The best strategy to treat in stent restenosis continues to be a dilemma. A new drug eluting stent (DES) seems to be the simplest treatment, even though it adds metal layers that will make it harder and harder to retreat. Drug coated balloons might be a viable alternative seeing as it seems to enable retreatment,...
Two-Stent Strategy is Safer in True Bifurcation Lesions
Courtesy of Dr. Carlos Fava. DES have improved PCI outcomes, but one of its biggest challenges continues to be bifurcations (especially when we have to use two stents, since it’s been associated to higher restenosis and stent thrombosis rates). Left main coronary artery true bifurcation lesions are the ones that generate the greatest challenge and...
Stenting of Lipid-Rich vs Fibrous and calcified Plaques: Different Prognosis?
Coronary PCI with contemporary drug eluting stents (DES) in lipidic-rich plaques were not associated with increased periprocedural events at long term compared against plaques with no significant lipidic composition. This study recently published in J Am Coll Cardiol looked into the association between lipidic rich plaques detected by near-infrared spectroscopy (NIRS) and clinical events in...
The Whole Toolkit Tested in Carotid Artery Stenting
This study sought to randomly compare the double-layer Roadsaver stent (Terumo) with the single-layer Carotid Wallstent device (Boston) in association with either distal filter-like embolic protection device FilterWire (Boston) or proximal protection device Mo.Ma (Medtronic) in patients with lipid-rich carotid plaques. This is a very interesting work because there are no head-to-head simultaneous comparisons between...
Meta-Analysis of Large TAVR Studies on Low-Risk: Evidence is Consistent
This meta-analysis which included the 4 large randomized studies on transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) in low-risk patients recently published in JACC, showed TAVR is associated with significant lower mortality compared against SAVR at one year follow up. These results add to the mounting evidence showing that when it...
The Era of Provisional Stenting for Bifurcations Comes to an End
After the large studies which set provisional stenting as the preferred strategy to treat bifurcations comes the double kissing crush technique (DK crush) to break the mold once again. This time, the DK crush technique is tested against provisional stenting in the left main, with a 3-year follow-up. The DKCRUSH-V, soon to be published in...
TCT 2019 | Onyx ONE: Durable Polymer vs. Polymer-Free Stent with Only One Month of Dual Antiplatelet Therapy
Courtesy of the SBHCI. This is the first randomized study comparing a durable-polymer drug-eluting stent (zotarolimus-eluting stent Onyx) and a polymer-free drug-eluting stent (biolimus-A9-coated stent BioFreedom), with only one month of dual antiplatelet therapy in patients at high risk for bleeding. Onyx ONE was a study conducted at 84 sites that randomized 1:1 2000 total patients at...
Do Polymers Play any Role in Drug Eluting Stents
The fact that polymers can degrade after drug release seems interesting, more so when there appears to be evidence that they might cause inflammation (manly eosinophil infiltration) given its unwanted consequences. However, nice theories often get a reality check, and the polymer discussion is no exception. This article, soon to be published in J Am...
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...
Mechanisms of Post PCI Persistent Angina
Angina persistence or recurrence after PCI can affect between 20 to 40% of patients in the short and mid-term. This might be true despite PCI optimization using FFR, intravascular ultrasound and the latest generation stents. This problem is associated with high healthcare cost, which can double in patients with recurrent or persistent angina compared against...