Patients undergoing acute coronary syndrome (ACS) benefit from percutaneous coronary intervention (PCI). At present, there is no question about this. However, residual ischemia after PCI is associated with a worse prognosis. Angiography studies and intravascular imaging are useful to assess post intervention outcomes, but they are limited when it comes to the physiological assessment of...
Devices to Prepare Severely Calcified Lesions: Is There a Difference When Assessed by Intravascular Imaging?
Severely calcified coronary lesions are found in 25% of patients undergoing PCI, and their presence has a negative impact in long term outcomes. These lesions difficult stent expansion and increase device failure rate, even when using the latest generation of drug eluting stents (DES). This is why there is an interest in lesion preparation strategies...
TCT 2022 | Angioplasty vs. Surgery: The BEST Study Long-Term Results
The BEST study was a prospective, randomized study to compare percutaneous coronary intervention (PCI) with everolimus-eluting stents vs. myocardial revascularization surgery (MRS) in patients with multivessel disease. The analysis was interrupted early due to slow patient inclusion. The study included 880 patients, who were randomized 438 to the PCI arm and 442 to the MRS arm....
Watch the Highlighted Presentations of the Paraguay Sessions 2022
The 44th SOLACI Regional Sessions – 15th South Cone Region took place in a hybrid setting (F2F and online) in Asuncion, Paraguay, between June 30 and July 1, 2022. It was a successful event that featured prestigious national and international guests and a world class scientific program. Next, we share some of the presentations held...
Is TCA Useful for Severe Impairment of Left Ventricular Ejection Fraction?
Heart disease is the most frequent cause of heart failure and, in some observational studies, transluminal coronary angioplasty (TCA) could help improve ventricular function. The only major randomized study to compare myocardial revascularization surgery (MRS) vs. medical treatment in patients with ventricular function impairment was the STICH study, which showed no difference at 5 years,...
Aspiration Thrombectomy in Acute Coronary Syndrome: Is the Japanese Perspective a Strategy to Emulate?
Aspiration thrombectomy (AT) in patients with high thrombotic burden could pathophysiologically reduce thrombus burden, decrease distal embolization, reduce no-reflow phenomenon, and improve microvascular perfusion. However, its usefulness has not been shown in the large, randomized trials (TASTE and TOTAL) that compared routine use of AT in primary angioplasty in patients with ST-segment elevation acute coronary...
Three-Year Outcomes after CTA with 2-Stent Technique Vs. Provisional Stenting for Complex Bifurcation Lesions
The prevalence of coronary lesions with bifurcation involvement is about 20% in patients undergoing coronary angiography (CTA). While provisional stenting is overall the most accepted technique, the 2018 myocardial revascularization guidelines recommend the 2-stent technique for complex bifurcation lesions, defined as side branch with lesion >5mm, distal reference diameter of the side branch ≥2.75, or...
An Abbreviated Dual Antiplatelet Regimen Is Also Safe in Patients at High Risk for Bleeding Undergoing Complex Angioplasty
The MASTER DAPT study analyzed the results of an abbreviated (mean 34 days) vs. conventional dual antiplatelet therapy (DAPT) in 4579 patients treated with angioplasty and a biodegradable polymer sirolimus-eluting stent. This recent publication on the same study analyzed the evolution within the same strategies of the subgroup of patients with complex angioplasty and compared...
Coronary Bifurcation Lesions: MRS or PCI? 10-Year Mortality of the SYNTAX Study
Percutaneous treatment of coronary lesions affecting bifurcations has increased in recent decades. Coronary angioplasty (percutaneous coronary intervention, PCI) in these cases is associated with an increased rate of adverse events in patients with multivessel disease and left main coronary artery lesions. The SYNTAX score, which is a predictor of total mortality, is used to evaluate...
The Current Role of Thrombus Aspiration in Primary PCI
In general, thrombus aspiration in acute myocardial infarction (AMI) has not been shown beneficial by large studies. It could even be prejudicial, since it has been associated with stroke. However, there are certain scenarios where the presence of a significant number of these prevents us from reaching adequate TIMI flow 3, or is associated with...