1- What to Do with Blood Pressure Levels Between 130/80 and 139/89 mmHg The decision to be made with a treatment-free patient with systolic blood pressure over 160 mmHg or diastolic blood pressure over 100 mmHg is an easy one. All guidelines agree: treatment should be started immediately alongside lifestyle changes. Read more 2-...
Courtesy of Dr. Carlos Fava. The femoral approach is preferred when it comes to TAVR, but sometimes it is not viable. This is when other access sites come into play, such as the trans-subclavian/axillary (TS/TAx), the apical, transcaval, transcarotid (TC) or transaortic. At present, few studies have looked into this matter, which is why it...
Patients who undergo complex angioplasty are at higher ischemic risk, but only benefit from extended dual antiplatelet therapy if there are no factors for high bleeding risk. These data suggest that the bleeding risk must weigh more than the ischemic risk on the determination of dual antiplatelet therapy duration. Complex angioplasty is associated with higher...
Courtesy of Dr. Carlos Fava. Nowadays, peripheral interventions are on the rise and the technological development of stents and balloons would help achieve better outcomes. Both drug-eluting stents (DES) and drug-coated balloons (DCB) have proved to be beneficial for femoropopliteal interventions, but the actual role of each of these technologies remains unclear. This prospective, randomized 1:1...
Courtesy of Dr. Carlos Fava. Carotid artery stenting (CAS) with a cerebral protection system has emerged as an alternative to surgery, particularly for patients with high surgical risk. Nowadays, there are a considerable number of cerebral protection systems, but these may sometimes fail due to anatomical issues, the diameter of embolized particles, or placement difficulties (among...
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...
This work (presented during the same American College of Cardiology [ACC] 2019 Scientific Session as the STOPDAPT-2 trial) enrolled 2993 patients who underwent angioplasty with current-generation stents Xience, Promus, Synergy, or Orsiro at 33 Korean sites. Patients were randomized to 12 months of dual antiplatelet therapy or dropping aspirin at 3 months. There was no difference between the short-...
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...
Courtesy of Dr. Carlos Fava. At present, the transfemoral is the preferred access site in TAVR, for it has been shown to present fewer complications. However, whenever not feasible, we can resort to other approaches. These include the subclavian, the transapical, the transcaval, the transaortic, and the transcarotid. This last one has been studied few...
Angiography-derived fractional flow reserve (FFR) demonstrated substantial usefulness, especially in patients with three-vessel lesions. The functional SYNTAX score derived from angiography has the potential to redefine prognosis and treatment strategies compared with the classic anatomical SYNTAX score. This study sought to investigate the applicability of this method in patients with multivessel lesions included in the...