Courtesy of Dr. Javier Castro. Certain coronary lesions have been historically discouraged for endovascular treatment. Among these can be found left main coronary artery lesions, multivessel disease, and proximal anterior descending artery lesions. As a matter of fact, the latter is actually considered separately as a criterion for choosing the revascularization method. Endovascular treatment of...
In the initial management of patients with stable chronic angina, a non-invasive strategy with cardiovascular MR perfusion imaging seems to provide similar results to invasive strategies. At one year, MACE rate (combination of all cause death, non-fatal infarction and target vessel revascularization) resulted 3.3% for MRI vs. 3.9% for fractional flow reserve (FFR) informed...
Closing off the left appendage as an add-on procedure while performing other cardiac surgery in patients with atrial fibrillation resulted in a reduction in risk of embolic stroke of nearly 40% over 12 months, according to an analysis carried out on the Society of Thoracic Surgeons (STS) database. Patients who had surgical appendage occlusion had...
The first and only randomized trial on chronic total occlusion (CTO) revascularization versus optimal medical therapy in stable patients has disappointed interventional cardiologists. According to Dr. Seung-Jung Park, who presented the study, evidence suggests that optimal medical therapy is a reasonable initial treatment strategy for chronic total occlusion, when compared with angioplasty. Critics...
Courtesy of Dr. Pablo Baglioni. Between the years 2000 and 2015, the authors of this article searched for reports on spontaneous coronary artery dissection (SCAD) in pregnant or immediate post-partum women aiming at defining the clinical characteristics of this pathology and offering management recommendations. Information on 120 women was analyzed; 116 were between 22...
Courtesy of Dr. Guillermo Migliaro. Events such as very late stent thrombosis and restenosis after first generation DES stenting were associated to the inflammatory response of site implantation. The presence of a durable or permanent polymer was thought to play a central role in said inflammatory process, which caused, among other things, delayed re-endothelialization and...
Courtesy of Dr. Agustín Vecchia. In the last few years, new percutaneous treatment options for mitral regurgitation have emerged. Transcatheter mitral annuloplasty with various devices is a relatively simple procedure that could compress the origin of circumflex artery branches due to the different orientation of mitral corners and the coronary sinus. The following work by Park...
Courtesy of Dr. Carlos Fava. Drug eluting stents (DES) have shown benefits in terms of restenosis vs. conventional bare metal stents (BMS). Many of the advantages of DES depend on correct implantation, especially in complex lesions. In complex lesions, the use of intravascular ultrasound (IVUS) provides important information on lesion length, vessel diameter, calcification...
The present work compared the safety and efficacy of the permanent polymer zotarolimus eluting stent vs. the biodegradable polymer biolimus eluting stent in unselected coronary artery disease patients. The biodegradable polymer biolimus eluting stent resulted superior to the first generation durable polymer stent in long term randomized studies. However, little evidence supports this superiority...
This study assessed the cumulative incidence of cardiovascular evens after zotarolimus eluting stent implantation. Individual studies often lack enough statistical power to show differences in low frequency adverse events. The Resolute zotarolimus eluting stent was evaluated across 10 prospective clinical trials designed with identical adverse events definitions. The Global Resolute clinical trial program...