David A. Burke

Imaging in Transcatheter Aortic Valve Replacement (TAVR): role of the radiologist

BackgroundTranscatheter aortic valve replacement (TAVR) is a novel technique developed in the last decade to treat severe aortic stenosis in patients who are non-surgical candidates because of multiple comorbidities.MethodsSince the technique is performed using a transvascular approach, pre-procedural assessment of the aortic valve apparatus, ascending aorta and vascular access is of paramount importance for both appropriate patient selection and correct device selection. This assessment is performed by a multi-disciplinary team with radiology being an integral and important part.ResultsAmong imaging modalities, there is growing scientific evidence supporting the crucial role of MDCT in the assessment of the aortic valve apparatus, suitability of the iliofemoral or alternative pathway, and determination of appropriate coaxial angles. MDCT also plays an important role in post-procedure imaging in the assessment of valve integrity and position.ConclusionThis review outlines the principal aspects of TAVR, the multidisciplinary approach and utilisation of different imaging modalities, as well as a step-by-step approach to MDCT acquisition protocols, reconstruction techniques, pre-procedure measurements and post-procedure assessment.Teaching Points• TAVR is a new technique to treat severe aortic stenosis in high-risk and nonsurgical candidates.• MDCT assessment of the aortic annulus is important for appropriate patient and device selection.• Multidisciplinary approach is required for patient selection, procedure planning and performance.• MDCT is required for assessment of the aortic root, iliofemoral or alternative vascular pathway.

Safety and efficacy metrics for primary nitinol stenting in femoropopliteal occlusive disease: A meta‐analysis and critical examination of current methodologies

The efficacy and safety of primary stenting for superficial femoral artery (SFA) disease have been benchmarked against historically derived performance goals. However, contemporary evidence evaluating SFA stenting is accumulating. The objective of this systematic review and meta‐analysis was to quantitatively assess outcomes after primary SFA stenting with nitinol stents in contemporary practice, to compare these rates with commonly used efficacy and safety goals, and to discuss the clinical and regulatory implications of these findings.

Long-term efficacy and safety of Zotarolimus-eluting stent in patients with diabetes mellitus: pooled 5-year results from the ENDEAVOR III and IV trials.

To assess long‐term outcomes of Endeavor Zotarolimus‐eluting stent (E‐ZES) implantation in patients with diabetes mellitus (DM). Background: Patients with DM and coronary artery disease have lower restenosis with drug‐eluting stent (DES) compared with bare‐metal stents. Recent data suggest that the E‐ZES is inferior to other DES in this population.

Which Antithrombin for Whom? Identifying the Patient Population that Benefits Most from Novel Antithrombin Agents

Anticoagulation has proven to be a key component in the management of acute coronary syndromes (ACS). Pharmacological agents with various modes of action are utilized to reduce thrombus development by impairing thrombin formation, platelet activation, and platelet aggregation. The optimal management of these patients is to achieve maximal anti-ischemic benefit while avoiding bleeding complications. Synthetic “novel” agents have been developed to specifically target factor Xa or thrombin to achieve this goal. A growing amount of data show that these agents provide a net clinical benefit in the setting of stable ischemic heart disease, unstable angina, non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI).

Role of Parenteral Agents in Percutaneous Coronary Intervention for Stable Patients

Numerous agents are available for anticoagulation during percutaneous coronary intervention (PCI), and various antiplatelet agents are also used. With all of the medications available, an assessment must be made regarding the ischemic risk and risk of bleeding for an individual patient during elective PCI when selecting the optimal medical strategy to support PCI. Whether new antiplatelet medications will enhance or reduce complications when paired with various newer anticoagulant agents requires further investigation. This article summarizes existing data examining the benefits and limitations of the various anticoagulant and antiplatelet medications, and summarizes guidelines for their use.