Percutaneous treatment for obstructive coronary artery disease has evolved in conjunction with technological advances from the initial era of balloon angioplasty to the first bare metal stents (BMS) and then through various iterations of drug eluting stent (DES) technology. Current generation DES data suggest progressively improved re-stenosis and thrombosis rates and on-going trials are examining […]
Category: Interventional cardiology
Long-term data on fractional flow reserve guided PCI
The Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) trial was a landmark study of the use of fractional flow reserve (FFR) to guide coronary revascularization through the identification of ischemia-inducing stenosis at the time of coronary angiography. The previously published 1- and 2-year results of the FAME trial demonstrated fewer major adverse cardiac […]
Absorbable stents non-inferior….but is that enough?
A coronary artery stent that scaffolds the vessel immediately after angioplasty but disappears over time has been proposed as means to avoid complications of late stent thrombosis and restore physiological vasomotion. Bioabsorbable platforms (termed scaffolds) are designed to slowly dissolve over 2 to 3 years, leaving little or no residue in the vessel. However, conventional […]
Similar Outcomes with Bivalirudin and Unfractionated Heparin During PCI for Acute Coronary Syndromes
Approximately two-thirds of all PCI are performed for acute coronary syndromes. In this setting, the optimal balance of anticoagulation to avoid thrombosis against the risk of major bleeding is a pivotal area of procedural management. Multiple clinical trials have compared bivalirudin and heparin (+/- IIb/IIIa inhibitor), but the optimal strategy remains debated. In particular, changes […]
Informed Decision Making for Percutaneous Coronary Intervention for Stable Coronary Disease
Prior studies suggest patients are often misinformed about the anticipated benefits of PCI for stable coronary disease. However, there is little data on patient-provider discussions that may explain discrepancies in patient understanding about the limited benefits of PCI in this setting. Rothberg and colleagues performed a cross-sectional analysis of 59 conversations between providers and patients […]
Antiplatelet therapy in long-term risk reduction after myocardial infarction
The activated platelet is central to development of ischemic cardiovascular events. Guidelines recommend treatment with a P2Y12 receptor antagonist for 1-year after myocardial infarction (MI) to reduce the risk of recurrent events. The PEGASUS trial sought to determine the impact of using the P2Y12 antagonist ticagrelor as part of long-term therapy after MI. In this […]
Precision Medicine to Reduce Bleeding with PCI
Periprocedural bleeding remains one of the most common adverse events after percutaneous coronary intervention (PCI) and is associated with increased mortality. Although strategies to minimize PCI bleeding have been identified, these strategies are infrequently applied to patients at highest bleeding risk. Using a pre-post study design, Spertus et al. evaluated the impact of assessing individual patient bleeding risk from validated models and providing this bleeding risk estimate in personalized informed […]
Second-generation stents fail to BEST CABG
The technology of drug eluting stents for percutaneous coronary intervention (PCI) has improved over time with resultant improvements in patient outcomes. Although prior studies have demonstrated the benefit of surgical coronary artery bypass grafting (CABG) over transcatheter PCI among patients with multivessel coronary artery disease (CAD), these studies did not incorporate newer generation drug-eluting stents. […]
Aspiration thrombectomy fails to demonstrate benefit in primary PCI
Although primary percutaneous coronary intervention (PPCI) restores epicardial coronary flow in the majority of patients with ST-segment myocardial infarction, this approach can lead to microvascular obstruction resulting from distal embolization of thrombus. Manual thrombectomy (i.e. aspiration thrombectomy) prior to PPCI has been proposed as a method to reduce thrombus burden and resultant distal embolization with […]
Coronary sinus reduction for intractable angina
An increasing number of patients have angina that is refractory to maximal medical therapy and unable to be addressed with revascularization procedures. Prior small studies have suggested the promise of generating a pressure gradient upstream of the myocardial venous drainage system to relieve angina. This can be accomplished through the percutaneous implantation of a device […]