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Acute ischemic stroke: improving access to intravenous tissue plasminogen activator.
This article gives an overview of the recent approaches pursued to improve access to alteplase for acute ischemic stroke patients. Utilization of stroke systems of care, quality metrics, and quality improvement initiatives to improve alteplase treatment rates are discussed. The implementation of Telestroke networks to improve access and timely evaluation by a stroke specialist are also reviewed. Lastly, this review discusses the use of neuroimaging techniques to identify alteplase candidates in stroke of unknown symptom onset or beyond the 4.5-hour treatment window.Expert commentary: Expanding access to alteplase therapy f...
Source: Expert Review of Cardiovascular Therapy - April 25, 2020 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Icosapent Ethyl: drug profile and evidence of reduced residual cardiovascular risk in patients with statin-managed LDL-C cholesterol.
Authors: Bazarbashi N, Miller M Abstract INTRODUCTION: Icosapent Ethyl (IPE) is a highly purified (>96%) form of eicosapentanoic acid, a marine-derived omega-3 fatty acid known to reduce serum triglyceride levels. Experimental and human studies also support anti-atherosclerotic properties of IPE including antioxidant, anti-inflammatory, endothelial and plaque stabilizing effects. In the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT)l),the addition of 4 grams IPE daily resulted in a 25% reduction in cardiovascular events beyond statins and other standard of care therapies. ...
Source: Expert Review of Cardiovascular Therapy - April 2, 2020 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Examining the evidence for PFO closure and novel oral anticoagulants for treatment of cryptogenic stroke.
Authors: Khan R Abstract Introduction: There has been considerable study assessing the treatment of cryptogenic stroke (CS) recently. This review examines the role of patent foramen ovale (PFO) closure in CS, while also discussing the evidence for alternative medical therapies in disease treatment.Areas Covered: PFO closure for treatment of CS has been assessed in 6 randomized controlled trials (RCTs). This review summarizes the background, results and limitations of these trials. Methodological and treatment-related differences in RCTs provide potential explanations for the discordance in outcomes observed between...
Source: Expert Review of Cardiovascular Therapy - February 23, 2020 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Choosing the right therapy for a patient with asymptomatic carotid stenosis.
Authors: Bogiatzi C, Azarpazhooh MR, Spence JD Abstract Introduction: Most patients with asymptomatic carotid stenosis (ACS) now have a lower risk with intensive medical therapy than with stenting (CAS) or endarterectomy (CEA); the annual risk of stroke or death with intensive medical therapy is ~ 0.5%, vs. a periprocedural risk with CAS of ~ 2.5-4.1% with CAS, and ~ 1.4-1.8% with CEA. The excess risk of CAS is greater in older patients.Areas covered: Discussed are the need for intensive medical therapy, the nature of intensive medical therapy, approaches to identifying the few patients with ACS who could benefit f...
Source: Expert Review of Cardiovascular Therapy - February 12, 2020 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Predictors of adverse outcomes after transcatheter mitral valve replacement.
Authors: Overtchouk P, Piazza N, Granada JF, Modine T Abstract Introduction: Transcatheter mitral valve replacement (TMVR) is still a recent technology with numerous unknowns but also great promises. The risk of complications reported in observational studies have limited its adoption by interventional cardiology and surgical communities. Areas covered: Some of the major setbacks of TMVR are complications related to the devices and those related to the pathway. Device-related complications include left ventricle outflow tract (LVOT) obstruction, transcatheter heart valve (THV) dislocation or embolization, thrombosi...
Source: Expert Review of Cardiovascular Therapy - August 15, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Management of patients with concomitant coronary and carotid artery disease.
Authors: Drakopoulou M, Oikonomou G, Soulaidopoulos S, Toutouzas K, Tousoulis D Abstract Introduction: Ideal management of concomitant carotid and coronary artery occlusive disease remains under investigation. Although researchers have advocated the potential benefits of varying treatment strategies based on either concomitant or staged surgical treatment, there is no consensus in treatment guidelines among national or international clinical societies. With emerging data suggesting favorable outcome of carotid artery stenting (CAS) compared to carotid endarterectomy (CEA) in patients with critical coronary artery d...
Source: Expert Review of Cardiovascular Therapy - July 16, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Closing the gap on patent foramen ovale and cryptogenic stroke.
Authors: Darmoch F, Al-Khadra Y, Bacha HM, Soud M, Alraies MC Abstract Introduction: The treatment options for prevention of recurrent of cryptogenic stroke in patients with patent foramen ovale (PFO) have been intensely debated in the recent decades. The suggested options were percutaneous closure of PFO versus medical therapy. However, up to these date there is a controversy regarding the indication of percutaneous closure. Multiple meta-analysis and recent randomized control trials showed the benefit of PFO closure when compared with medical therapy alone. Areas covered: The article reviews the prevalence, physi...
Source: Expert Review of Cardiovascular Therapy - June 13, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Liraglutide for the prevention of major adverse cardiovascular events in diabetic patients.
Authors: Madsbad S Abstract INTRODUCTION: The GLP-1 receptor agonist (GLP-1 RA) liraglutide has a half-life of approximately 13 h and is suitable for subcutaneous administration once daily. The use of liraglutide in people with type 2 diabetes has become popular because of the efficacy and durability in relation to glycemic control in combination with weight loss in most patients. Areas covered: PubMed searches were completed using the terms "GLP-1 receptor agonist", "Liraglutide", "Liraglutide and CVD", "Liraglutide and CVD risk factors". The reference list of articles subsequently identified was searched and arti...
Source: Expert Review of Cardiovascular Therapy - May 7, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Edoxaban for the prevention of stroke in patients with atrial fibrillation.
Authors: Cervantes CE, Merino JL, Barrios V Abstract INTRODUCTION: Edoxaban is the last direct oral anticoagulant marketed for the prevention of stroke among patients with nonvalvular atrial fibrillation (AF). Areas covered: ENGAGE AF-TIMI 48 was the pivotal clinical trial that led to the approval of edoxaban 60 mg once daily. After the publication of this study, a great number of substudies and post hoc analyses have been published, together with some observational studies. The aim of this review was to update the current evidence about the use of edoxaban in AF patients. Expert commentary: In the ENGAGE AF-TIMI 4...
Source: Expert Review of Cardiovascular Therapy - March 24, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Mitral valve prolapse.
This article reviews the pathophysiology, genetics, clinical features, diagnostic imaging, complications, long term outcomes and indications for intervention in mitral valve prolapse. Expert commentary: Several key dilemmas in the management of mitral valve prolapse remain. Factors which influence progression of mitral regurgitation are unclear and therefore we have no therapeutic targets to prevent progression. Evidence-based methods to reduce the risk of sudden death, stroke and endocarditis have not been identified. In symptomatic patients with severe mitral regurgitation valve surgery is recommended. In asymptomatic pa...
Source: Expert Review of Cardiovascular Therapy - November 30, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Is it safe to stop oral anticoagulation after catheter ablation for atrial fibrillation?
Authors: Romero J, Avendano R, Diaz JC, Taveras J, Lupercio F, Di Biase L Abstract INTRODUCTION: Atrial fibrillation is the most common arrhythmia worldwide. Its increasing prevalence has made the use of oral anticoagulants for stroke prevention routine, however the use of them after the blanking period of catheter ablation remains uncertain. Areas covered: This review outlines the pros and cons of stopping oral anticoagulation after catheter ablation. Major databases such as Pubmed or Embase were used. The most relevant articles published were used along with major recommendations of society guidelines. Authors wi...
Source: Expert Review of Cardiovascular Therapy - November 23, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Organizing stroke systems in the field for patients with suspected large vessel occlusion acute stroke.
Authors: Almekhlafi MA, Holodinsky JK, Hill MD, Kamal N, Goyal M Abstract INTRODUCTION: The dawn of endovascular stroke therapy has reshaped stroke care. Eligible patients need to be rushed to capable centers for intervention. This may entail bypassing closer hospitals that could confirm the diagnosis, administer thrombolytic therapy, then transfer patients for intervention. This has created a set of challenges: identifying endovascular candidates in the field, determining the best transport destination, and getting patients there quickly. Areas covered: This review provides a context for these emerging challenges....
Source: Expert Review of Cardiovascular Therapy - November 20, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Neurological complications associated with left ventricular assist device therapy.
Authors: Goodwin K, Kluis A, Alexy T, John R, Voeller R Abstract INTRODUCTION: Associated with significant morbidity and mortality, neurological complications in adult patients with left ventricular assist devices (LVAD) approaches a prevalence as high as 25%. As the number of individuals using LVAD support grows, it is increasingly important for providers to understand the hematologic and hemodynamic changes associated with LVAD implantation, the risk factors for neurological complications and their mitigation strategies. Areas covered: PubMed searches were completed using the terms 'Left ventricular assist device...
Source: Expert Review of Cardiovascular Therapy - November 15, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

A comparison of alternative access routes for transcatheter aortic valve implantation.
Authors: Overtchouk P, Modine T Abstract INTRODUCTION: Alternative TAVI approaches offer the possibility of valve replacement in patients ineligible to the transfemoral route. Authors provide an updated review of the existing alternative approaches. Areas covered: A systematic review of alternative approaches for TAVI was undertaken. The feasibility, safety, efficacy and technical requirements of the transapical, transaortic, transcarotid, transsubclavian and transcaval approaches have been compared. A multi-slice computed tomography is often necessary for pre-operative planning. Although the first developed, the t...
Source: Expert Review of Cardiovascular Therapy - September 21, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Triple antithrombotic therapy in patients with atrial fibrillation undergoing PCI: Current evidence and practice.
Authors: Clarke A, Ibrahim A, Kiernan TJ Abstract INTRODUCTION: Patients with atrial fibrillation taking oral anticoagulation and undergoing percutaneous coronary intervention with stent insertion are recommended to receive antithrombotic therapy with aspirin and P2Y12 receptor antagonist. This combinatory regime encompasses triple therapy (TT). Although TT reduces the risk of ischaemic events such as stroke and stent thrombosis, it is associated with an increased bleeding risk. Areas covered: The efficacy and safety profile of TT is uncertain with undetermined optimal duration and therapeutic combination. This rev...
Source: Expert Review of Cardiovascular Therapy - September 16, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

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