With the new devices (drug-eluting balloons [DEB], drug-eluting stents [DES], and atherotomes) percutaneous treatment is becoming the first line of approach for femoropopliteal disease, especially when dealing with not very long total occlusions. Randomized studies and registries on the use of drug-coated balloons (DCB) in femoropopliteal disease are currently available, but their evolution beyond 2…
Left Main Coronary Artery PCI Using State-of-the-Art Zotarolimus-Eluting Stents
Percutaneous coronary intervention (PCI) to the left main coronary artery (LMCA) with drug-eluting stent implantation is currently a major challenge due to the size of the vessel, the compromise of a bifurcation lesion in important branches, and the potential risk of complications. Available information on LMCA PCI comes from studies where DES stents were implanted…
Can We Use DAPT for 3 Months in Acute Coronary Syndrome?
Current guidelines recommend 12-month dual antiplatelet therapy (DAPT) after DES stenting for acute coronary syndrome (ACS) because of elevated MACE risk. The development of more modern stents, with thin and ultrathin struts, compared against prior versions, has resulted in more effective devices in terms of stent thrombosis and restenosis. Prolonged DAPT has been associated with…
P2Y12 Inhibitor Monotherapy vs Aspirin: Results of a Network Meta-Analysis
Revascularization and antiaggregation guidelines have typically recommended aspirin (AAS) as first choice for secondary prevention of cardiovascular events after DES stenting. However, these past few years this strategy has been called into question, seeing as studies have shown the superiority of P2Y12 inhibitor monotherapy (IP2Y12) with clopidogrel or ticagrelor. There is little data comparing both…
EMINENT Trial | Stent Eluvia vs BMS in Femoropopliteal Territory
Endovascular therapy in femoropopliteal territory has become the standard, mainly with self-expanding stents, aimed at preventing early vascular recoil and late constrictive remodeling. Randomized studies have shown that the use of Paclitaxel drug eluting stents (DES) reduces the number of new revascularizations (even though these studies compared mostly against conventional balloons, which is why we…
Should We Start Using Ultra-Thin Struts?
The benefits of DES are well known, as well as the benefits of more recent polymer-based DES versions (even those with no polymers). However, strut size is no small matter, and might even make the difference, seeing as thinner struts are associated to better deliverability, simpler crossing profile in bifurcations, better endothelization and healing. Besides,…
Revascularization Using DES in Infrapopliteal Disease: Meta-Analysis and Change of Paradigm?
Peripheral vascular disease (PVD) has been under-studied and under-recognized in comparison with ischemic heart disease and stroke, despite its well-known impact on quality of life and its associated morbidity and mortality. According to a systematic review, it was estimated that in 2015 about 238 million people globally had PVD. This number is on the rise.…
IVUS-Guided Coronary Angioplasty: Promising Results at 3-Year Follow-Up
Intravascular ultrasound (IVUS) to guide drug-eluting stent (DES) implantation has been evaluated in several studies. Two randomized studies, IVUS-XPL (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions) and ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in All-Comers Coronary Lesions), have shown fewer repeat revascularizations compared with angiography-guided…
Should We Start Stenting with DES in Femoropopliteal Territory?
Percutaneous intervention of femoropopliteal lesions have been the standard strategy these past two decades. The development of drug eluting stents (DES) or drug eluting balloons (DEB) has improved patency rate compared against conventional balloon angioplasty. The ILLUMINA -a multicenter study- looked into the polymer free self-expanding stent NiTiDES, which showed at 1 year an 87%…
Drug Eluting Stents: Does Strut Size Matter?
The benefit of first-generation Drug-Eluting Stents (DES) over Bare Metal Stents (BMS) is largely known. Moreover, technological developments have led to reduced strut size, biodegradable polymers, and new scaffolds, which in turn have led to improved outcomes. These are known as ultrathin stents, and its struts measure between 70 and 100 microns, which contributes to…