Courtesy of Dr. Guillermo Migliaro. The latest 2011 American College of Cardiology (ACC) guideline states that “coronary intravascular ultrasonography (IVUS) may be considered for guidance of coronary stent implantation, particularly in cases of left main coronary artery stenting (Class IIB, Level of Evidence: B).” This has been long debated with no clear winners. This analysis provides new information…
DES: Best Option in Saphenous Vein Grafts
These results confirm that, despite being used less and less worldwide, DES (drug eluting stents) are the best option in saphenous vein grafts. Saphenous vein graft atherosclerosis has a different pathophysiology to that of native arteries, and PCI in this context is less effective because of high risk of friable thromboembolic material, faster plaque…
Six Month DAPT Enough for Nobori BES
Patients treated with A9 biolimus eluting stent with biodegradable polymer (Nobori, Terumo) can receive only six months of dual antiplatelet therapy (DAPT) with no increase in adverse events, compared against more prolonged treatments. The net adverse clinical and cerebrovascular events that included all cause death, MI, cerebrovascular events and major bleeding was: 1.92% for…
Current Bare-Metal Stents: Similar to DES in the Very Long-Term
The largest randomized trial in history found no difference in the primary endpoint of death and nonfatal infarction between current conventional stents and drug-eluting stents at over 5 years in patients with stable or unstable coronary disease. As expected, NORSTENT did find a difference in revascularization rates between both groups. This study presented at the…
Optimal Duration of DAPT: How to Predict Long-Term Events
Courtesy of Dr. Santiago F. Coroleu. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel after percutaneous coronary intervention (PCI) reduces the risk for coronary thrombotic events (CTEs) at the expense of increasing risk for major bleeding (MB). However, the lack of information to accurately predict the occurrence of each event in out-of-hospital patients under…
DES in primary PCI: The Best Option?
Courtesy of Dr. Brian Nazareth Donato. The relative safety of drug-eluting stents (DES) and conventional bare-metal stents (BMS) in primary angioplasty (percutaneous coronary intervention, PCI) in patients with ST elevation myocardial infarction (STEMI) is still subject of debate. A search was carried out using Medline, CENTRAL, EMBASE, TCTMD and Cardiosource. There were 9673 patients included,…
DAPT after PCI with EES: 6 or 12 Months?
Original Title: 6-Month versus 12-Month Dual-Antiplatelet Therapy Following Long Everolimus-Eluting Stent Implantation. The IVUS-XPL Randomized Clinical Trial. Reference: Hong et al. JACC Cardiovasc Interv. 2016 May 11. [Epub ahead of print] Courtesy of Dr. Brian Nazareth Donato. This publication stems from the IVUS-XPL published by JAMA in November 2015. This study presents outcomes on the…
Tissue Protrusion after DES: Adverse Events at Long Term?
Original Title: Tissue Protrusion after Stent Implantation. An ADAPT-DES Intravascular Ultrasound Substudy. Reference: Fuyu Qiu et al. J Am Coll Cardiol Intv. 2016;9(14):1499-1507. After DES implantation we may observe tissue protrusion (plaque or thrombus) relatively often, especially in unstable lesions; however, its clinical impact has not been studied. The aim of this study was…
Radiotherapy: Post PCI Cardiovascular Death Predictor
Original Title: Long-Term Mortality in Patients With Radiation-Associated Coronary Artery Disease Treated with Percutaneous Coronary Intervention. Reference: Reed GW et al. Circ Cardiovasc Interv. 2016 Jun;9(6). Courtesy of Dr. Brian Nazareth Donato. Radiotherapy is often used to treat malignant tumors; however, it is associated with adverse cardiovascular effects such as constrictive pericarditis, valve deterioration…
Stent Fracture: More Frequent than Expected
Original Title: Incidence and Clinical Outcome of Stent Fractures on the Basis of 6555 Patients and 16482 Drug Eluting Stents From 4 Centers. Reference: Kan J et al. JACC Cardiovasc Interv. 2016 Jun 13;9(11):1115-23. Courtesy of Dr. Guillermo Migliaro. Stent fracture (SF) has been associated with instent restenosis (ISR), stent thrombosis (ST) and repeat revascularization…