This session was a summary of hot topics presented at EuroPCR in Paris this year.
The first speaker, Prof. Thomas Cuisset (Marseille, FR) stated that radial access is the preferred access for primary PCI in STEMI. But practical issues and anatomical variations have to be considered. With respect to concomitant pharmacotherapy in STEMI, dual antiplatelet therapy is first line therapy, including the newer P2Y12 inhibitors, Prasugrel and Ticagrelor. Bivalirudin as an anticoagulant has superior bleeding data, but a trend to more early stent thrombosis.
Routine use of thrombus aspiration during primary PCI was explored in the TASTE trial, which has some methodological concerns, but only short-term data are available to date. He raised the issue of how to correctly perform manual thrombus aspiration and how that could impact patients’ outcome. The current consensus is that selective thromboaspiration should be performed in the case of large visual thrombus burden. Drug-eluting stents have become the stent of choice also during primary PCI. Finally, primary PCI in multivessel disease was addressed by the PRAMI trial showing superior results for complete revascularisation. Nevertheless, the current consensus is to take an individualized approach to treatment.
Martyn Thomas (London, GB) then gave an update on achievements in TAVI procedures with the development of second generation prosthesis, addressing limitations of the first generation devices (size of delivery catheter, no or limited repositioning, paraprothetic regurgitation and demand for permanent pacemaker). He explained the current patient selection and indication for TAVI: patients who cannot be operated on or patients at high risk for conventional cardiac surgery. Health economical data were more favourable for TAVI over conventional surgical valve replacement for patients with these conditions. He highlighted the importance of three-dimensional imaging for planning the TAVI procedure. Finally, he said that TAVI for valve-in-valve treatment has gained broad acceptance.
The next speaker, Felix Mafoud, (Homburg/Saar, DE) reported about important new insights in the mechanism of action in renal denervation and how this impacts the efficacy of this procedure. Multiple simultaneously working electrodes are the most efficient. Most nerves are located around the anterior and superior wall of the renal arteries requiring more intense ablation in these areas. With this knowledge, the negative outcome of the Simplicity HTN-3 trial could be explained in part, since patients within this trial showed better results where more than 12 ablation attempts were performed.
Finally, Petr Widimski (Prague, CZ), reported about the first results on catheter-based on ischemic cerebrovasular stroke, which is a new treatment concept that requires even more intense networking then in STEMI treatment and especially a multidisciplinary approach (neurologists, neuroradiologists, radiologists).