Collateral circulation develops during the gradual progression of coronary occlusions in order to replace the original artery and supply blood to areas jeopardized by ischemia. However, the relevance of collaterals has remained controversial for many years. Several works have suggested a rapid regression of collaterals after rechanneling of chronic total coronary occlusions, which could render…
Successful CTO reduces local and remote residual ischemia
Courtesy of Dr. Carlos Fava. The presence of Chronic Total Occlusion (CTO) is about 30%, with an ischemic threshold between 10% and 12.5% to justify rechannelization. Using the new devices, the new guidelines and with more experience operators, these procedures are successful in 10% to 30% of cases. More often than not these patients are not treated…
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…
Successful angioplasty in elderly patients with chronic total occlusion reduces mortality
Courtesy of Dr. Carlos Fava. Nowadays, the number of coronary angioplasties carried out on patients with chronic total occlusion (CTO) is increasing due to many studies showing that it improves ventricular function, reduces symptoms, and improves survival. However, most of these works do not include patients of over 75 years old due to their frailty and…
Same-day discharge after coronary angioplasty is increasingly popular but still not the gold standard
The length of hospital stay after elective coronary angioplasty varies significantly among operators and hospitals, according to a recent survey of interventional cardiologists in the United States (US), Canada, and the United Kingdom (UK), published in Catherization and Cardiovascular Interventions. While same-day discharge is a routine proceeding in the UK, most interventional cardiologists surveyed mentioned…
Incomplete Revascularization: Increased Events Rate in Non-Cardiac Surgery?
The aim of this study was to determine whether incomplete revascularization is associated to higher adverse events risk and acute myocardial infarction in patients undergoing non-cardiac surgery. Coronary artery disease patients or patients with prior PCI often have non cardiac surgery. These patients may have had all obstructions treated before surgery (complete revascularization) or…
RESOLUTE Global: 5 Years of Zotarolimus DES Stenting
This study assessed the cumulative incidence of cardiovascular evens after zotarolimus eluting stent implantation. Individual studies often lack enough statistical power to show differences in low frequency adverse events. The Resolute zotarolimus eluting stent was evaluated across 10 prospective clinical trials designed with identical adverse events definitions. The Global Resolute clinical trial program…
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.…
Double Kissing Crush vs. Provisional Stenting at 5 Years
Courtesy of Dr. Guillermo Migliaro. The Provisional Stenting technique (PS) consists of sequentially placing a stent in the main branch of the bifurcation and, only when faced with a suboptimal outcome (such as < 3 TIMI flow, flow limiting dissection or high residual stenosis), a second stent in the side branch. Several studies have shown…
The ReACT Study: Is Angiographic Follow-Up Necessary?
The purpose of this study was to assess the long-term clinical impact of routine angiographic follow-up after coronary angioplasty. Routine angiographic follow-up has been criticized by both clinical and interventional cardiologists for increasing the rate of coronary revascularization due to the “oculostenotic reflex.” This caused a shift in the paradigm for clinical studies, and…