In this large randomized trial, there were significant differences as regards both target-lesion failure and target-vessel-related infarction, which persisted through a 2-year follow-up and favored treatment with an ultrathin-strut bioresorbable-polymer sirolimus-eluting stent (Orsiro) compared with the gold standard, a durable-polymer everolimus-eluting stent (Xience). Moreover, there were significantly lower rates of target lesion revascularization and late/very…
Predicting Coronary Angioplasty Benefits
Coronary angioplasty or percutaneous coronary intervention (PCI) reduces angina and improves quality of life in patients with stable ischemic cardiomyopathy, though the ORBITA study has shed new light on this. Meanwhile, we will assume this is indeed the case, until new studies either confirm or refute the above mentioned, controversial study. Either way, it is…
Safety of Combining New Anticoagulant Agents and Dual Antiplatelet Therapy
Atrial fibrillation is the most common arrhythmia and its combination with a history of acute myocardial infarction or coronary angioplasty is quite frequent. According to this study (recently published in JACC), in a real-world population, the combination of direct anticoagulant agents and dual antiplatelet therapy reduces significantly the risk of bleeding and provides similar thromboembolic…
Practical Management of Coronary Perforations
Coronary perforation has an incidence of 0.5% and it is associated with a 13-fold increase in in-hospital events and a 5-fold increase in 30-day mortality. This event is so catastrophic that its management has become indispensable knowledge to all interventional cardiologists. This accident is most frequently provoked by artery over-dilation caused by a balloon or…
TCT 2018 | OAC-ALONE: Anticoagulation Alone 1 Year After Stenting in Patients with Atrial Fibrillation
Up to now, there had been no randomized controlled trial assessing oral anticoagulation alone vs. oral anticoagulation plus antiplatelet therapy in patients with atrial fibrillation 1 year after stenting in a setting of stable coronary disease. Such was the vacuum that this work, presented at TCT 2018 and published simultaneously in Circulation, attempted to fill. This trial…
TCT 2018 | ULTIMATE: IVUS Guided DES Implantation for All Vessels, for All Lesions
Intravascular Ultrasound (IVUS) guided drug eluting stent (DES) implantation is associated with less adverse events compared against angiography guided stenting. This is especially clear for certain populations (with left main PCI as paradigmatic) but not so clear when dealing with all comers. 1448 all comer patients requiring DES stenting were randomized 1:1 to IVUS guided…
ESC 2018 | GLOBAL LEADERS: Ticagrelor Monotherapy Is Not Superior to Classic Therapies After Angioplasty
Dropping aspirin after the first month and continuing with ticagrelor monotherapy was not better than standard dual antiplatelet therapy (aspirin plus ticagrelor or clopidogrel) in patients who underwent coronary angioplasty. Patrick Serruys presented this work (which was simultaneously published in The Lancet) at the European Society of Cardiology (ESC) Congress 2018 and explained that, given…
What Happens with Small Dissections and Imperfections Only Shown by OCT?
When we carry out an angioplasty guided by angiography alone, as we historically have, we are almost blind. Nowadays, optical coherence tomography (OCT) offers plenty of detail but also raises costs, procedure time, and contrast volume. The question that this study aimed to answer is whether becoming aware of all small defects and imperfections in…
Left Main PCI: Despite Auspicious Long-Term Outcomes, Optimal Strategy Still under Discussion
Left main coronary artery bifurcation interventions have shown very good results at long term, especially with new generation DES. The one-stent strategy has seen better results than the two-stent strategy, according to this registry recently published in J Am Coll Cardiol Intv. However, how does this registry of the daily practice between the years 2002 and…
EXCEL Sub-Study: The Site of the Left Main Coronary Artery Lesion Does Not Alter History
The EXCEL study, originally presented at TCT 2016 and published simultaneously in the New England Journal of Medicine (NEJM), showed that angioplasty and surgery in patients with left main coronary artery disease have similar rates of mortality, infarction, and stroke at 3 years. This sub-study, recently published in J Am Coll Cardiol Intv, adds that the…