We are still asking the same question: ticagrelor or prasugrel? With narrow margins between these drugs in terms of efficacy and bleeding, it is difficult to decide which to prescribe. While it has certain methodological limitations, this research published in JAMA seems to clarify the picture at least for patients with acute coronary syndromes who...
Patients with peripheral vascular disease who undergo angioplasty in the lower limbs find benefit from treatment with rivaroxaban, according to the VOYAGER PAD study, presented at the scientific sessions of the American College of Cardiology (ACC) 2021 Congress and simultaneously published in JACC. Patients with said disease present a higher risk of ischemic events not...
Potent P2Y12 receptor inhibitors, such as prasugrel and ticagrelor, have been tested mainly in a setting of acute coronary syndromes. There is little evidence on stable patients, particularly for prasugrel. Designing a study with that purpose seemed challenging enough, but adding aspirin discontinuation in patients without a particularly high bleeding risk took this research to...
Patients with vulnerable plaque identified by means of intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) are at a significantly increased risk of adverse cardiovascular events. Revascularization of these vulnerable lesions could prevent clinical events. That is the theory behind prophylactic angioplasty, which still needs to be proven in clinical practice. The PROSPECT ABSORB study, nested...
Courtesy of Dr. Carlos Fava. Bifurcation lesions account for about 25% of all angioplasties and it is a challenge for which there is no single treatment strategy. Intravascular ultrasound (IVUS) has proven its usefulness, improving outcomes by reducing mortality in unprotected left main coronary artery (LMCA) angioplasty. A new strategy consists in conducting an IVUS after...
This prospective study analyzed patients with critical lower limb ischemia (due to complex, multiple lesions in several places) who were treated uniformly with common femoral artery endarterectomy combined with angioplasty to improve inflow and/or outflow. This hybrid treatment, which must be carried out by a team, can be greatly beneficial for this high-risk patient group...
After 10 years of follow-up, there were no significant differences in the rates of major adverse cardiovascular or cerebrovascular events among patients with left main coronary artery disease randomized to angioplasty or surgery. Since this was the first study to randomize patients with left main coronary artery disease to angioplasty or surgery, it enrolled very few...
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...
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...