For many years, percutaneous transluminal coronary angioplasty (PCTA) has expanded significantly worldwide. However, despite the demonstrated advantages of intravascular ultrasound (IVUS) in terms of minimal luminal area, reduced cardiovascular events, and restenosis, its use is not very common due to various reasons. On the other hand, optical coherence tomography (OCT) offers even higher resolution than…
ACC 2023 | RENOVATE-COMPLEX-PCI: Intravascular Imaging-Guided vs. Angiography-Guided Complex PCI
Patients with complex coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) have worse clinical outcomes tan patients with non-complex CAD. Several studies have shown that the use of intravascular imaging (IVUS, OCT) have reduced major adverse events vs. angiography guided PCI. However, these studies present limitations both of size, studied population, short term followup…
FRAME-AMI: FFR vs. Angiography of Non-Culprit Vessel in ACS
This study compared fractional flow reserve (FFR) vs. angiography to guide the angioplasty of non-culprit vessels in patients with acute coronary syndrome (ACS) and multivessel disease. Landmark studies such as COMPLETE, COMPARE-ACUTE and DANAMI-3-PRIMULTI have demonstrated the prognostic value of revascularization (after treatment of the artery responsible for the ACS) of non-culprit arteries with respect…
Should We Start Using OCT in Myocardial Infarction with Non-Obstructive Lesions?
In ST elevation MI, the common assessment methodology continues to the angiography; however, we all know it has certain limitations, especially when it comes to intermediate lesions or coronary dissections. Using imaging, especially high resolution such as OCT, has been looked into by some studies, but never randomized studies. The EROSION III is a randomized…
IVUS in Femoropopliteal PCI: Should We Start Using It?
For approximately two decades now, PCI has been the treatment of choice in femoropopliteal territory, and even though technological developments and increasing operator experience have indeed improved outcomes, IVUS (which has showed great benefits in PCI, even reducing left main mortality) is hardly used in this territory. This was a prospective randomized controlled study including…
First Guidelines Focused Specifically on Chest Pain Management
Many years of developing and waiting have led us to the latest guidelines published by ACC/AHA together with other societies. This is the first document exclusively dedicated to the assessment and diagnosis of acute chest pain. In this regard, we can safely say this is no mere update of a previous set of guidelines, but…
ESC 2021 | TOMAHAWK: Angiography After Resuscitated Patients from Out-Of-Hospital Cardiac Arrest with No ST Elevation.
What triggered this study was a long unanswered question: should patients successfully resuscitated from an out-of-hospital cardiac arrest presenting a non-STEMI ECG be immediately taken to the cath lab? In response to this question the TOMAHAWK randomized 554 out-of-hospital resuscitated patients without electrocardiographic evidence of ST-segment elevation patients to immediate angiography (n=281) vs intensive care…
EuroPCR 2018 | SYNTAX III REVOLUTION: Excellent Correlation Between Angiography and Computerized Tomography in Patients with Left Main and Multivessel Disease
In patients with left main or three-vessel coronary disease, heart team decisions on revascularization strategy (angioplasty or surgery) may be made based solely on noninvasive computerized tomography (CT) angiography, since there is great correlation between its results and those determined by conventional angiography. For the SYNTAX III REVOLUTION study, Dr. Serruys and his colleagues randomized…
The use of IVUS in unprotected left main PCI associated to better outcomes, compared to angiography guided PCI
Courtesy of Dr. Gustavo Leiva. Coronary Artery Bypass Graft (CABG) has traditionally been the procedure of choice in patients with left main coronary artery disease. However, the use of percutaneous techniques in this kind of lesions has been on the rise, partly due to recent research showing similar outcomes with both procedures. Unprotected left main…