Stroke events do not seem to be related to valve thrombosis or structural degeneration, but to a higher baseline risk in patients who undergo transcatheter aortic valve replacement (TAVR). About 1 in 20 patients who underwent TAVR experienced a stroke or transient ischemic attack during follow-up. According to this new analysis, the consequences of these events…
AHA 2019 | Treat Stroke to Target: Post-Stroke Aggressive Therapy with Statins
Indicating statins to reach more aggressive LDL goals in patients that have suffered transient ischemic attack or ischemic stroke driven by atherosclerosis significantly reduces major cardiovascular events according to this study presented in the AHA 2019 scientific sessions simultaneously published in NEJM. The study was prematurely ended because of lack of funding, but its outcomes…
Bariatric Surgery Associated with a Lower Rate of Mortality Due to Infarction and Stroke
Prior bariatric surgery in a patient with morbid obesity is associated with a significant effect on survival after infarction or stroke. While these are observational data, the significant metabolic improvement experienced after the surgery can explain perfectly such findings. This large nationwide registry of bariatric surgery found a 40% decrease in the risk of death,…
New Percutaneous Devices to Prevent Embolism in Atrial Fibrillation
Patients with atrial fibrillation (AF) unsuitable for anticoagulation because of bleeding risk, require other strategies to prevent stroke. For some years, there have been in the market (limited to some places; not as part of the regular agenda of cardiologists and hematologists) devices to occlude the atrium that have been proved safe and effective. These…
EXCEL Outcomes: PCI vs CABG in Patients with Prior Cerebrovascular disease
Most certainly, as we read this title, we imagine the conclusion (as does the editor): patients with prior cerebrovascular disease (CEVD) benefit from a less invasive revascularization strategy, such as PCI. However, the EXCEL outcomes tell us that patients with left main coronary artery disease (LMCAD) and a history of CEVD will not benefit from…
Long-Term Foramen Ovale Closure after Cryptogenic Stroke
Patent foramen ovale closure is the standard treatment for cryptogenic stroke patients. However, there are is little information on its long-term evolution. The aim of this study was to determine clinical outcomes (death, ischemic or bleeding events) after foramen ovale closure over a 10-year evolution. The study included 201 consecutive patients (mean age 47…
New Device for More Protection in Carotid Artery Stenting
This new “Paladin” system for post-dilation during carotid artery stenting was safe and may effectively reduce the number of particles that reach the brain, with a subsequent decreased risk for peri-procedural stroke. This study evaluated the safety and efficacy of the Paladin System, a novel post-dilation balloon with an integrated distal protection filter designed to…
We Must Still Fear the “Big Five Complications” After TAVR
Surgical risk scores cannot be used for transcatheter aortic valve replacement (TAVR) and they usually overestimate procedural risk. There are 5 big complications after TAVR, specifically, that cannot be predicted by conventional surgical scores. These 5 peri-procedural complications are considered important because they have a somewhat significant impact on survival after TAVR. They are: 1)…
Mechanical Thrombectomy in Stroke Could Have Worse Results in Low Volume Centers
The number of centers that are starting endovascular stroke therapy (EST) to treat acute stroke is growing fast, with a significant increase of cases in low volume centers. Interventional neurologists are not able to cover the high demand and interventional cardiologists are always ready to learn something new. Is this right? Should interventional cardiologists treat…
Cautious Administration of Supplemental 02, Especially in Acute Stroke or MI
Recent studies show the potential damaging effect of supplemental oxygen in the context of acute stroke and myocardial infarction. Experts now say that it should not be used in patients with >92% oxygen saturation. These guidelines have looked into the most recent studies, including the DET02X-AMI, which suggest supplemental oxygen therapy could increase mortality in…