Publications by authors named "Toelg R"
Introduction And Objectives: Patients undergoing percutaneous coronary intervention in vessels with moderate-to-severe tortuosity are at higher risk of adverse outcomes, but data are scarce in the era of newer-generation stents. We compared outcomes following percutaneous coronary intervention in vessels with moderate-to-severe tortuosity using a bioresorbable-polymer sirolimus-eluting stent (BP-SES) vs a durable-polymer everolimus-eluting stent.
Methods: A total of 2350 patients from the BIOFLOW II, IV, and V randomized trials were stratified into 2 groups based on target-vessel tortuosity: none-to-mild and moderate-to-severe.
Background: Coronary physiology to guide multi-vessel coronary intervention is associated with better outcome. In the presence of a coronary chronic total occlusion (CTO), hemodynamic evaluation of intermediate lesions in the donor coronary artery supplying a CTO territory still has limitations. We aim to evaluate implementing quantitative flow ratio (QFR) in assessing angiographically intermediate lesions of the main donor coronary artery supplying a CTO territory.
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- Planning noncardiac surgeries after transcatheter aortic valve implantation (TAVI) is complex and this study analyzed the results and outcomes of such surgeries in TAVI patients.
- Out of 1,602 TAVI patients, 104 underwent 148 noncardiac surgeries, with 56.7% being elective and most categorized as intermediate-risk.
- Adverse events occurred in 38.5% of these surgeries, significantly higher in high-risk procedures, indicating a greater risk of complications following high-risk surgeries.
Article Synopsis
- A hybrid strategy combining plug-based and suture-based vascular closure devices (VCDs) was studied to determine the effectiveness of ProGlide/AngioSeal versus ProGlide/FemoSeal after transcatheter aortic valve implantation (TAVI).
- A retrospective study of 608 patients revealed that the ProGlide/AngioSeal group had significantly higher rates of major bleeding and overall complications compared to the ProGlide/FemoSeal group.
- The findings suggest that using ProGlide/FemoSeal may lead to better outcomes within 30 days and that anterior wall calcification at the access site increases the risk of complications.
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- The BIOMAG-I study evaluated the first-in-human resorbable magnesium scaffold (DREAMS 3G) and showed positive outcomes for clinical results and late lumen loss after 12 months.
- The current substudy looked into vascular healing parameters using optical coherence tomography (OCT) and intravascular ultrasound (IVUS), focusing on aspects like strut visibility and neointimal growth.
- Results from 56 patients indicated that almost all scaffold struts became invisible by 12 months, with a favorable vascular healing response, including a significant decrease in protruding neointimal tissue.
Article Synopsis
- Shortening dual-antiplatelet therapy (DAPT) to 1 month after percutaneous coronary intervention (PCI) is effective and safe for high bleeding risk (HBR) patients, regardless of chronic kidney disease (CKD) status.
- A study analyzed data from 3 prospective studies involving 3,286 patients, of whom 43.6% had CKD, comparing outcomes between 1-month and 3-month DAPT.
- Results indicated that both durations had similar rates of death and myocardial infarction after 12 months, with a slight trend for fewer bleeding complications at 1 month compared to 3 months in both CKD and no-CKD groups.
Background: Severely calcified coronary bifurcations complicate percutaneous coronary interventions (PCI) and often necessitate dedicated lesion preparation. We compared the outcomes of single- versus two-stent techniques for treating heavily calcified true bifurcation lesions following rotational atherectomy (RA).
Methods: Among patients receiving RA for severely calcified true bifurcations at a single center, 59 were treated with a single stent, and another 59 received two stents.
Article Synopsis
- Some doctors suggest giving patients with a high bleeding risk a shorter treatment of medication after getting a special type of heart stent.
- This study looked at how safe and effective 1 month of this medication is compared to 3 months for patients who also had a type of heart problem or not.
- They found that 1-month treatment had the same chance of serious heart issues as the 3-month treatment, but it caused less bleeding after a year.
Introduction: The expansion of transcatheter aortic valve implantation (TAVI) to low-risk and younger patients has increased the relevance of the long-term durability of transcatheter heart valves (THV). The present study aims to assess the 10-year durability, hemodynamic performance, and clinical outcomes after TAVI using the CoreValve system.
Methods: An analysis from a prospective registry with predefined clinical and echocardiographic follow-up included 302 patients who underwent TAVI with the CoreValve system between 2007 and 2015.
Background: In the PREPARE-CALC trial, severely calcified lesion preparation with rotational atherectomy (RA) before biodegradable polymer sirolimus-eluting stent (SES) implantation demonstrated higher procedural success and comparable rates of acute lumen gain and late lumen loss compared to modified balloons (MB) (scoring/cutting). We aimed to analyze the 5-year outcomes of both lesion preparation strategies.
Methods: PREPARE-CALC randomly assigned 200 patients 1:1 to MB or RA, followed by SES implantation.
Article Synopsis
- The analysis evaluated the impact of 1-month versus 3-month dual antiplatelet therapy (DAPT) in older patients after percutaneous coronary intervention (PCI), focusing on those with high bleeding risk.
- In a study of 3,364 patients, they found similar rates of all-cause death or myocardial infarction for both therapy durations, regardless of whether patients were ≥75 years or <75 years old.
- However, patients aged ≥75 experienced significantly less bleeding with the 1-month DAPT compared to the 3-month treatment, suggesting a clearer benefit in reducing bleeding risk without increasing heart-related complications.
Background: Although the use of rotational atherectomy (RA) is off-label in the setting of ST-elevation myocardial infarction (STEMI), it can be the only option in severely calcified culprit lesions to achieve procedural success. We sought to investigate the safety and feasibility of RA during primary percutaneous coronary intervention (PPCI).
Methods: This was a retrospective observational study of patients who underwent RA during PPCI from 12 European centres.
Introduction: The preference for using transradial access (TRA) over transfemoral access (TFA) in patients requiring percutaneous coronary intervention (PCI) is based on evidence suggesting that TRA is associated with less bleeding and fewer vascular complications, shorter hospital stays, improved quality of life, and a potential beneficial effect on mortality. We have limited study data comparing the two access routes in a patient population with atrial fibrillation (AF) undergoing PCI, who have a particular increased risk of bleeding, while AF itself is associated with an increased risk of thromboembolism.
Methods: Using data from the RIVA-PCI registry, which includes patients with AF undergoing PCI, we analyzed a high-bleeding-risk (HBR) cohort.
Article Synopsis
- The study aimed to evaluate how the initial composition of plaque affects late loss in the lumen after DREAMS 3G implantation and to compare plaque changes over 6 and 12 months.
- 116 patients from the BIOMAG-I trial underwent imaging using optical coherence tomography (OCT) before and after the procedure, revealing that those with more fibrous tissue in their plaque initially had greater differences in lumen area after a year.
- Results showed a significant reduction in lipid areas and an increase in fibrous tissue at follow-up, indicating favorable healing of coronary walls post-implantation.
Article Synopsis
- - The study examined the effects of 1-month vs. 3-month dual antiplatelet therapy (DAPT) in patients who had undergone percutaneous coronary intervention (PCI), particularly those on long-term oral anticoagulation (OAC) therapy.
- - Results showed that patients on OAC had similar rates of death or myocardial infarction (MI) whether they were on 1-month or 3-month DAPT, but those on 1-month therapy experienced lower rates of bleeding complications.
- - Overall, 1-month DAPT was found to be as effective as 3-month DAPT in preventing serious cardiovascular events while significantly reducing bleeding risks for patients, regardless of their OAC status.
The EVOLVE Short DAPT study demonstrated the safety of truncated dual antiplatelet therapy (DAPT) in patients with a high bleeding risk (HBR) treated with SYNERGY stent(s) (Boston Scientific Company, Marlborough, Massachusetts). In this population, bleeding and ischemic risk prediction may further inform DAPT decisions. This post hoc analysis of the EVOLVE Short DAPT study identified predictors of ischemic and bleeding events up to 15 months using Cox proportional hazard models.
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- The study examines the prognostic significance of quantitative flow ratio (QFR) measured after successful coronary artery recanalization in predicting target-vessel failure (TVF) compared to the target-vessel SYNTAX score (tvSS).
- Out of 470 chronic total occlusion (CTO) lesions, 324 could be analyzed, revealing that lower post-procedure QFR was associated with a trend toward higher TVF rates, yet it did not significantly predict outcomes.
- In contrast, the pre-procedural tvSS was identified as a significant independent predictor for 2-year TVF, suggesting its importance over immediate QFR assessment for long-term prognosis.
Article Synopsis
- The DREAMS 3G is a new coronary magnesium scaffold designed to match the performance of traditional drug-eluting stents (DES).
- The BIOMAG-I study is a first-in-human trial that evaluates the safety and effectiveness of this scaffold with a follow-up period of up to 5 years.
- Results showed that after 12 months, the scaffold demonstrated low rates of complications, confirming its safety and efficacy as a potential alternative to DES.
Introduction: Patients at high bleeding risk (HBR patients) represent an important subset of patients undergoing percutaneous coronary intervention (PCI). It remains unclear whether a shortened duration of dual antiplatelet therapy (DAPT) confers benefits compared with prolonged duration of DAPT in this patient population. The aim of this study was to investigate and compare bleeding and ischemic outcomes among HBR patients receiving short- versus long-term DAPT after PCI.
View Article and Find Full Text PDFBackground: A third-generation coronary drug-eluting resorbable magnesium scaffold (DREAMS 3G) was developed to enhance the performance of previous scaffold generations and achieve angiographic outcomes comparable to those of contemporary drug-eluting stents.
Methods: This prospective, multicenter, non-randomized, first-in-human study was conducted at 14 centers in Europe. Eligible patients had stable or unstable angina, documented silent ischemia, or non-ST-elevation myocardial infarction, and a maximum of two single de novo lesions in two separate coronary arteries with a reference vessel diameter between 2.
Background: Patients with atherothrombotic risk are at high hazard of ischemic events. Preventive medicine plays a major role in modifying their outcomes. Whether the choice of a BP-SES or DP-EES can contribute to the occurrence of events remains unclear.
View Article and Find Full Text PDF: Coronary vessels in women may have anatomical and histological particularities. The aim of this study was to investigate sex-specific characteristics and outcomes of patients with calcified coronary arteries in the Prepare-CALC (Comparison of Strategies to Prepare Severely Calcified Coronary Lesions) trial. : The Prepare-CALC trial randomised patients with severe coronary calcification to coronary lesion preparation either using modified balloons (MB; cutting or scoring) or rotational atherectomy (RA).
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- - The study examined the long-term outcomes and in-hospital results of rotational atherectomy (RA) in treating chronic total occlusion (CTO) lesions versus non-CTO calcified lesions, involving 812 patients and 869 lesions.
- - Findings showed that while the angiographic success rate was lower for CTO patients (88.8% vs 94.9%), the in-hospital major adverse cardiac events rates were similar between the two groups.
- - At two years, the CTO group had a higher target lesion failure rate (25.5% vs 15.1%) mainly due to increased cardiac mortality, although elective RA proved to be a beneficial method with shorter procedure times and fewer complications.