Anticoagulation with heparin The art of simplicity even in patients on dialysis.

In current PCI practice, anticoagulation with either bivalirudin or unfractionated heparin in patients with ACS share comparable efficacy and safety. Nonetheless, their individual performance in patients on dialysis remains unclear. This observational PCI study reported in-hospital clinical outcome in patients on dialysis undergoing PCI according to drug regimen: bivalirudin versus heparin.

Direct stenting versus balloon predilation: Jury is still out.

Compared to balloon predilation, direct stenting (DS) shortens procedural time and reduces radiation and contrast exposure. A meta-analysis that included 7 studies comparing these 2 strategies revealed lower adverse event rate with DS. Studies included in the present meta-analysis were mostly observational and utilized first generation drug-eluting stent.

Predicting Early Readmission Following PCI: A Work in Progress.

Early hospital readmissions after percutaneous coronary interventions (PCI) are common and costly. From the NCDR CathPCI Registry and the Centers for Medicare and Medicaid Services, a risk prediction model was generated using 14 clinical variables, demonstrating modest discrimination. Future research is needed to identify interventions aim to reduce early readmissions.

Overlapping bioresorbable scaffolds seems safe for now.

Overlapping permanent scaffolds carries a long-term risk of target vessel failure due to late malapposition and the development of neoatherosclerosis. Potentially, overlapping bioresorbable scaffold (BRS) may lead to lower long-term risk. The GHOST-EU registry reported similar short- and mid-term risks in patients with and without BRS overlap.

Double-stenting in distal left main lesions: Let's crush.

Unprotected distal left main (ULM) lesions often require double-stenting. In the MITO Registry, a mini-crush stenting technique was safer than culotte stenting. Performing mini-crush arises as the best approach in patients with distal ULM lesions requiring elective double-stenting.

Aorto-Ostial Lesions: Battling an Old Foe.

Aorto-ostial lesions (AOLs) entail several diagnostic and treatment challenges. The Flash Ostial System enables flaring of the overhanging stent, optimizing stent deployment in AOLs. Careful planning is essential to achieve optimal stent implantation and avoid early and late complications during the treatment of AOLs.

Ischemic Postconditioning: Not Giving Up Yet.

Ischemic postconditioning protects against reperfusion injury. Adjunctive use of manual thrombus aspiration improves reperfusion results in patients undergoing primary angioplasty. Combining both strategies (ischemic postconditioning and thrombus aspiration) may have additive effects in terms of myocardial salvage.

To achieve, or not to achieve complete revascularization.

Prior to minimally invasive valve surgery, a strategy of complete revascularization did not impact overall survival. Angiographically guided revascularization may have resulted in unnecessary procedures. A larger sample size and greater atherosclerotic burden may be needed to observe an impact with complete revascularization.

Optimal anticoagulation prior to cath: Bivalirudin vs. Heparin the saga continues….

During the pre-procedural (medication) phase, the use of bivalirudin monotherapy is associated with the lowest rate of bleeding in patients with Non-ST elevation myocardial infarction (Non-STEMI) undergoing an early invasive strategy. Monotherapy with either bivalirudin or unfractionated heparin (UFH) appear interchangeable in this setting. The use of GPI upstream with either drug should be discouraged due to an increased risk of bleeding and net adverse events.

Real-world experience with BVS: Trading early sacrifices for a (possible) brighter future.

Randomized clinical trial data suggest non-inferiority of bioresorbable vascular scaffolds (BVS) compared to current drug-eluting stent. Compared to randomized data, observational studies with BVS have revealed higher rates of scaffold thrombosis. Meticulous deployment technique of the device including appropriate vessel sizing, optimal scaffold apposition, and avoidance of overexpansion may likely limit the risk of scaffold thrombosis.

Acute kidney injury after TAVI: Predict, detect, and prevent.

Acute kidney injury (AKI) is frequently observed immediately after transcatheter aortic valve implantation (TAVI). Both classifications, the RIFLE (the Risk, Injury, Failure, Loss, and End-stage Kidney) and the KDIGO (Kidney Disease: Improving Global Outcomes) from the VARC-2 (Valve Academic Research Consortium-2) are fairly interchangeable and performed well as clinical predictors of all-cause mortality. Patients with baseline reduced glomerular filtration rate (GFR) or known atherosclerotic arterial disease are at increased risk of AKI.

Transcatheter aortic valve implantation: Watch out for the leak, irrespective of aortic valve disease type.

Postprocedural aortic regurgitation (PAR) after transcatheter aortic valve implantation (TAVI) is associated with a worst clinical outcome. The presence of chronic aortic regurgitation in TAVI candidates increases PAR risk but not overall survival. Future valve prototypes will likely reduce the degree and frequency of this complication.

Bioresorbable vascular scaffold for the treatment of coronary bifurcations: What have we learned?

Bioresorbable vascular scaffolds (BVS) remain experimental for the treatment of coronary bifurcations (B) and further clinical data is needed before widespread adoption in this setting. Preliminary, clinical outcome in B using a provisional stenting or double stenting approach with BVS is encouraging and close to the one observed with next-generation drug-eluting stent. Improvements in device navigability, reduction in strut bulk and reabsorption time may render the device more predictable and simpler to use.

A single degree of oversize does not fit all valve types.

Moderate valve oversize increases the risk of aortic regurgitation with self-expandable valves, and larger oversizing may be preferable with this valve type. Large oversizing increases the risk of aortic annular rupture in patients treated with balloon-expandable valves and less oversizing appears safer. Anatomical factors may also may influence procedural success and should not be overlooked.

Being reasonable during coronary revascularization.

The SYNTAX score is an angiographically based tool useful for clinical decision-making prior to coronary revascularization. The residual SYNTAX score (after angioplasty) is an independent predictor of clinical long-term outcome in patients with complex coronary artery disease. Both scores require functional lesion assessment.

StentBoost Visualization for the Evaluation of Coronary Stent Expansion During Percutaneous Coronary Interventions.

Introduction: Inadequate stent implantation is associated with stent thrombosis and restenosis. StentBoost can enhance stent visualization and evaluate stent expansion. Currently, there are limited comparison studies between StentBoost and intravascular ultrasound (IVUS).