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...
Drug Coated Balloons vs. Drug Eluting Stents in Primary PCI
There might come the time when we are finally able to leave nothing behind, at least in the context of primary PCI. The REVELATION study, soon to be published in J Am Coll Cardiol Intv, has shown that paclitaxel coated balloons resulted non inferior to drug eluting stents (DES) in terms of FFR (fractional flow...
ACC 2019 | STOPDAPT-2: P2Y12 Monotherapy After Short-Term Dual Antiplatelet Therapy After Angioplasty
Aspirin is against the ropes: first, it was primary prevention; now, its use is being reconsidered even in relation to angioplasty. There might be paradigm changes as regards antiplatelet therapy after angioplasty. These two studies presented at the American College of Cardiology (ACC) 2019 Scientific Session can really change what we have been doing unquestioningly...
ACC 2019 | AUGUSTUS: Apixaban Plus P2Y12 Inhibitor Is the Best Combination in Atrial Fibrillation and Angioplasty
Aspirin increases bleeding with no ischemic benefit, but a trend toward more stent thrombosis with placebo warrants further studies. Patients with atrial fibrillation who receive an anticoagulant agent and coronary angioplasty with a stent, and then continue with aspirin, experience an increased risk of bleeding without any ischemic benefit whatsoever. The use of a...
Strategies to Reduce Acute Kidney Injury in Angioplasty
The title of this article leads us to think that we will find a list of things that we can do to reduce kidney injury. However, (unfortunately) sodium bicarbonate showed no benefit over saline and n-acetylcysteine showed no benefit over a placebo for the reduction of kidney damage after coronary angioplasty. Among the protective measures...
EXCEL Sub-Analysis: Angioplasty vs. Surgery in Chronic Renal Insufficiency
EXCEL patients with chronic kidney disease and left main coronary artery disease have higher rates of acute renal failure and other events compared with the general population. However, acute renal failure was less frequent with angioplasty than with surgery, while other events such as death, stroke, or infarction at 3 years were similar for both revascularization...
TCT 2018 | MAIN COMPARE: Angioplasty vs. Surgery for Left Main Coronary Artery Disease at 10 Years
Several studies (some of them recent, some of them not so much so) have compared left main coronary artery angioplasty and myocardial revascularization surgery. Combined, these works compose a large corpus of evidence, but follow-up has not gone beyond 5 years in any case. The main aim of this study (presented at TCT 2018 and published simultaneously...
Direct Stenting vs. Conventional Angioplasty and Their Interaction with Thrombus Aspiration
The rates of direct stenting are higher among patients randomized to thrombus aspiration. The rates of clinical events and myocardial reperfusion did not differ significantly between a direct stenting strategy vs. predilation and stenting, and no interaction was observed as regards thrombus aspiration. Several preliminary studies have emerged from the hypothesis that a direct stenting...
ESC 2018 | GLOBAL LEADERS: Ticagrelor Monotherapy Is Not Superior to Classic Therapies After Angioplasty
Dropping aspirin after the first month and continuing with ticagrelor monotherapy was not better than standard dual antiplatelet therapy (aspirin plus ticagrelor or clopidogrel) in patients who underwent coronary angioplasty. Patrick Serruys presented this work (which was simultaneously published in The Lancet) at the European Society of Cardiology (ESC) Congress 2018 and explained that, given...
EuroPCR 2018 | SYNTAX II: Results at 2 Years for Best Angioplasty vs. Surgery in Multivessel Disease
Since the publication of the original SYNTAX trial, there have been great technical advancements that have influenced the results of angioplasty: New tools for risk stratification using the SYNTAX II score which integrate clinical and anatomical variables to the team’s decision-making process. Functional revascularization (hybrid use of fractional flow reserve or instantaneous wave-free ratio). Optimization of...