Courtesy of Dr. Carlos Fava. Chronic Total Occlusions (CTO) are truly challenging and different technologies are being developed to treat them, but currently our most pressing questions about them are whether in-stent CTO present the same success rate as de novo CTO, and what their prognosis is. The present trial analyzed 899 CTO: 111(12.3%)...
Why We Should Use IVUS in Complex Coronary Lesions
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...
Is The Transradial Approach Useful in CTO?
Courtesy of Dr. Carlos Fava. The transradial approach has been advanced in time, and is being increasingly used in more and more complex angioplasty procedures with the same benefit, compared to the classical femoral approach. As a result, in many high volume centers, this reality has demoted the femoral approach to a few particular procedures....
IVUS vs. Angiography in New-Generation Drug-Eluting Stents Preimplantation
Courtesy of Dr. Guillermo Migliaro. The latest 2011 American College of Cardiology (ACC) guideline states that “coronary intravascular ultrasonography (IVUS) may be considered for guidance of coronary stent implantation, particularly in cases of left main coronary artery stenting (Class IIB, Level of Evidence: B).” This has been long debated with no clear winners. This analysis provides new information...
Rechanneling a CTO in a Non-Infarct-Related Artery After Primary PCI: Yes or No?
Between 10% and 15% of patients admitted with ST-segment elevation myocardial infarction present concurrent coronary chronic total occlusion (CTO) in a non-infarct-related artery, which is associated with increased morbidity and mortality. The EXPLORE (Evaluating Xience and Left Ventricular Function in Percutaneous Coronary Intervention on Occlusions After ST-Elevation Myocardial Infarction) trial evaluated whether patients admitted...
Retrograde Technique: High Success Rate in CTO
Original Title: Outcomes With the Use of the Retrograde Approach for Coronary Chronic Total Occlusion Interventions in a Contemporary Multicenter US Registry. Reference: Dimitri Karmpaliotis et al. Circ Cardiovasc Interv. 2016 Jun;9(6). This study evaluated the safety and efficacy of the retrograde technique for chronic total occlusions. Researchers compared retrograde vs. anterograde technique outcomes...
Femoropopliteal Artery Stent Thrombosis
Original Title: Femoropopliteal Artery Stent Thrombosis. Report from the Excellence in Peripheral Artery Disease Registry. Reference: Subhash Banerjee et al. Circ Cardiovasc Interv. 2016 Feb;9(2):e002730. There is limited information on peripheral stent thrombosis and involved factors. This study analyzed 604 stent procedures in femoropopliteal territory form the multicenter registry “Excellence in Peripheral Artery Disease”. Stent...
Complete revascularization in acute myocardial infarction. 1 culprit lesion , then all the others
Original title: Randomized Trial of Preventive Angioplasty in Myocardial Infarction (PRAMI trial). Referencia: David S. Wald et al. N Engl J Med 2013.DOI: 10.1056/NEJMoa1305520. Patients developing ST segment elevation myocardial infarction are effectively treated with primary angioplasty to responsible artery . It is unclear whether revascularized other significant lesions in other non culprit vessels will prevent future events...
Primary vs Secondary Retrograde Approach in CTO: Differences
Successful chronic total occlusion procedures are on the rise, especially in high volume centers, seeing as they count on more sophisticated materials and different techniques, such the retrograde approach. However, the significant increase of success rate with this technique has also brought along an increase in associated complications. The aim of this study was to...
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...