relationship between subclinical LMCA disease (preserved luminal diameters) and long-term mortality is still unknown. A retrospective...