Commissural alignment during TAVR reduces the risk of overlap to coronary ostia

The Role of Coronary Imaging in Chronic Total Occlusions: Applications and Future Possibilities

Chronic total occlusions (CTOs) represent a challenging scenario in coronary artery disease (CAD). The prevalence of CTOS in patients undergoing coronary angiography underscores the need for effective diagnostic and therapeutic strategies. Coronary angiography, while essential, offers limited insights into lesion morphology, vessel course, and myocardial viability. In contrast, coronary imaging techniques-including optical coherence tomography (OCT), intravascular ultrasound (IVUS), and coronary computed tomography angiography (CCTA)-provide comprehensive insights for each stage of CTO percutaneous coronary intervention (PCI). OCT facilitates the assessment of plaque morphology and stent optimization, despite low evidence and several limitations in CTO-PCI. IVUS offers deeper penetration, allowing managing proximal cap scenarios and guiding subintimal navigation. CCTA provides a non-invasive, three-dimensional view of coronary anatomy, enabling the precise evaluation of myocardial mass at risk and detailed procedural planning. Despite their individual limitations, these imaging modalities have enhanced the success rates of CTO-PCI, thus reducing procedural and long-term complications and improving patient outcomes. The future of CTO management lies in further technological advancements, including hybrid imaging, artificial intelligence (AI) integration, and improved fusion imaging. These innovations promise to refine procedural precision and personalize interventions, ultimately improving the care of patients with complex coronary artery disease.

Clinical impact of cerebral protection during transcatheter aortic valve implantation

BACKGROUND

Embolization of debris can complicate transcatheter aortic valve implantation (TAVI) causing stroke. Cerebral embolism protection (CEP) devices can divert or trap debris.

PURPOSE

To evaluate the efficacy of CEP during TAVI vs the standard procedure.

DATA SOURCES

PubMed, SCOPUS and DOAJ 1/01/2014-04/12/2023.

STUDY SELECTION

Randomized and observational studies comparing CEP versus standard TAVI, according to PRISMA.

PRIMARY OUTCOME

stroke.

SECONDARY OUTCOMES

death, bleeding, vascular access complications, acute kidney injury and infarct area.

DATA EXTRACTION

Two investigators independently assessed study quality and extracted data.

DATA SYNTHESIS

Twenty-six articles were included (540.247 patients). The primary endpoint was significantly lower (RR = 0.800 95%CI:0.682-0.940; p = 0.007) with CEP. Similarly, death rates were significantly lower with CEP (RR = 0.610 95%CI:0.482-0.771; p < 0.001). No difference was found for bleeding (RR = 1.053 95%CI:0.793-1.398; p = 0.721), vascular complications (RR = 0.937 95%CI:0.820-1.070; p = 0.334) or AKI (RR = 0.982 95%CI:0.754-1.279; p = 0.891).

CONCLUSIONS

Use of CEP during TAVI is associated with improved outcomes. Future studies will identify patients who benefit most from CEP.