Insights and Lessons Useful to Everyday Practice

In this month’s issue of the Journal of Invasive Cardiology, we have a line-up of work from some of the top interventional cardiology centers in the world. Dr Antonio Colombo’s group from Milan, Italy provides valuable comparative data regarding drug-eluting stents for bifurcations. They find that two second-generation drug-eluting stents perform equally well. This type of head-to-head data of one contemporary stent versus another for complex lesions is something that is not typically studied in randomized clinical trials. Therefore, observational data such as these fill an important gap in our evaluating which stents to use in daily practice. 

Dr Alistair Lindsay’s group from the NHLI Cardiovascular Biomedical Research Unit in London, England reports use of optical coherence tomography to determine the cause of stent strut malapposition in calcified vessels. They find that extent of circumferential superficial calcification is an important and independent predictor of malapposition. Optical coherence tomography is providing many insights into the practice of interventional cardiology.

Dr Colombo is pitching in a doubleheader with this issue. Another article from Dr Colombo’s group estimates the impact of the radiation from PCI for acute and chronic occlusions on cancer risk. Patient radiation exposure and safety has become a huge issue in interventional cardiology (and in other realms of cardiology and medicine as well). We need to continue to find ways to reduce radiation exposure in the catheterization suite and improvements in imaging technology will allow that.

Be sure to check out some really useful and novel techniques described in this issue that should help get operators (and patients!) out of trouble should they find themselves in a tight
 spot. We maintain a focus on evolving techniques in transcatheter aortic valve replacement. Dr Kazuaki Okuyama and colleagues from Cedars-Sinai Medical Center in Los Angeles describe two cases of using the “buddy-balloon technique” to allow aortic valve crossing. Vishal Patel, Ahmad Zankar, and Manos Brilakis from Texas Southwestern Medical Center describe using a retrograde approach during a STEMI involving the right coronary artery after the antegrade approach resulted in subintimal wire passage and balloon inflation — now that is an innovative use of the retrograde approach! 

Deepak L. Bhatt, MD, MPH

Senior Associate Editor

Journal of Invasive Cardiology