Percutaneous coronary intervention (PCI) to the left main coronary artery (LMCA) with drug-eluting stent implantation is currently a major challenge due to the size of the vessel, the compromise of a bifurcation lesion in important branches, and the potential risk of complications. Available information on LMCA PCI comes from studies where DES stents were implanted...
Current guidelines recommend 12-month dual antiplatelet therapy (DAPT) after DES stenting for acute coronary syndrome (ACS) because of elevated MACE risk. The development of more modern stents, with thin and ultrathin struts, compared against prior versions, has resulted in more effective devices in terms of stent thrombosis and restenosis. Prolonged DAPT has been associated with...
There are many current randomized trials comparing percutaneous coronary intervention (PCI) with myocardial revascularization surgery (MRS) for the treatment of left main coronary artery disease (LMCAD). In the European Society of Cardiology guidelines, PCI is classified as Ia (LMCAD with low-complexity coronary disease) or IIa indication (intermediate complexity), whereas, according to the American Heart Association...
Aortic stenosis is associated to significant coronary artery disease (CAD) in nearly 50% of cases. When we decide to treat aortic disease using surgery, it has been established we should also treat heart disease. However, when using transcatheter aortic valve replacement (TAVR), this is still unclear, given that in many occasions we see stable lesions...
The ISAR-REACT 5 showed a significant reduction in the composite outcome of death, acute myocardial infarction (AMI), or stroke when using prasugrel vs. ticagrelor in patients with acute coronary syndrome (ACS), mainly at the expense of an AMI reduction. While this study changed clinical practice, it has stirred some criticism regarding certain methodological aspects, such...
Dual antiplatelet therapy (DAPT) after acute myocardial infarction (AMI) has been shown useful to reduce thrombotic events, but one of its downsides is bleeding, especially in elderly patients. BARC bleeding type I, also called nuisance bleeding (NB), is of low frequency, but its evolution and impact remain unclear, as does its management. A subanalysis of...
Much research has been done on the usefulness of functional testing such as fractional Flow reserve (FFR) after percutaneous coronary intervention (PCI), resulting in the correlation of pathological FFR values with major adverse events at 6 months, as shown by Pijls, et al. The impact of post PCI FFR on prognosis has not been studied...
Critical lower limb ischemia (CLLI) is associated with a major deterioration in quality of life and a significant increase in morbidity and mortality. Its estimated annual incidence is 220 to 3500 cases per million people, with an expected prevalence of 11% of patients with peripheral arterial disease. CLLI is the “terminal” stage of peripheral artery...
Ischemic stroke is the main reason behind disability in the world, and it is often followed by death. The rupture of carotid atherosclerotic plaque and its embolization are the main cause of this entity. Different randomized studies have shown that carotid endarterectomy is beneficial in symptomatic patients with 70 to 99% carotid obstruction, but we...
In the era of endovascular intervention, with shorter revascularization times, we see lower rates of mechanical complications due to acute myocardial infarction (AMI). Increased rates were recorded during the COVID-19 pandemic, but driven by delays in consultation. Though occasional (with an estimated incidence of 0.2%), post AMI ventricular septal defect (VSD), or interventricular communication, involves...