Courtesy of Dr. Carlos Fava. One of the characteristics of chronic total occlusion (CTO) is the use of two access routes: femoral and radial. The radial approach is safer, but it has not been thoroughly analyzed in this type of PCI. The study looked at 3709 patients undergoing left main percutaneous coronary intervention (PCI) for...
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...
Although chronic total occlusion (CTO) is a common finding, there is little consensus as to when such lesions should be treated routinely with angioplasty. Benefits of successful rechanneling include relief of symptoms, resolution of ischemia, improvement in ventricular function, and avoidance of myocardial revascularization surgery. Unsuccessful rechanneling is common and may be associated with several adverse events,...
Courtesy of Dr. Carlos Fava. Nowadays, chronic total occlusions (CTO) due to in-stent restenosis (ISR) represent 5%-25% of all coronary angioplasties. These lesions pose a new and true challenge, since CTOs are often associated with stent-related problems (fractures, lack of expansion, overlapping, deformation), extreme tortuosity, severe calcification, tandem lesions after CTO, and aorto-ostial lesions, with little...
Courtesy of Dr. Carlos Fava. The transradial approach has been proven beneficial for quite some time now, but certain scenarios require the use of a 7 Fr or 8 Fr introducer, which is a great limitation. This study included 60 patients who underwent complex angioplasty with the help of 7 Fr dedicated transradial (TR) introducer Glidesheath Slender (Terumo, Tokyo,...
Courtesy of Dr. Guillermo Migliaro. The Provisional Stenting technique (PS) consists of sequentially placing a stent in the main branch of the bifurcation and, only when faced with a suboptimal outcome (such as < 3 TIMI flow, flow limiting dissection or high residual stenosis), a second stent in the side branch. Several studies have shown...
Original Title: Bioresorbable Everolimus-Eluting Vascular Scaffold for Patients With Peripheral Artery Disease (ESPRIT I) 2-Year Clinical and Imaging Results CME. Reference: Johannes Lammer et al. J Am Coll Cardiol Intv. 2016;9(11):1178-1187. This is the first study on humans to assess the bioresorbable everolimus eluting vascular scaffold for the treatment of peripheral artery disease involving...
Original Title: Optimal Strategy for Provisional Side Branch Intervention in Coronary Bifurcation Lesions3-Year Outcomes of the SMART-STRATEGY Randomized Trial. Reference: Young Bin Song et al. J Am CollCardiolIntv. 2016;9(6):517-526. This study compared the long term outcomes of the conservative strategy vs. the aggressive strategy for provisional side branch intervention in coronary bifurcations. It has already...
Original Title: Outcomes of anatomical versus functional testing for coronary artery disease. Presenter: Douglas PS. Early this year, the PROMISE trial was not able to confirm that testing patients with chest painusingcomputed tomography angiography (CTA) instead of functional tests, affects clinical outcomes, even though several sub analysis are currently suggesting other additional benefits,including enhanced diagnostic...
Original title: Pivotal Trial to Evaluate the Safety and Efficacy of the Orbital Atherectomy System in Treating de Novo, Severely Calcified Coronary Lesions (ORBIT II) Reference: Jeffrey Chambers, et al. JACC Intervention 2014;7:510-8 Severely calcified coronary lesions, traditionally associated to difficult or impossible stent implantation, asymmetric stent expansion, higher post procedural events rate, more restenosis, more lesion revascularization,...