Courtesy of Dr. Carlos Fava. Coronary perforation (CP) is a very uncommon event (≈0.4%), associated with severe complications that entail risk of death. It has usually been related to patients with a history of myocardial revascularization surgery (MRS). However, this group usually presents lower rates of cardiac tamponade due to pericardial fibrosis caused by surgery. This<a href="https://solaci.org/en/2017/10/05/frequency-and-evolution-of-cardiac-perforation-in-patients-with-a-history-of-mrs/" title="Read more" >...</a>
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<a href="https://solaci.org/en/2017/10/04/new-strategies-for-the-femoropopliteal-artery/" title="Read more" >...</a>
Diabetics’ Silent Ischemia Myth Busted
Diabetes mellitus patients generally present more diffuse coronary disease, faster lesion progression and higher risk of restenosis after PCI. The way these anatomical differences translate into in a different clinical practice, compared to non-diabetic patients, remains unclear. Prior studies comparing the frequency of angina symptoms in diabetic vs. non-diabetic patients have arrived to contradicting outcomes,<a href="https://solaci.org/en/2017/09/29/diabetics-silent-ischemia-myth-busted/" title="Read more" >...</a>
Introducing the number one enemy of PCI: diabetes
About 25% of patients with multivessel disease undergoing myocardial revascularization surgery or PCI have diabetes. In this subgroup, the benefit of surgery in terms of mortality has long been shown: in the BARI study (Bypass Angioplasty Revascularization Investigation) patients undergoing PCI had close to double the mortality rate at 5 years compared to those<a href="https://solaci.org/en/2017/09/22/introducing-the-number-one-enemy-of-pci-diabetes/" title="Read more" >...</a>
REDUCE Trial: Patients with PFO and cryptogenic stroke at lower risk of recurrent stoke when treated with APT and closure device
Courtesy of Dr. José Álvarez. This is a multicenter randomized study on patients with patent foramen ovale (PFO) and a first episode of cryptogenic stroke. It only included patients with moderate to large shunt based on the number of bubbles observed in the left atrium within the first three beats after being noticed in the<a href="https://solaci.org/en/2017/09/18/reduce-trial-patients-with-pfo-and-cryptogenic-stroke-at-lower-risk-of-recurrent-stoke-when-treated-with-apt-and-closure-device/" title="Read more" >...</a>
Long-term results of the RESPECT study favor closure with the Amplatzer device
Courtesy of Dr. José Álvarez. The RESPECT trial is a multicenter randomized trial with blinded adjudication of end-point events. It randomly assigned patients from 18 to 60 years of age who had a patent foramen ovale (PFO) and a history of cryptogenic ischemic stroke to undergo closure of the PFO with the Amplatzer device plus medical<a href="https://solaci.org/en/2017/09/15/long-term-results-of-the-respect-study-favor-closure-with-the-amplatzer-device/" title="Read more" >...</a>
SYNTAX II: Better Stents, IVUS, FFR, or a Combination of All of Them to Catch Up with Surgery
In patients with 3-vessel disease, surgery obtained better outcomes than angioplasty, according to results from the SYNTAX and FREEDOM trials, which used first-generation drug-eluting stents. Even in the BEST trial, which used new-generation stents, surgery still offered far better outcomes. Nobody is surprised by the fact that, whenever angioplasty evolves due to a new device<a href="https://solaci.org/en/2017/09/13/syntax-ii-better-stents-ivus-ffr-or-a-combination-of-all-of-them-to-catch-up-with-surgery/" title="Read more" >...</a>
DETO2X-AMI: Supplemental O2 Provides No Benefit for Patients with Suspected Infarction
According to this study simultaneously presented at the European Society of Cardiology Congress 2017 and published in the New England Journal of Medicine, routinely providing supplemental oxygen therapy to patients without hypoxemia with suspected acute myocardial infarction did not result in a reduction in the 1-year risk of all-cause mortality when compared with patients receiving<a href="https://solaci.org/en/2017/09/13/deto2x-ami-supplemental-o2-provides-no-benefit-for-patients-with-suspected-infarction/" title="Read more" >...</a>
Routine FFR in Patients with Acute Coronary Syndrome?
Fractional flow reserve (FFR) has proven to be superior to angiography as a guide to revascularization due to a significant reduction in the number of both long-term and short-term events. Furthermore, deferring treatment of lesions without evidence of ischemia offers an excellent prognosis. Many studies including mostly stable patients showed a significant degree (as high<a href="https://solaci.org/en/2017/09/12/routine-ffr-in-patients-with-acute-coronary-syndrome/" title="Read more" >...</a>
Polymer-Free DES Also Show Efficacy in Anticoagulated Patients with High Risk for Bleeding
Patients who receive chronic anticoagulation therapy and then undergo angioplasty are frequently discharged on a triple anti-thrombotic scheme that usually includes aspirin, clopidogrel, and warfarin. The optimal duration of this indication remains unclear, particularly for patients at high bleeding risk. According to expert consensus, patients receiving chronic anticoagulation may receive from 1 to 12 months of dual<a href="https://solaci.org/en/2017/09/08/polymer-free-des-also-show-efficacy-in-anticoagulated-patients-with-high-risk-for-bleeding/" title="Read more" >...</a>