Courtesy of Dr. Carlos Fava. Coronary perforation (CP) is a very uncommon event (≈0.4%), associated with severe complications that entail risk of death. It has usually been related to patients with a history of myocardial revascularization surgery (MRS). However, this group usually presents lower rates of cardiac tamponade due to pericardial fibrosis caused by surgery. This…
New Strategies for the Femoropopliteal Artery
Courtesy of Dr. Carlos Fava. The incidence of peripheral vascular disease is clearly increasing, progressing towards critical ischemic claudication and amputation. Angioplasty is currently the treatment of choice for these pathologies. Several times, an implanted stent ends up cracking due to extensive calcification, increasing the rate of restenosis and worsening critical ischemia. Technological development on drug-eluting…
Should We Begin to Use IVUS in CTO?
Courtesy of Dr. Carlos Fava. Currently, chronic total occlusions (CTO) are one of the obstacles that coronary angioplasties must overcome, particularly with the development of drug-eluting stents (DES) and new devices and strategies for these challenging lesions. However, there is little information on the safety, efficacy, and real clinical benefit of implanting stents of over 60 mm (known as full metal jackets, FMJ).…
Common Femoral PCI Becomes a Valid Alternative
Gentileza del Dr. Carlos Fava. The common femoral artery has always been treated with surgery. Thanks to the development of new generation stents and the advancement of percutaneous intervention, common femoral lesions are currently being treated with PCI. However, data on the safety of PCI vs. surgery, remain unavailable. The TECCO is multicenter study, randomized…
SOLACI CACI 2017 | Left main PCI in 2017: Ready to EXCEL?
Read articles on the main presentations of the first day of SOLACI-CACI 2017 Congress. See the presentation by Dr. Gregg Stone, entitled “Left main PCI in 2017: Ready to EXCEL?”. We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.
MRS vs. DES: Which one is associated with better long-term quality of life?
The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, which included patients with 3-vessel or left main coronary artery lesions, showed that myocardial revascularization surgery (MRS) turned out to be superior to angioplasty with drug-eluting stents (DES), mainly due to differences in acute myocardial infarction and repeat revascularization. Up to this work, patient sensations (which can be…
Prior assistance with Impella 2.5 lowers 30-day mortality in cardiogenic shock due to unprotected left main coronary artery lesion
Courtesy of Dr. Carlos Fava. The prevalence of cardiogenic shock in acute myocardial infarction (MI) is 7%-10%, and it is associated with high mortality rates. Unfortunately, 0.7% of these cases are a consequence of unprotected left main coronary artery (ULMCA) as MI-culprit lesion. Its evolution is generally disastrous. Ventricular assist device support and its implementation time may…
Less volume, more mortality: should we be concerned?
Courtesy of Dr. Agustín Vecchia. In general, guidelines recommend a number of procedures a year for operators to maintain a reasonably safe level of proficiency. Even though this number is arbitrary and operators’ aptitude varies considerable, more than one publication has found an inverse correlation between procedure volume and outcomes. This study incorporated 10,496 operators…
Success in CTOs caused by restenosis lowers cardiac mortality
Courtesy of Dr. Carlos Fava. Nowadays, chronic total occlusions (CTO) due to in-stent restenosis (ISR) represent 5%-25% of all coronary angioplasties. These lesions pose a new and true challenge, since CTOs are often associated with stent-related problems (fractures, lack of expansion, overlapping, deformation), extreme tortuosity, severe calcification, tandem lesions after CTO, and aorto-ostial lesions, with little…
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…