Publications by authors named "Alexandra-J Lansky"
Background: To understand the relative safety and efficacy of endovascular treatment modalities used for superficial femoral artery (SFA) disease, we performed a network meta-analysis to compare outcomes between percutaneous transluminal angioplasty (PTA), atherectomy (A), bare metal stent (BMS), brachytherapy/radiotherapy, covered stent graft (CSG), cutting balloon angioplasty (CBA), drug-coated balloon (DCB), drug-eluting stent (DES), and intravascular lithotripsy (L).
Methods: We performed a systematic literature search of PubMed from January 2000 to January 2023 to identify randomized trials comparing endovascular interventions for the treatment of SFA disease. The primary end points were technical success and 12-month primary patency.
Background And Aims: In the Surgical Treatment for Ischaemic Heart Failure Trial Extension Study (STICHES), coronary artery bypass grafting (CABG) improved outcomes of patients with ischaemic left ventricular dysfunction receiving medical therapy, whereas in the Revascularization for Ischaemia Ventricular Dysfunction trial (REVIVED-BCIS2), percutaneous coronary intervention (PCI) did not. The aim of this study was to explore differences in outcomes of participants treated with medical therapy alone in STICHES vs. REVIVED-BCIS2 and to assess the incremental benefit of CABG or PCI.
View Article and Find Full Text PDFBackground: Aortic stenosis (AS) is the leading cause of valvular heart disease-related morbidity and mortality, but there are no medical treatments to slow its progression. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have pleiotropic effects which could be disease modifying in AS.
Objectives: Determine if SGLT2i usage is associated with slower progression of AS.
Can Contrast Injections Cause or Propagate Coronary Injuries? Insights From Vessel and Guiding Catheter Hemodynamics.
J Soc Cardiovasc Angiogr Interv
December 2024
Background: The mechanistic association between the hydraulic forces generated during contrast injection and the risk of coronary injury is poorly understood. In this study, we sought to evaluate whether contrast injections increase intracoronary pressures beyond resting levels and estimate the risk of hydraulic propagation of coronary dissections.
Methods: This is a prospective, single-arm, multicenter study that included patients with nonculprit, non-flow-limiting coronaries.
Background: Coronary artery disease (CAD) is the leading cause of death for women, yet they remain underrepresented in interventional CAD studies. Women have been shown to be at increased risk of mortality and major adverse events after percutaneous coronary intervention (PCI). The poorer outcomes are likely because women are typically diagnosed with CAD late, at an older age, with more comorbidities, and with more challenging anatomy including smaller vessels and higher prevalence of coronary artery calcification.
View Article and Find Full Text PDFEditor's Choice - Results of SurVeil Versus IN.PACT Admiral Paclitaxel Coated Balloons in Femoropopliteal Arteries: 24 Month Outcomes of the Randomised TRANSCEND Study.
Eur J Vasc Endovasc Surg
March 2025
Article Synopsis
- * In this randomized controlled trial involving 446 patients, the SurVeil PCB showed a primary safety rate of 91.8% and a primary efficacy rate of 82.2%, while the IN.PACT Admiral had rates of 89.8% and 85.9%, respectively.
- * The results indicate that the SurVeil PCB is a safe and effective treatment option, demonstrating non-inferiority to the IN.PACT Admiral PCB over a 24-month period.
Article Synopsis
- The text discusses the challenges in treating below-the-knee (BTK) lesions, particularly due to their complexity and calcification, with existing studies showing varied outcomes and often excluding severely calcified cases.
- The Disrupt BTK II study aimed to assess the efficacy of intravascular lithotripsy (IVL) on patients with moderate to severe calcification in BTK lesions, enrolling 250 subjects across various sites in the U.S. and Europe, focusing on safety and procedural success.
- The results showed a high procedural success rate of 97.9%, with significant reductions in stenosis after treatment, and no major adverse limb events reported at the 30-day mark, indicating IVL may be an effective option
Article Synopsis
- * Among 239 patients assessed, 124 had RVD, which was linked to factors like lower left ventricular ejection fraction and higher blood urea nitrogen levels, but did not significantly affect certain immediate procedural outcomes.
- * RVD was found to be a strong predictor of worse long-term outcomes, with higher rates of major adverse cardiac and cerebrovascular events (MACCE) at 90 days and increased mortality at one year post-procedure.
Article Synopsis
- Cerebrovascular events (CVEs) can happen during or after a procedure called TAVR, which replaces a heart valve, and can lead to serious health problems.
- Even though strokes have become less common since TAVR started, they’re still a major concern because TAVR is being used more often.
- New devices and treatments are being tested to help prevent CVEs, but current options may not reduce stroke risk enough, and there are concerns about bleeding from the medication used.
Background: The prognosis of myocardial ischaemia with no obstructive coronary artery disease (INOCA) and its underlying vasomotor disorders, vasospastic angina (VSA) and microvascular angina (MVA), is not well defined. The aim of this study was to perform a systematic review and meta-analysis of studies evaluating the long-term prognosis of patients with INOCA.
Methods: We included studies evaluating the prognosis of patients with INOCA published between January 1984 and August 2023 in Medline, Embase, Web of Science and Cochrane databases.
Background: Mitral valve regurgitation (MR) is associated with worse outcomes in patients undergoing percutaneous coronary intervention (PCI). We sought to evaluate outcomes of Impella-supported high-risk PCI (HRPCI) patients according to MR severity.
Methods: Patients from the PROTECT III study undergoing Impella-supported HRPCI were stratified into 4 groups according to MR severity: No or trace MR, mild MR, moderate MR, and severe MR.
Background: Patients with complex coronary artery disease, as defined by high SYNTAX scores, undergoing percutaneous coronary intervention (PCI) have poorer outcomes when compared with patients with lower SYNTAX I scores. This study aimed to assess if mechanical circulatory support using Impella mitigates the effect of the SYNTAX I score on outcomes after high-risk percutaneous coronary intervention (HRPCI).
Methods: Using data from the PROTECT III study, patients undergoing Impella-assisted HRPCI between March 2017 and March 2020 were divided into 3 cohorts based on SYNTAX I score-low (≤22), intermediate (23-32), and high (≥33).
Article Synopsis
- The study examines the connection between acute brain injuries detected by diffusion-weighted MRI and stroke outcomes in patients who undergo transcatheter aortic valve replacement (TAVR).
- A total of 495 patients were analyzed, revealing that 85% experienced brain injuries, with a significant link between the total lesion volume and the occurrence of clinical strokes.
- The findings suggest that measuring the extent of brain injury could be important for predicting stroke risk and recovery in TAVR patients, indicating potential for enhancing stroke prevention strategies.
Background: Despite advances in therapy options, pulmonary embolism (PE) continues to carry a high risk of mortality and morbidity. Currently, therapeutic options are limited with only 2 US Food and Drug Administration-cleared catheter-based embolectomy devices approved for the treatment of intermediate-risk PE. The novel Hēlo PE thrombectomy catheter (Endovascular Engineering, Inc) has a flexible and collapsible funnel with an internal agitator for a dual mechanism of treatment for acute PE.
View Article and Find Full Text PDFDetermining the Cause of Coronary Vasomotor Disorders in Patients With Ischemia and Nonobstructive Coronary Arteries: Design and Rationale of the DISCOVER INOCA Prospective, Multicenter Registry.
J Soc Cardiovasc Angiogr Interv
June 2024
Article Synopsis
- * The DISCOVER INOCA registry aims to enroll 500 patients to study the prevalence of different INOCA phenotypes and their relationship with atherosclerosis over a follow-up period of five years, assessing both short-term and long-term health outcomes.
- * This study is the first to prospectively combine anatomical and physiological data to better understand INOCA and its effects on long-term cardiovascular health, potentially improving diagnosis and treatment strategies.
Reaches Another Milestone: We Are Indexed in PubMed Central.
J Soc Cardiovasc Angiogr Interv
July 2024
Background: We aimed to perform a meta-analysis of randomized trials comparing long-term outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) for severe aortic stenosis. The short-term efficacy and safety of TAVR are proven, but long-term outcomes are unclear.
Methods: We included randomized controlled trials comparing TAVR vs SAVR at the longest available follow-up.
Impact and Implications of Neurocognitive Dysfunction in the Management of Ischemic Heart Failure.
J Soc Cardiovasc Angiogr Interv
December 2023
Article Synopsis
- Neurocognitive dysfunction affects 30% to 80% of heart failure patients, impacting memory, attention, and other cognitive areas due to factors like reduced cardiac output and brain injury.
- Cognitive impairment is linked to worse health outcomes, such as higher mortality and rehospitalization rates, especially in patients struggling with treatment adherence.
- While coronary revascularization may improve heart function, it poses risks for cognitive decline; thus, alternative less-invasive methods, like percutaneous coronary intervention, need further evaluation to better manage neurocognitive health in these patients.
Current Landscape and Future Directions of Coronary Revascularization in Ischemic Systolic Heart Failure: A Review.
J Soc Cardiovasc Angiogr Interv
December 2023
Article Synopsis
- Ischemic heart disease is the leading cause of death globally and is significantly linked to heart failure (HF), with an increase in incidence attributed to an aging population and better acute cardiac care.
- There is a notable underutilization of coronary artery disease testing in HF patients, and while coronary artery bypass grafting (CABG) shows a survival benefit, percutaneous coronary intervention (PCI) lacks demonstrated advantages over medical therapy based on recent clinical trials.
- The review highlights the urgent need for more randomized controlled trials to compare the effectiveness of CABG and PCI in treating ischemic systolic HF, especially considering advancements in medical therapies and the treatment of less severe cases.
Article Synopsis
- Intravascular lithotripsy (IVL) is effective and safe for preparing calcified lesions before drug-eluting stent placement, particularly in women, compared to other treatment options which can lead to more complications.
- A study analyzing data from 448 patients found that women were generally older, less likely to smoke, and had smaller and shorter lesions than men, yet resulted in similar angiographic outcomes and complication rates post-procedure.
- Long-term results showed no significant differences in major adverse cardiac events or target lesion failure between women and men at 1 year, indicating that IVL has comparable safety and effectiveness across sexes.
Article Synopsis
- Complete revascularization after a myocardial infarction (MI) leads to lower all-cause mortality compared to just treating the main blockage (culprit revascularization) in patients with multivessel coronary artery disease.
- An analysis of 24 trials with over 16,000 patients showed that complete revascularization also significantly decreased rates of additional MIs and major cardiac events.
- Immediate complete revascularization is preferred over staged approaches for achieving better outcomes, while risks of stent thrombosis and other complications remained similar between methods.