• interventional cardiology and endovascular procedures

The increasing prevalence of aortic stenosis (AS) in our ageing population and clinical trials demonstrating the benefits of transcatheter valve implantation for severe symptomatic AS have focused attention on this disease in recent years. Yet, despite clear recommendations from professional societies, it remains unclear whether all patients receive timely and appropriate treatment. To address this concern, Frey and colleagues1 looked at data from the Study to Improve Outcomes in Aortic Stenosis (IMPULSE) registry which included 2171 adults with severe AS at 23 tertiary care hospitals in 9 European countries, including the UK. Patient mean age was 78 years, 48% were women and 27% had a left ventricular ejection fraction less than 50%. Over 80% of these patients were symptomatic, but only 76% of those with severe symptomatic AS were treated appropriately with aortic valve replacement (AVR), most often by the transcatheter approach (figure 1). Of even more concern, among asymptomatic patients with an indication for AVR, 42% (22/52) were not treated, whereas AVR was performed in 36% (123/339) of asymptomatic AS patients with no established indication.