Aspirin nonadherence after MI increases long-term risk for recurrent MI, stroke, death www.healio.com March 25, 2024, 3:51 p.m.
Aspirin nonadherence became more prevalent over time, from 10% at 2 years to 19% at 8 years. The greatest risk for recurrent MI, stroke or death occurred at 2 to 4 years for the adherent and nonadherent groups.
Renal Function Mediates Link Between Lp(a), Adverse Cardiovascular Outcomes www.hcplive.com March 25, 2024, 3:49 p.m.
Among ≥10,000 eligible patients undergoing PCI, elevated Lp(a) was significantly associated with increased MACCE risk in patients with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, but the association was weakened to diminished in patients with mild to normal renal function.
Lipoprotein(a): Evidence for Role as a Causal Risk Factor in Cardiovascular Disease and Emerging Therapies www.mdpi.com March 25, 2024, 3:49 p.m.
Lp(a) is now well-established as a risk factor for ASCVD and calcific aortic valve disease. However, optimal management of individuals with elevated Lp(a) is not well-established. Several currently available therapies have been evaluated for use in individuals with elevated Lp(a). However, improvement in clinical outcomes has only been shown in post hoc analyses from PCSK9i cardiovascular outcomes trials and in uncontrolled studies involving lipoprotein apheresis. There may also be an expanded role for anti-platelet therapy in both primary and secondary prevention in individuals with elevated Lp(a), but more research is needed. Multiple promising therapies that produce potent Lp(a) lowering are currently under investigation. Representative patient case scenarios are presented (Figure 2) to summarize an approach to management based on currently available evidence and guidelines. There are several areas in which future research is needed.
Lipoprotein(a) and Major Adverse Cardiovascular Events in Patients With or Without Baseline Atherosclerotic Cardiovascular Disease www.sciencedirect.com March 25, 2024, 3:47 p.m.
Lipoprotein(a) [Lp(a)] is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). However, whether the optimal Lp(a) threshold for risk assessment should differ based on baseline ASCVD status is unknown.
Optimizing antithrombotic therapy in patients with coexisting cardiovascular and gastrointestinal disease www.nature.com March 25, 2024, 3:44 p.m.
Balancing the safety and efficacy of antithrombotic therapy in patients with gastrointestinal disorders is challenging because of the potential for interference with the absorption of antithrombotic drugs or for an increased risk of bleeding. Various clinical states, including malabsorption syndromes, bariatric surgery, short-bowel syndrome or enteral tube feeding, can influence the absorption and bioavailability of oral antithrombotic agents. Bleeding events are an essential prognosticator in patients with cardiovascular diseases — at times as important as thrombotic events — and using antithrombotic agents in patients at high risk of gastrointestinal bleeding (GIB) is very challenging. Most of the existing models to predict the risk of bleeding in patients with coronary artery disease do not estimate the risk of GIB specifically. Identifying patients at high risk of GIB, modifying the bleeding risk by using gastroprotective agents, and determining the appropriate antithrombotic therapy regimen have crucial roles in preventing GIB. After an episode of acute GIB, determining the duration of antithrombotic therapy interruption and the regimen for re-initiation requires consideration of the balance between the bleeding severity and the risk of thrombotic events.
FDA Breakthrough Device Designation for BIOTRONIK Freesolve™ Below-the-Knee Resorbable Magnesium Scaffold (RMS) www.prnewswire.com March 25, 2024, 3:43 p.m.
The Freesolve BTK RMS is designed for individuals suffering from chronic limb-threatening ischemia (CLTI). CLTI is the most severe form of peripheral arterial disease (PAD), estimated to affect 11% of the 200 million people suffering from PAD globally. CLTI is associated with high rates of amputation and mortality as well as high care costs.
CE Mark Granted To Reflow Medical's Bare Temporary Spur Stent System www.mpo-mag.com March 25, 2024, 2:43 p.m.
Chronic limb-threatening ischemia (CLTI) increases the risk of mortality, amputation, and impaired quality of life. The Bare Temporary Spur Stent System, followed by drug-coated balloon treatment, reduces clinically driven target lesion revascularization (CD-TLR), improves wound healing, reduces recoil, and improves vessel patency through one year, compared to historical treatment outcomes with plain balloon angioplasty or a DCB alone.
Current Status of and Future Prospects for Drug-Eluting Stents and Scaffolds in Infrapopliteal Arteries www.mdpi.com March 25, 2024, 2:40 p.m.
Newer devices like drug-eluting resorbable scaffolds are promising as they allow the restoration of vessel wall vasomotion without a residual foreign body and can be used to treat longer, complex lesions.
Enabling Angioplasty‐Ready “Smart” Stents to Detect In‐Stent Restenosis and Occlusion onlinelibrary.wiley.com March 25, 2024, 9:42 a.m.
The prototypes deployed in the vascular grafts were tested to demonstrate wireless monitoring of in-stent blood pressure using a swine model. These results from both the bench tests and the animal study advance smart stent technology further, toward its clinical evaluation and application for long-term monitoring of implanted stents.
FDA Breakthrough Recognition! Below The Knee Absorbable Magnesium Stent mp.weixin.qq.com March 24, 2024, 8:10 p.m.
In BTK interventions, the stent resists vessel retraction in the short term, but ultimately does not require a vascular implant. According to Dr Jörg Pochert, President of the Company's Vascular Intervention Division, "By introducing Freesolve™ RMS for the treatment of coronary artery disease, we continue to expand the therapeutic possibilities with this breakthrough innovation in the BTK indication." Ryan Walters, President of the company, stated, "Our next generation RMS represents a quantum leap in existing absorbable technology, combining technological innovations designed to meet physician needs and optimise the prognosis of CLTI patients." Biotronik plans to launch the product in major European markets such as Germany and Switzerland during 2024 and is actively initiating post-marketing clinical studies to further evaluate the long-term efficacy and safety of the stent. In the future, the Freesolve™ stent is expected to benefit more patients with peripheral arterial disease and play a role in a wider range of indications.
CD31 Coated Surfaces Enhance Endothelialisation and Reduce Platelet Adhesion: A Promising Strategy for Improving Stent Graft Biocompatibility www.ejves.com March 24, 2024, 8:05 p.m.
The use of endovascular devices can trigger a pathogenic local tissue response at sites of stent implantation, which can eventually lead to restenosis. Although new generations of drug eluting stents are associated with lower incidence of intra-stent restenosis, the latter remains a concern. To address this issue, the aim was to camouflage the surface of the device with an endothelial like coating, which can help reduce the pathogenic tissue response triggered by the foreignness of the device and potentially decrease the incidence of restenosis.
Durable endothelium-mimicking coating for surface bioengineering cardiovascular stents www.sciencedirect.com March 24, 2024, 7:55 p.m.
A durable endothelium-mimicking coating was developed for surface bioengineering of cardiovascular stents. The durable endothelium-mimicking surface was realized by stepwise grafting of Cu-DOTA and heparin on a robust coating. The durable endothelium-mimicking coating endows the vascular stents with ability to dramatically reduce restenosis.
Specialty Balloons in Japan and Abroad mp.weixin.qq.com March 21, 2024, 10:57 a.m.
In recent years, the emergence of some special balloons, such as pressure-focused balloon: cutting balloon, double/triple guide wire balloon, scoring balloon and constrained balloon (also called chocolate balloon), has significantly improved the pre-dilation of peripheral stenosis, and greatly improved the immediate success rate of the procedure and long-term prognosis. However, for some fibrotic or calcified lesions, it is difficult to achieve adequate dilatation with ordinary balloons, resulting in a poor prognosis for patients. Compared with ordinary balloon, special balloon has the following advantages in clinical application: ① fibrotic plaque and calcified lesions: for elastic fibre-dense fibrotic plaque and hard texture calcified lesions, ordinary balloon has the problem of high dilatation resistance, poor dilatation effect, and also increases the risk of vascular tear, perforation, and no re-flow during the operation. Special balloons such as cutting and scoring can better anchor the lesion, directionally cut fibrous plaques and calcified rings, fully squeeze the plaque, reduce elastic retraction, and significantly increase the minimum lumen area and immediate lumen rate. 近年来,一些特殊球囊,如压力聚焦型球囊:切割球囊、双导丝/三导丝球囊、刻痕球囊和约束型球囊(也叫巧克力球囊)等的出现,明显改善了外周血管狭窄预扩张的效果,大大提高了手术即刻成功率及远期预后。然而,对于一些纤维化或者钙化病变,普通球囊难以达到充分扩张的目的,导致患者预后不良。特殊球囊相较普通球囊,在临床应用中有如下优势:①纤维化斑块和钙化病变:对于弹力纤维密集的纤维斑块和质地坚硬的钙化病变,普通球囊存在扩张阻力大、扩张效果差的问题,操作过程中还会增加血管撕裂、穿孔和无复流等风险。切割、刻痕等特殊球囊能更好地锚定病变,定向割断纤维斑块和钙化环,充分挤压斑块,减小弹性回缩,显著增加最小管腔面积与即刻管腔率。
Paclitaxel-Coated Balloon Superior for In-Stent Restenosis www.medscape.com March 18, 2024, 7:52 a.m.
Agent DCB received breakthrough device designation in 2021 and was approved by the FDA in part on the basis of the results of a prespecified analysis of the pivotal trial, presented at the Transcatheter Cardiovascular Therapeutics 2023 Congress. This paper provides details of that trial, in which the primary endpoint of 1-year target lesion failure occurred in 17.9% of the paclitaxel-coated balloon group vs 28.6% of the uncoated balloon group, meeting criteria for superiority (hazard ratio [HR], 0.59).
Minimal-Metal PCI: A Drug-Coated Balloon philosophy combined with selective lesion stenting where necessary - the hybrid approach www.pcronline.com March 17, 2024, 9:08 a.m.
Watch this webinar on 19 March at 5:00pm with P. O'Kane, D. Pan and H. Routledge to understand what factors during PCI lead to the switch from DCB to DES and much more!
Outcomes by sex in the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial eurointervention.pcronline.com March 16, 2024, 4:24 p.m.
In ISCHEMIA, women assigned to the INV arm were less likely to undergo revascularisation than men. The effect of an INV versus CON strategy was consistent by sex, but women had a significantly lower contribution of procedural MI to the primary outcome.
Ticagrelor vs Clopidogrel for complex percutaneous coronary intervention in chronic coronary syndrome www.pcronline.com March 16, 2024, 4:23 p.m.
The results of this sub-analysis of the ALPHEUS trial show that complex PCI criteria are present in a large percentage of patients with chronic coronary syndrome and are associated with higher rates of both periprocedural events and MACE than non-complex PCI.
Transluminal angioplasty: Why was Dotter's disruptive innovation initially rejected? www.pcronline.com March 16, 2024, 4:22 p.m.
Firstly, his position as a radiologist, not a vascular surgeon; secondly, his aggressive presentation of the technique, coupled with limited patient data; and lastly, his unconventional approach to developing tools and the lack of clear objectives.
Drug-coated balloons textbooks.pcronline.com March 16, 2024, 4:21 p.m.
Drug coated balloons (DCB) represent a clinical treatment modality for non-stent based local drug delivery in coronary and peripheral artery disease. Their advantages over standard angioplasty and stent technologies include a homogeneous drug delivery to the vessel wall, an immediate drug release without the use of a polymer, the option of using balloon catheters alone or in combination with a stent, no foreign object left behind in the body, the potential of reducing antiplatelet therapy, and a lower restenosis rate in some indications.
Israeli stent co InspireMD raises up to $113m en.globes.co.il March 13, 2024, 2:19 p.m.
InspireMD seeks to utilize its proprietary MicroNet technology to make its products the industry standard for carotid stenting by providing outstanding acute results and durable, stroke-free, long-term outcomes.