This meta-analysis is an update on the role of drug-coated balloons in the treatment of infrapopliteal arterial disease, a difficult pathology for all strategies. The primary endpoint of this meta-analysis was treated lower limb salvage at 12 months. The secondary endpoints included survival at 12 months, amputation free survival, restenosis, and target lesion repeat revascularization rate. This...
Courtesy of Dr. Carlos Fava. Around half the treated lesions in peripheral disease are femoropopliteal lesions. Long lesions are among the challenges faced: they are associated with higher mortality and morbidity, and revascularization in that setting always entails some degree of difficulty. Nowadays, with the development of nitinol stents and more operator experience, angioplasty is becoming...
The aim of revascularization, whether through angioplasty or surgery, is to restore adequate flow to the myocardium; that much is obvious. However, after millions of “successful” procedures with the best technology applied to drug-eluting stents and optimal medical treatment, we still have a high ratio of patients who experience new events. Could an optimal angiographical...
Courtesy of SBHCI. The aim of this work, which was presented during the TCT 2019 Scientific Session and simultaneously published in JACC Intv, was to prove the benefit of intravascular ultrasound (IVUS) in angioplasty. The IVUS-XPL trial randomized 1400 patients with long coronary lesions (≥28 mm) to IVUS-guided angioplasty (n = 700) vs. angiography-guided angioplasty (n = 700). All procedures were...
Courtesy of Dr. Carlos Fava. Unprotected left main coronary artery angioplasty with drug-eluting stents has emerged as an acceptable strategy for a select group of patients, with results comparable to those of myocardial revascularization surgery at 2 or 3 years. However, beyond such term, we had no valid information. Researchers analyzed the 5-year follow-up results for the...
Remote ischemic conditioning does not offer any clinical benefit to patients with ST-segment elevation acute myocardial infarction undergoing primary angioplasty, according to this study presented on Sunday at the European Society of Cardiology Congress 2019. Prior studies were limited and small, but this analysis seems to provide definitive evidence with regard to ischemic pre-conditioning. The...
This analysis of data from an already published study, “Bypass Versus Angioplasty in Severe Ischemia of the Limb (BASIL-1),” confirms the superiority of bypass over balloon angioplasty, with or without stenting, in patients with chronic lower limb ischemia who require a femoropopliteal intervention. While analyzed interventions took place between 1999 and 2003 (a fact subject...
According to the EXCEL trial, peri-procedural infarction was more common after left main coronary artery surgery compared with angioplasty, and it was strongly associated with increased 3-year mortality after controlling all possible confounding variables. This increased mortality was only present in extensive infarctions with an increase in CK-MB ≥10×. The EXCEL trial seems to want...
What is the most appropriate antithrombotic strategy for a patient with atrial fibrillation and coronary artery disease, particularly when admitted with acute coronary syndrome or undergoing coronary angioplasty? This is a question whose answer is still in the works and that literature is addressing dynamically. Whatever we read yesterday may already be out of date...
Cost and time are the two main enemies of intravascular imaging, but lack of expertise may also play a role. A new European Association of Percutaneous Cardiovascular Interventions (EAPCI) expert consensus statement released at EuroPCR 2019 argues that there is a need for more use of intracoronary imaging in settings of acute coronary syndromes and...