Objectives To assess the safety and efficacy of the Absorb bioresorbable vascular scaffold (BVS) in complex, infrapopliteal lesions for the management of chronic limb ischemia. Background The interventional management of infrapopliteal PAD remains challenging due to high restenosis rates with metallic drug‐eluting stents and balloon angioplasty. Metallic stents are associated with impaired vessel vasomotor tone, remodeling, autoregulation, and long‐term inflammation. BVSs are biodegradable scaffolds that provide short‐term vascular support before degrading to allow restoration of vasomotor tone and endothelial function. A recent trial reported excellent 12‐month vessel patency rates in simple infrapopliteal arterial lesions treated with Absorb BVS. Methods This single‐center, retrospective study evaluated the use of the Absorb BVS (everolimus impregnated poly‐L‐lactic scaffold) in patients with infrapopliteal PAD with respect to safety (thrombosis and TIMI bleeding), technical success, and clinically driven target vessel failure (CD‐TVF) at 12 months. Results Thirty‐one patients (51.6% male) with a median age of 67 years with advanced infrapopliteal disease were treated with 49 BVS in 41 vessels. The mean stenosis was 94% (80–100), with 49% of lesions being CTOs. No scaffold thrombosis or periprocedural bleeding was observed. Procedural success was achieved in all patients. Freedom from CD‐TVF was 95.1% at 12 months driven by one revascularization and one amputation. Primary patency was 96.7% at 12 months. All patients were alive at 12 months, and 96.8% of patients improved their Rutherford–Becker classification. Conclusions At 12 months, our study found that patients with advanced infrapopliteal PAD who were treated with Absorb BVS reported improved clinical status and a low rate of CD‐TVF.

This Clinical Guidelines Synopsis summarizes the American Academy of Neurology’s practice advisory update on management of patients with a patent foramen ovale who have a history of stroke or transient ischemic attack.

Objectives To assess the safety, efficacy, and durability of the Absorb bioresorbable vascular scaffold in predominantly complex, infra-popliteal lesions for the management of chronic limb ischemia at two-year clinical follow-up. Bioresorbable vascular scaffold are biodegradable scaffolds that provide short-term vascular support before undergoing intravascular degradation. A recent trial reported excellent 36-month vessel patency rates in simple infrapopliteal arterial lesions treated with Absorb bioresorbable vascular scaffold. Methods This single-center, retrospective study evaluated the use of the Absorb bioresorbable vascular scaffold (everolimus impregnated poly-L-lactic scaffold) in patients with infra-popliteal peripheral arterial disease (PAD) with respect to safety (thrombosis and TIMI bleeding), technical success, and freedom from clinically driven target vessel failure at 24 months. Results 31 patients (51.6% male) with a median age of 67 years with predominantly advanced infra-popliteal disease were treated with 49 bioresorbable vascular scaffold in 41 vessels. The mean stenosis was 94% (80–100), with 49% of lesions being chronic thrombotic occlusions. No scaffold thrombosis or peri-procedural bleeding was observed. Procedural success was achieved in all patients; 93.5% of patients experienced freedom from clinically driven target vessel failure at 24 months, driven by one revascularization and one amputation. Primary patency was 96.7% at 12 months and 87.1% at 24 months. All patients were alive at 12 and 24 months. Conclusions At 24 months, our study found that patients with predominantly advanced infra-popliteal PAD who were treated with Absorb bioresorbable vascular scaffold reported improved clinical status and a low and durable rate of clinically driven target vessel failure extending out to 24 months.

Symptomatic severe aortic stenosis has a 2-year mortality of nearly 50%. 1 Aortic valve replacement is indicated for patients with severe aortic stenosis (aortic valve area <1 cm 2 or velocity >4 m/s) who have symptoms, have left ventricular dysfunction, or are undergoing cardiac surgery for another indication. 2 Nearly 30% of patients with severe symptomatic aortic stenosis are not candidates for SAVR because of multiple medical comorbidities, advanced age, prior surgery, or high-risk anatomic features. 3 Since TAVR has emerged as an alternative to SAVR, guidelines regarding preferred procedures in various clinical contexts may be helpful. Characteristics of the Guideline SourceThe guideline was developed by the ACC and AHA without commercial support. 2 The ACC/AHA Task Force on Clinical Practice Guidelines selected experts, mostly in cardiology, cardiothoracic surgery, and anesthesiology, to form a writing committee (Table ). An independent evidence review committee was commissioned for questions deemed of utmost clinical importance that merited formal systematic review. Members of the writing group disclosed associations with industry, which were published online. Members were required to recuse themselves from voting on sections to which their specific relationships with industry may have applied. Evidence BaseThe guideline makes a strong recommendation regarding a multidisciplinary approach including experts in structural cardiology, car-

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