Most acute coronary syndromes (ACS) are caused by the following three different pathologies: Plaque rupture Plaque erosion Calcified nodule In daily clinical practice, all patients who experience them are treated with angioplasty, regardless of which of these physiopathologies led to the ACS in each case. Some early reports indicate that patients with plaque erosion might...
1) New High Blood Pressure Guidelines The wait is finally over: the high blood pressure guidelines that have been in the works for the past 3 years saw the light of day at the American Heart Association (AHA) 2017 Scientific Sessions. Read more 2) Nearly half of interventional cardiologists may have pre-cataract lesions This statement is based on eye...
The presence of inducible ischemia is an essential prerequisite to obtain clinical benefits from revascularization through angioplasty. In that sense, the measurement of fractional flow reserve (FFR) is the gold standard as regards invasive methods assessing the functional significance of epicardial artery stenosis. As opposed to FFR, the measurement of the instantaneous wave-free ratio (iFR)...
Intravascular imaging, which includes ultrasound intravascular (IVUS) and optical coherence tomography (OCT), shows live details that better characterize post stenting plaque, anatomy and outcomes. The already familiar limitations of the angiography has lead us to think that IVUS and OCT could improve clinical outcomes; however, we should still find the evidence to support this claim. To shed some...
Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are commonly used to assess physiological severity of angiographically intermediate stenosis. Both indexes quantify a pressure ratio as subrogate to measuring flow, which is much harder to do. Discordance between FFR and iFR occurs in up to 20% of cases, which should not be a matter...
In recent years, angioplasty with drug-eluting stents (DES) has emerged as an alternative to myocardial revascularization surgery in patients with left main coronary artery disease. Both European and American guidelines offer a Class IIa recommendation for left main coronary artery (LMCA) angioplasty in selected patients. The EXCEL (Evaluation of Xience Versus Coronary Artery Bypass Surgery for...
Courtesy of Dr. Carlos Fava. Severe left main coronary artery (LMCA) lesions have a bad prognosis in coronary disease. In that scenario, current guidelines recommend surgery as the treatment of choice. However, due to the current development of second-generation drug-eluting stents (DES) and greater operator expertise, left main coronary artery angioplasty appears as a valid alternative...
During primary angioplasty, it is not uncommon to see several other lesions in coronary arteries. Current guidelines advise against the treatment of these lesions in the same primary angioplasty procedure, although there is evidence supporting such a course of action that may warrant changes in these recommendations. The functional assessment of these nonculprit lesions may...
Courtesy of Dr. Carlos Fava. Transcatheter aortic valve replacement (TAVR) has been proven to reduce mortality and improve the quality of life of patients with pure severe aortic stenosis (PAS). However, there is a significant number of patients who experience mixed aortic stenosis associated with moderate/severe aortic regurgitation (MAS). These subjects were excluded from the PARTNER...
1) Radiation Exposure in Chronic Total Occlusions Even in the hands of experienced operators, rechanneling and angioplasty of a chronic total occlusion (CTO) results in patients and the whole cath lab team receiving high doses of radiation, according to this registry presented at the American Heart Association 2017 Scientific Sessions. Read more 2) Should We Begin to Use IVUS in CTO?...