For this Canada-based study, the increased number of patients who required a transcatheter aortic valve replacement (TAVR) may have come hand in hand with an equal increase in healthcare financing, so as to cover procedural costs. In spite of that, the wait-time between the formal request for authorization and the actual procedure was 3 months, and...
Study Confirms Lead Shields Protect Cath Lab Staff from Radiation Exposure
The recent publication of several reports on risk of cataract, left sided brain tumors, subclinical atherosclerosis and chromosome damage among interventional cardiologists has raised increasing concerns about radiation exposure in the cath lab. Recognizing these risks has created a demand of these new forms of protection. Unfortunately, these have mainly been focused on the main operator,...
Though on the Rise, the Transradial Approach to Primary PCI Remains Underused
There is evidence to support the use of the transradial approach to coronary angioplasty. Several randomized studies have shown reduced bleeding and vascular complications when adopted, compared against patients treated with the femoral approach. There are also studies and meta-analysis suggesting that, in the context of primary PCI, the benefit would be even bigger, with significant events...
Multivessel Disease and Severe Carotid Stenosis: How to Proceed
Myocardial revascularization surgery (CABG) is the most frequent of all cardiovascular surgeries and is still the gold standard to treat multivessel disease. Between 6 and 8% of these patients present concomitant carotid stenosis and it is associated with increased peri and post procedural stroke rates during and after surgery. To prevent carotid stenosis, either PCI or endarterectomy...
Endarterectomy vs. Stenting in Asymptomatic Carotid Artery Stenosis
The comparative efficacy and safety of carotid stenting vs. endarterectomy in asymptomatic carotid stenosis patients remains controversial and, what is worse, consensus seems unlikely in the near future. Given the lack of definite evidence, several meta-analyzis and systematic reviews have been produced in an attempt to shed some light on this matter. This study included all...
New Strategies for the Femoropopliteal Artery
Courtesy of Dr. Carlos Fava. The incidence of peripheral vascular disease is clearly increasing, progressing towards critical ischemic claudication and amputation. Angioplasty is currently the treatment of choice for these pathologies. Several times, an implanted stent ends up cracking due to extensive calcification, increasing the rate of restenosis and worsening critical ischemia. Technological development on drug-eluting...
Different Techniques for the Improvement of Outcomes in Intermittent Claudication
Peripheral vascular diseases affect over 20% of the population and can affect up to 30% of people with cardiovascular risk factors. The most important treatment points include modification of risk factors, exercise, optimal medical treatment, and timely revascularization. Given its lower risk of peri-procedural complications (when compared to surgery), endovascular therapy is generally the first...
Statin Pre-Treatment for the Prevention of Peri-Procedural Events in Carotid Artery Stenting
Recent randomized studies have shown that the rates of combined peri-procedural events for carotid artery stenting and carotid endarterectomy are similar. While the final numbers are similar, the actual events are different: more infarction events for endarterectomy and more stroke (particularly minor stroke) events for carotid artery stenting. The reduction of these rates of stroke has been the aim of...
Protection Systems Reduce Stroke and Mortality in Carotid Artery Stenting
So far, the main controlled randomized studies have almost exclusively been aimed at comparing the efficacy and safety of carotid artery stenting vs. endarterectomy. Almost all of them have left at operator discretion the choice of the devices to be used during the procedure, which is why there is few direct information to help us...
Early Endarterectomy Seems Superior to Carotid Stenting in Symptomatic Patients
Patients with symptomatic stenosis of the internal carotid artery benefit from early intervention. The challenge lies in what intervention to choose. Most studies comparing endarterectomy to carotid stenting are fairly heterogeneous as regards timing of intervention. This element is key to comparing between procedures, since there is no doubt timing will directly affect results. ...