Catheterization And Cardiovascular Interventions[JOURNAL]
Sun
200 papers
Long-Term Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement in Patients With Small Aortic Annuli.
Loewenstein I, Gitter B, Itach T … +7 more , Arbel Y, Ben-Shoshan J, Konigstein M, Finkelstein A, Halkin A, Banai S, Steinvil A
Catheter Cardiovasc Interv · 2026 May · PMID 41766252 · Full text
BACKGROUND: Prosthesis-patient mismatch (PPM) remains common following transcatheter aortic valve replacement (TAVR) and is associated with worse clinical outcomes. PPM is of particular concern in small aortic annuli (SA...
BACKGROUND: Prosthesis-patient mismatch (PPM) remains common following transcatheter aortic valve replacement (TAVR) and is associated with worse clinical outcomes. PPM is of particular concern in small aortic annuli (SAA). AIMS: To compare the incidence, predictors, and long-term impact of PPM in SAA TAVR. METHODS: Single-center retrospective registry analysis of native, severe aortic stenosis patients with computed tomography-derived annulus area ≤ 430 mm², undergoing TAVR via transfemoral access. Significant PPM was defined as moderate and above and classified by the Valve Academic Research Consortium (VARC)-3. Additional analyses were conducted for predicted PPM and gender-based criteria. Inverse probability treatment weighting (IPTW) was applied to identify predictors of significant PPM and long-term mortality. RESULTS: The cohort included 631 consecutive patients with SAA undergoing TAVR between 2015 and 2024. Significant PPM occurred in 23.3%. Multivariable analyses identified BEV implantation (OR 2.1, 95% CI 1.3-4.9, p < 0.001) and larger body surface area (OR 4.6, 95% CI 1.7-18.8, p < 0.001) as independent predictors of PPM. Large annulus perimeter had a protective association (OR 0.85, 95% CI 0.79-0.91, p < 0.001). Five-year mortality was significantly higher among patients with significant PPM (32.0% vs. 25.4%; log-rank p = 0.008). Age (HR 1.04, 95% CI 1.004-1.07, p = 0.03), moderate and above paravalvular leak (HR 3.25, 95% CI 1.3-8.0, p = 0.01), and significant PPM (HR 1.97, 95% CI 1.2-3.1, p = 0.004) were independently associated with 5-year mortality. CONCLUSIONS: Significant PPM remains highly prevalent following SAA TAVR. BEV implantation and larger BSA were associated with significant PPM, and a larger implanted valve had a protective association. Significant PPM is independently associated with long-term mortality.
Transcatheter Aortic Valve Implantation in Complex Aortic Pathology: Managing Aortic Regurgitation With Chronic Dissection and Previous Endovascular Repair.
Mazzi W, Azzola Guicciardi N, Beneduce A … +3 more , Nicola B, Saccocci M, Maisano F
Catheter Cardiovasc Interv · 2026 May · PMID 41766067 · Publisher ↗
Transcatheter aortic valve implantation (TAVI) is generally contraindicated in patients with severe aortic regurgitation associated with anatomically complex scenarios such as prior aortic dissection and/or aortic graft...
Transcatheter aortic valve implantation (TAVI) is generally contraindicated in patients with severe aortic regurgitation associated with anatomically complex scenarios such as prior aortic dissection and/or aortic graft replacement. However, it may be considered in selected patients following heart team evaluation and optimal procedure planning. We report the case of an 81-year-old man with severe aortic regurgitation (AR) who had previously undergone ascending aorta replacement and aorto-bisiliac endovascular aneurysm repair (EVAR) in two consecutive procedures, due to an acute aortic dissection extending from the sinotubular junction to the iliac bifurcation. This case highlights the feasibility and efficacy of TAVI in anatomically extreme post-dissection scenarios, underscoring the importance of individualized decision-making and detailed pre-procedural planning.
A Second Encounter With a Retained Cardiac Bullet: Post-Traumatic Pericarditis Managed Conservatively.
Vijayvergiya R, Mukherjee A, Uppal L … +3 more , Narayan A, Mahajan S, Lal A
Catheter Cardiovasc Interv · 2026 May · PMID 41749071 · Publisher ↗
Abstract loading — click title to view on PubMed.
Rethinking Bifurcation PCI: A Conceptual Rationale for a Planned Side Branch-First Drug-Coated Balloon Strategy.
Astan R
Catheter Cardiovasc Interv · 2026 May · PMID 41738456 · Publisher ↗
Abstract loading — click title to view on PubMed.
Physiologic Assessment Using Angiography-Derived Fractional Flow Reserve After Drug-Coated Balloon Angioplasty in De Novo Coronary Lesions.
Chang CC, Lee JY, Chou HL … +7 more , Sung WT, Lu YW, Tsai YL, Teng HI, Chou RH, Aben JP, Huang PH
Catheter Cardiovasc Interv · 2026 May · PMID 41732831 · Publisher ↗
BACKGORUND: Drug-coated balloon (DCB) angioplasty offers a potential alternative to avoid permanent metallic stent implantation and the associated risk of in-stent restenosis. AIMS: This study aimed to evaluate the safet...
BACKGORUND: Drug-coated balloon (DCB) angioplasty offers a potential alternative to avoid permanent metallic stent implantation and the associated risk of in-stent restenosis. AIMS: This study aimed to evaluate the safety and effectiveness of DCB angioplasty for de novo coronary stenoses in real-world clinical practice. METHODS: This was a single-center, retrospective observational study. Between March 2017 and October 2023, patients who underwent DCB angioplasty for at least one de novo coronary stenosis were included. The primary endpoint was the device-oriented composite endpoint (DOCE), defined as a composite of cardiovascular death, device failure-related myocardial infarction, or device failure-related target lesion revascularization. Post-procedural angiography-derived fractional flow reserve (vFFR) was evaluated after DCB angioplasty in eligible patients with angiograms of adequate quality. RESULTS: A total of 255 de novo coronary stenoses undergoing DCB angioplasty were analyzed. Among the treated lesions, 92.5% were located in the main epicardial vessels. Cutting or scoring balloons and rotational atherectomy were employed for lesion preparation in 14.5% and 5.9% of lesions, respectively. The bailout stenting rate was 1.9%. During a follow-up duration of 558 ± 499 days, the primary endpoint, DOCE, occurred in 13 lesions (5.1%). Post-procedural vFFR was analyzable in 130 lesions. Residual stenosis ≤ 30% was achieved in only 39.1% of lesions, whereas 80.7% of lesions demonstrated a post-procedural vFFR ≥ 0.75. CONCLUSIONS: Patients undergoing DCB angioplasty for de novo coronary stenoses demonstrated favorable clinical outcomes during mid-term follow-up. The clinical utility of vFFR in the context of DCB angioplasty warrants further investigation in large-scale studies to determine its impact on clinical outcomes.
Differences in Vascular Responses and Underlying Mechanisms Following Paclitaxel-Coated Balloon Angioplasty Between Lipid-Rich and Non-Lipid-Rich Lesions in Chronic Coronary Syndrome.
Matsuhiro Y, Egami Y, Nohara H … +9 more , Kawanami S, Yasumoto K, Okamoto N, Matsunaga-Lee Y, Yano M, Nakamura D, Mizote I, Sakata Y, Nishino M
Catheter Cardiovasc Interv · 2026 May · PMID 41732818 · Publisher ↗
BACKGROUND: Lipid-rich plaques are strongly associated with adverse cardiac events. However, the vascular response of lipid-rich lesions to drug-coated balloon (DCB) angioplasty has not been fully elucidated. AIMS: This...
BACKGROUND: Lipid-rich plaques are strongly associated with adverse cardiac events. However, the vascular response of lipid-rich lesions to drug-coated balloon (DCB) angioplasty has not been fully elucidated. AIMS: This study aimed to compare vascular responses following DCB angioplasty between lipid-rich and non-lipid-rich lesions in patients with chronic coronary syndrome. METHODS: This study included patients scheduled for paclitaxel-coated balloon angioplasty for de novo small-vessel lesions in the setting of chronic coronary syndrome between February 2021 and April 2024. All patients underwent pre- and post-procedural near-infrared spectroscopy combined with intravascular ultrasound (NIRS-IVUS), along with follow-up coronary angiography and NIRS-IVUS at 8 months. Lesions were categorized as lipid-rich or non-lipid-rich based on the pre-procedural maximum lipid core burden index over 4 mm (maxLCBImm). Changes in plaque volume and maxLCBImm from post-procedure to the 8-month follow-up, as well as the incidence of late lumen enlargement (LLE), were compared between the two groups. RESULTS: Forty-six patients were included in the final analysis: 15 in the lipid-rich group and 31 in the non-lipid-rich group. LLE occurred in 27% of the lipid-rich group and 39% of the non-lipid-rich group (p = 0.52). Percent plaque volume showed minimal change in the lipid-rich group (+0.3%), while a significant reduction was observed in the non-lipid-rich group (-3.6%; p = 0.045). Conversely, maxLCBImm significantly decreased in the lipid-rich group compared with the non-lipid-rich group (-240 vs. -42; p = 0.0030), resulting in comparable values at the 8-month follow-up. CONCLUSIONS: Paclitaxel-coated balloon treatment was associated with favorable outcomes, including LLE and a reduction in maxLCBImm, irrespective of lipid burden. However, the mechanisms underlying LLE may differ between lipid-rich and non-lipid-rich lesions, suggesting potential heterogeneity in biological responses to DCB therapy.
Drug-Coated Balloon-Based Versus Drug-Eluting Stent-Only Treatment for Patients With High-Bleeding Risk.
Shin ES, Kim S, Kang DO … +2 more , Choi BJ, Her AY
Catheter Cardiovasc Interv · 2026 May · PMID 41732815 · Publisher ↗
BACKGROUND: Managing patients with high-bleeding risk (HBR) requiring percutaneous coronary intervention (PCI) is challenging, and data are limited. AIMS: This study investigates the clinical outcomes of drug-coated ball...
BACKGROUND: Managing patients with high-bleeding risk (HBR) requiring percutaneous coronary intervention (PCI) is challenging, and data are limited. AIMS: This study investigates the clinical outcomes of drug-coated balloon (DCB)-based PCI compared to drug-eluting stent (DES)-only PCI in patients with HBR undergoing PCI. METHODS: We included 652 consecutive patients with HBR undergoing DCB-based PCI and compared them to 652 propensity-matched patients who received conventional PCI with second-generation DES. Patients were followed up for 2 years to assess major adverse cardiovascular events (MACE). RESULTS: Baseline clinical characteristics were comparable between the groups. In the DCB-based PCI group, 71.6% of patients were successfully treated with DCB alone. In the DCB-based PCI, patients had lower cardiac mortality at 2 years (2.0% vs. 5.2%; hazard ratio: 0.37; 95% confidence interval: 0.18-0.74; p = 0.005). Rates of target vessel revascularization (2.5% vs. 6.0%; hazard ratio: 0.43; 95% confidence interval: 0.24-0.78; p = 0.005), and major bleeding events (1.4% vs. 5.4%; hazard ratio: 0.26; 95% confidence interval: 0.12-0.58; p = 0.001) were also lower with DCB-based PCI than with DES-only PCI. Myocardial infarction events were comparable between the two groups. In a multivariable model, DCB-based PCI was independently associated with reduced risk of 2-year cardiac death, target vessel revascularization, and major bleeding. CONCLUSION: In patients with HBR, DCB-based PCI was associated with a significantly lower risk of MACE compared to DES-only treatment. These findings suggest that DCB-based PCI may be a viable treatment strategy for improving outcomes in patients with HBR.
Manipulation of a Bent Bare Metal Needle for Breaking Calcified Obstruction via a High-Precision Orifice Puncture Into the Keystone Deep Femoral Artery (Bamboo Hook Technique).
Yamaguchi K, Mori S, Kobayashi N … +1 more , Ito Y
Catheter Cardiovasc Interv · 2026 May · PMID 41731980 · Publisher ↗
Severely calcified ostial occlusion of the deep femoral artery (DFA) is a condition that is technically challenging to manage. Surgical reconstruction has been traditionally considered the most reliable treatment option,...
Severely calcified ostial occlusion of the deep femoral artery (DFA) is a condition that is technically challenging to manage. Surgical reconstruction has been traditionally considered the most reliable treatment option, and evidence on feasible endovascular strategies remains limited. Herein, we report the case of a woman in her 80 s who presented with Rutherford class 5 lower-extremity arterial disease and a nonhealing ulcer of the right first toe. A long-segment occlusion of the superficial femoral artery (SFA) with heavy calcification and an ostial occlusion of the DFA were observed on angiography. The SFA was successfully revascularized with stent placement. However, revascularization of the DFA origin was required to secure a collateral source because of the risk of acute limb ischemia due to multiple implanted stent grafts. The antegrade and retrograde wiring attempts were not successful owing to severe calcification and jailed stent struts. Therefore, a modified stylet puncture-based direct orifice puncture of the DFA origin was performed via manipulation of a Bent bAre Metal needle for Breaking calcified ObstructiOn using a High-precisiOn Orifice puncture into the Keystone DFA (referred to as the "BAMBOO HOOK") technique. A pull-through was established, and balloon angioplasty yielded sufficient lumen gain despite the jailed stent struts. Hemostasis was secured via prolonged balloon inflation, and complete wound healing was achieved approximately 3 months after minor toe amputation. The bamboo hook technique can be a feasible endovascular approach for recanalizing severely calcified ostial occlusions of the DFA.
Computed Tomography Derived Procedure Simulations for Redo Transcatheter Aortic Valve Replacement.
van den Dorpel MMP, de Backer O, Abdel-Wahab M … +17 more , Beneduce A, Dumonteil N, Blackman DJ, Willemen Y, Dargan J, Poon K, Daemen J, de Assis LU, van Niekerk J, Kardys I, Tchetche D, De Beule M, Jan Nuis R, Rocatello G, Debusschere N, Mortier P, Van Mieghem NM
Catheter Cardiovasc Interv · 2026 May · PMID 41731978 · Publisher ↗
BACKGROUND: Transcatheter aortic valve (TAV) failure may require redo transcatheter aortic valve replacement (redo-TAVR). The multiple layers of metal after redo-TAVR may jeopardize coronary artery patency and accessibil...
BACKGROUND: Transcatheter aortic valve (TAV) failure may require redo transcatheter aortic valve replacement (redo-TAVR). The multiple layers of metal after redo-TAVR may jeopardize coronary artery patency and accessibility and result in prosthesis-patient mismatch. Dedicated software may use multi-slice computed tomography (MSCT) imaging to simulate TAV deployment relative to the prior TAV and the individual's anatomy and predict coronary accessibility and TAV expansion. AIM: We aimed to validate redo-TAVR simulations created in FEops HEARTguide. METHODS: This multicenter observational study included redo-TAVR patients who had MSCT imaging available at baseline, after index-TAVR and after redo-TAVR. Patient-specific redo-TAVR simulations were created. Simulated valve-to-aorta distances (a proxy for coronary accessibility), neoskirt height, TAV expansion at multiple frame levels, and residual valve area after redo-TAVR were compared to follow-up MSCT. RESULTS: Among 25 patients, HEARTguide simulations of valve-to-coronary (VTC) distance (left VTC 6.0 ± 2.2 vs. 6.4 ± 2.3 mm, ICC = 0.856, p < 0.001; right VTC 5.8 ± 1.9 vs. 5.6 ± 1.9 mm, ICC = 0.740, p < 0.001) showed good agreement while valve-to-sinotubular-junction (VTSTJ) distance showed moderate agreement with follow-up MSCT (left VTSTJ 2.5 ± 1.8 vs. 3.3 ± 1.8 mm, ICC = 0.614, p = 0.004; right VTSTJ 2.8 ± 1.8 vs. 2.9 ± 1.2 mm, ICC = 0.613, p = 0.003). Redo-TAVR frame expansion simulations (mean frame area 434.8 ± 141.6 vs. 401.6 ± 142.9 mm, ICC = 0.930, p < 0.001; 393.5 ± 63.2 vs. 383.1 ± 82.5 mm, ICC = 0.822, p < 0.001, respectively) and simulations of residual valve area after redo-TAVR showed good agreement for self-expanding and balloon-expandable TAV (407.8 ± 67.8 vs. 389.6 ± 50.4 mm, ICC = 0.837, p < 0.001; 358.0 ± 66.1 vs. 336.1 ± 79.9 mm, ICC = 0.823, p < 0.001). CONCLUSIONS: In this pilot study, MSCT-derived simulations of redo-TAVR provided accurate insights into coronary accessibility, TAV expansion, and residual valve area.
Balloon-Expandable Versus Self-Expanding Valves in Low-Flow, Low-Gradient Aortic Stenosis: Does Valve Type Matter?
Warraich N, Brown JA, Sultan A … +8 more , Kliner D, Serna-Gallegos D, Toma C, Makani A, Hasan I, Ogami T, Zhu J, Sultan I
Catheter Cardiovasc Interv · 2026 May · PMID 41731970 · Full text
BACKGROUND: The optimal choice between balloon-expandable (BE) and self-expanding (SE) transcatheter heart valves (THVs) in patients with low-flow low-gradient aortic stenosis (LFLG AS) undergoing transcatheter aortic va...
BACKGROUND: The optimal choice between balloon-expandable (BE) and self-expanding (SE) transcatheter heart valves (THVs) in patients with low-flow low-gradient aortic stenosis (LFLG AS) undergoing transcatheter aortic valve replacement (TAVR) remains unclear. AIMS: This study aims to compare outcomes of BE THVs and SE THVs in patients with LFLG AS. METHODS: This was a retrospective, single-institution cohort study of TAVR procedures between 2012 and 2024. Patients with LFLG AS (mean gradient < 40 mmHg and ejection fraction < 50% or stroke volume index < 35 mL/m) were stratified by respective valve type. Patients with prior aortic valve replacement were excluded. Postoperative outcomes were compared between groups. Kaplan-Meier estimates and a Cox regression model were generated for survival. Cumulative incidence curves and a cause-specific cox regression model were generated for heart failure (HF) readmission. RESULTS: A total of 732 patients identified underwent TAVR for LFLG AS. Of these, 478 (65.3%) received a BE THV and 254 (34.7%) received a SE THV. STS PROM was similar between groups. There was no difference in 30-day mortality between groups. SE THVs had a lower mean gradient but increased rates of paravalvular leak at 30 days post-TAVR. Kaplan-Meier estimates were comparable between groups and there was no significant difference after multivariable analysis (HR 1.15, 95% CI 0.90-1.46, p = 0.27). Cumulative incidence estimates of HF readmission were similar between groups, however, BE THV was associated with reduced hazard of HF readmission on multivariable analysis (HR 0.77, 95% CI 0.59-0.99, p = 0.04). CONCLUSIONS: In patients with LFLG AS undergoing TAVR, BE and SE THVs have comparable midterm survival. BE THVs have a reduced risk of HF readmission on multivariable analysis.
Predicting Coronary Occlusion Risk during Redo-TAVR at First TAVR: Asymmetric Calcification Causes Failure.
Onishi K, Yasuda M, Yamada N … +10 more , Soejima N, Yoshida A, Fujita K, Matsuzoe H, Miyoshi T, Matsumura K, Mizutani K, Ueno M, Sakaguchi G, Nakazawa G
Catheter Cardiovasc Interv · 2026 May · PMID 41724696 · Full text
BACKGROUND AND AIMS: Predicting coronary artery occlusion due to sinus sequestration (SS) during a second transcatheter aortic valve (TAV) procedure using pre-procedural computed tomography (CT) after the first TAV repla...
BACKGROUND AND AIMS: Predicting coronary artery occlusion due to sinus sequestration (SS) during a second transcatheter aortic valve (TAV) procedure using pre-procedural computed tomography (CT) after the first TAV replacement (TAVR) is underreported. This study aimed to investigate the accuracy of SS risk prediction using pre-procedural CT by comparing it to the actual SS risk observed on post-procedural CT during TAV-in-TAV. METHODS AND RESULTS: We retrospectively evaluated 139 consecutive patients who underwent TAVR with a balloon-expandable valve. The predicted valve-to-sinotubular junction (VTSTJ) length and calcium volume of each coronary cusp were measured on pre-procedural CT. The observed VTSTJ length was assessed on post-procedural CT. High SS risk was defined as VTSTJ < 2.0 mm in either the right or left coronary cusp. Pre-procedural CT classified 78 patients into the high predicted SS (PSS) risk group; 77 (98.7%) showed a high observed SS (OSS) risk on post-procedural CT. Among the 61 patients classified as having low PSS risk, 44 (72.1%) were found to have high OSS risk post-TAVR. In this subgroup, patients with high OSS risk had a significantly higher proportion of non-coronary cusp calcium volume (NCC-CV) compared to those with low OSS risk (median 48.7% [interquartile range (IQR): 42.1-55.2] vs. 39.2% [IQR: 33.7-45.4]; p = 0.004). Multivariable logistic regression revealed NCC-CV ≥ 41.6% as an independent predictor of high OSS risk during TAV-in-TAV (odds ratio: 12.59 [95% confidence interval: 4.20-44.14], p < 0.001). CONCLUSION: Asymmetric NCC calcification was associated with discrepancies in SS predictions on pre-procedural CT.
Post-Transcatheter Aortic Valve Replacement Acute Severe Mitral Regurgitation: A Case Report.
Manasrah A, Khan F, Singh P … +1 more , Yarkoni A
Catheter Cardiovasc Interv · 2026 May · PMID 41709509 · Publisher ↗
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become the standard of care for patients with severe aortic stenosis (AS) who are at elevated surgical risk. Although generally well tolerated, TAVR can be as...
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become the standard of care for patients with severe aortic stenosis (AS) who are at elevated surgical risk. Although generally well tolerated, TAVR can be associated with uncommon but potentially serious complications, including acute mitral regurgitation (MR) following valve deployment. CASE SUMMARY: We present the case of a 94-year-old woman with symptomatic severe AS who developed acute, new-onset severe MR immediately after TAVR. Preprocedural imaging had shown no significant MR. The patient experienced acute hemodynamic compromise with pulmonary edema and hypotension, necessitating prompt medical intervention with vasopressors, diuretics, and noninvasive ventilation. Postoperative imaging excluded structural mitral valve (MV) damage and suggested impaired leaflet coaptation. The severity of MR improved markedly over the subsequent days, and at 1-year follow-up, only trace MR was observed. The likely mechanism was transient ischemic dysfunction of the posteromedial papillary muscle due to hypotension. CONCLUSION: New-onset severe MR following TAVR is an uncommon yet clinically significant complication that necessitates prompt identification and intervention. In cases where intraprocedural hypotension occurs, transient papillary muscle dysfunction should be considered as a potential underlying mechanism, particularly when the MR is reversible and not associated with structural MV abnormalities or evidence of myocardial ischemia.
Assessment of the Safety and Effectiveness of the FLOWer Antiembolic Filter Supporting Transcatheter Aortic Valve Implantation.
Sorropago A, De Marco F, Toscano E … +12 more , Brambilla N, Montorfano M, Stabile E, Kedhi E, Agostoni P, Gennari M, Vitali P, Sorropago G, Basso C, Finn AV, Lanzarone E, Scalise F
Catheter Cardiovasc Interv · 2026 May · PMID 41709490 · Publisher ↗
BACKGROUND: Embolic events are life-threatening complications of transcatheter aortic valve implantation (TAVI) with clinically relevant stroke rates of 2%-4%. AIMS: This study aims to evaluate the safety and effectivene...
BACKGROUND: Embolic events are life-threatening complications of transcatheter aortic valve implantation (TAVI) with clinically relevant stroke rates of 2%-4%. AIMS: This study aims to evaluate the safety and effectiveness of FLOWer, a novel embolic protection device (EPD) used in TAVI procedures. METHODS: Data on the FLOWer device were obtained from its CE-mark clinical trial (the NAUTILUS study, NCT04704258). Safety outcomes were the 30-day rate of major adverse events (MAEs, including all deaths, ischemic strokes, and acute kidney injury), while effectiveness data consisted of the number of particles captured by the filter during the procedure. These data were compared with benchmark values from the EPD literature. In addition, the total number (TNL) and volume (TVL) of new brain lesions were evaluated. RESULTS: A total of 52 intention-to-treat (ITT) patients were considered, 45 of whom were per protocol (PP) patients. The rate of 30-day MAEs for the PP population was 2.2% (1/45% vs. 14.3%, p = 0.0082); no strokes were observed. The median number of captured debris larger than 60 μm was 213 (IQR: 128-315 vs. 46.1, p < 0.0001), and larger than 150 μm, 105 (IQR: 60-190 vs. 41.6, p < 0.0001). The median TVL and TNL per patient were 291.7 mm (IQR: 98.5-630.7 mm) and 4.5 mm (IQR: 2.0-8.3 mm), respectively. CONCLUSIONS: The use of FLOWer during TAVI was found to be feasible and safe, with a low incidence of MAEs and a reduced number and volume of new brain lesions. The significant amount of debris captured compared to similar devices demonstrates effective device performance.
Direct Puncture of Calcified Plaque Using a Percutaneous Transcholangiography Needle in Endovascular Treatment for Superficial Femoral Artery Chronic Total Occlusion: A Case Report.
Tanaka K, Hosokawa Y, Ko T … +1 more , Asai K
Catheter Cardiovasc Interv · 2026 May · PMID 41709489 · Full text
Endovascular treatment (EVT) for chronic total occlusion (CTO) lesions has progressed recently; however, severely calcified lesions remain difficult to treat owing to challenges in guidewire passage and limited balloon o...
Endovascular treatment (EVT) for chronic total occlusion (CTO) lesions has progressed recently; however, severely calcified lesions remain difficult to treat owing to challenges in guidewire passage and limited balloon or stent expansion. We report the case of a 79-year-old Asian male with intermittent claudication who had previously undergone bare metal stent (BMS) implantation for CTO of the left superficial femoral artery (SFA). He underwent open surgical repair with end-to-end anastomosis of the left common femoral arter (CFA) to treat a puncture-site perforation. However, a chronic left CFA aneurysm later developed despite the initial repair. Angiography revealed a completely occluded SFA with a severely calcified plaque distal to the BMS. We selected a retrograde approach to perform EVT for the CTO of the left SFA via the popliteal artery, to avoid the ipsilateral antegrade approach crossing the aneurysm. As the puncture site was near the lesion, a direct puncture of the plaque was performed from the inserted sheath using a percutaneous transcholangiography (PTC) needle (calc-pick technique). The implanted BMS and calcification were useful as markers for needle insertion. To confirm the direction, we advanced the needle into the calcified occlusion and introduced a 0.014-in. wire toward the distal true lumen. After the wire position was confirmed using intravascular ultrasonography, step-by-step balloon dilatation was performed. A drug-coated balloon was used to finalize the procedure, resulting in good forward flow without any complications. Therefore, direct puncture of a severely calcified plaque with a PTC needle is a useful and safe EVT strategy if the lesion is close to the puncture site.
A Novel Technique for Percutaneous Mitral Paravalvular Leak Closure: LBBAP Lead Assisted Ventricular Septal Way.
Ari H, Tütüncü A, Ari S … +2 more , Balyimez AD, Bozat T
Catheter Cardiovasc Interv · 2026 May · PMID 41709488 · Publisher ↗
BACKGROUND: Percutaneous mitral paravalvular leak (PVL) closure in patients with double mechanical valves presents substantial technical challenges when conventional transseptal antegrade approaches fail. Transapical pun...
BACKGROUND: Percutaneous mitral paravalvular leak (PVL) closure in patients with double mechanical valves presents substantial technical challenges when conventional transseptal antegrade approaches fail. Transapical puncture, while an alternative, carries significant risks including hemothorax and coronary injury. Safe and reliable left ventricular (LV) access without high-risk transapical puncture remains a critical unmet need in complex structural heart interventions. METHODS: A 69-year-old woman with mechanical mitral and aortic valve replacements and persistent PVL despite prior percutaneous closure presented with recurrent heart failure symptoms. Transesophageal echocardiography demonstrated two moderate-to-severe PVL jets at the 7 o'clock position surrounding the previous occluder device. A Left Bundle Branch Area Pacing (LBBAP) delivery system was advanced from the left subclavian vein to create a controlled interventricular septal puncture under continuous unipolar pacing and electrocardiographic monitoring. RESULTS: The LBBAP-assisted interventricular septal crossing established a stable transventricular tract from right to left ventricle, enabling advancement of an 8.5 Fr steerable sheath. A separate transseptal puncture provided left atrial access. A veno-venous loop was created using a snare technique, facilitating deployment of two Amplatzer vascular plugs (8 × 7 mm AVP-II and 12 × 5 mm AVP-III) across the mitral PVL defects under transesophageal echocardiographic and fluoroscopic guidance. At follow-up, she remained asymptomatic, with no residual ventricular septal flow on imaging. CONCLUSIONS: This first reported case of LBBAP-assisted interventricular septal access for mitral PVL closure demonstrates feasibility and safety as an alternative when conventional approaches are not viable. This technique avoids transapical puncture risks and may expand therapeutic options for anatomically challenging structural heart interventions, particularly in patients with double mechanical valves (NCT07129122).
The Prognostic Impact of Multiple Adverse Events on Long-Term Mortality Following Acute Myocardial Infarction.
Roh KH, Kim YH, Choo EH … +10 more , Lee KY, Choi IJ, Lee JM, Yoo KD, Park MW, Park CS, Kim HY, Kim MC, Ahn Y, Chang K
Catheter Cardiovasc Interv · 2026 May · PMID 41709119 · Full text
BACKGROUND: Adverse events after acute myocardial infarction (AMI) are individually associated with poor outcomes, but the prognostic impact of the overlap of different event types occurring sequentially within the same...
BACKGROUND: Adverse events after acute myocardial infarction (AMI) are individually associated with poor outcomes, but the prognostic impact of the overlap of different event types occurring sequentially within the same patient remains uncertain. AIMS: Mortality associated with multiple events-defined as ≥ 2 different event types among spontaneous myocardial infarction (MI), ischemic stroke, and major bleeding-was compared with single events after AMI. METHODS: We analyzed 10,719 AMI patients in the multicenter Korean AMI registry. Patients contributed person-time to mutually exclusive, time-varying states: no event; MI only; stroke only; Bleeding Academic Research Consortium (BARC) type 3 bleeding only; and multiple events (≥ 2 different types). Mortality was modeled using multivariable Cox regression with stabilized inverse-probability weighting (IPW) and piecewise intervals for early (≤ 30 days), intermediate (30 days to 1 year), and late (>1 year) risk. RESULTS: Over a median 4.9 years, 2625 patients died. Multiple events occurred in 108 patients (1.0%): MI + bleeding (55%), stroke+bleeding (31%), and MI + stroke (15%). Mortality patterns were consistent across multiple-event combinations. Multiple events conferred the highest risk of death (5-year IPW-adjusted hazard ratio [HR]: 5.85, 95% confidence interval [CI]: 3.48-9.85), exceeding MI only (HR: 3.78), stroke only (HR: 2.72), or bleeding only (HR: 3.08). Mortality was most pronounced within 30 days, most markedly after multiple events (IPW-adjusted HR: 24.0, 95% CI: 12.9-44.7). CONCLUSIONS: Multiple adverse events after AMI confer substantially higher mortality risk than single events, with the greatest impact in the first 30 days. These findings support the need for an immediate and tailored approach and sustained surveillance to prevent further ischemic or bleeding complications.
First-in-Human Innovative Modification of the Harmony™ Transcatheter Pulmonary Valve to Accommodate Short Right Ventricular Outflow Tract Anatomy in Patients With Severe Pulmonary Regurgitation.
Aslam N, Qadir AA, Mohsin SS … +1 more , Aldoss O
Catheter Cardiovasc Interv · 2026 May · PMID 41692598 · Publisher ↗
A short right ventricular outflow tract represents an anatomical limitation for transcatheter self-expandable pulmonary valve placement. In this report, we present an innovative modification of the Harmony transcatheter...
A short right ventricular outflow tract represents an anatomical limitation for transcatheter self-expandable pulmonary valve placement. In this report, we present an innovative modification of the Harmony transcatheter pulmonary valve to accommodate the short right ventricular outflow tract anatomy in an 11-year-old boy in a setting in which an appropriately-sized balloon expandable valve was unavailable.
Comparison of Three TR Band Deflation Protocols Following Radial Coronary Procedures: A Prospective Randomized Trial.
Elhihi EA, Alromaili RH, Valiyapeediakkal S … +11 more , Alsharif RH, Ashraf LM, Abdul Rassak ARV, Patarasa MR, Fouta RS, Elamkulavan MR, Alsulaimani RW, Alrizqi AS, Meleraroth M, Albandar AB, Tukruni AB
Catheter Cardiovasc Interv · 2026 May · PMID 41691454 · Publisher ↗
BACKGROUND: Radial artery hemostasis can be achieved through a variety of methods after the excision of the sheath. The risk of radial artery blockage presents a challenge linked to the radial approach, potentially limit...
BACKGROUND: Radial artery hemostasis can be achieved through a variety of methods after the excision of the sheath. The risk of radial artery blockage presents a challenge linked to the radial approach, potentially limiting its future application. The patent hemostasis method effectively achieves hemostasis while maintaining the patency of the radial artery, thereby reducing the likelihood of radial artery occlusion. AIMS: The aim of this study was to compare three TR band deflation protocols (early initiation with long intervals, delayed initiation with short intervals, and routine protocol) to determine the optimum approach for TR band deflation following radial coronary procedures. METHODS: A randomized controlled trial was performed at King Abdullah Medical City, including 207 cardiac patients undergoing trans-radial coronary procedures. The TR band was utilized with the patented hemostasis technique, wherein 2 mL of air was injected following the detection of the radial pulse on pulse oximetry after complete occlusion with 16 mL of air. Patients were randomized using electronic randomization in a 1:1:1 ratio into three groups. Total time for TR band removal, bleeding complications, and radial artery occlusions' occurrence were measured through one tool developed by the researcher. This study was conducted in accordance with the CONSORT guidelines. RESULTS: A total of 207 patients were recruited. Protocols A, B, and C had significantly different mean percentages of total TR band removal time (194.1 ± 38.15, 200.1 ± 27.2, and 152.9 ± 59.4, p = 0.000). The three groups had similar bleeding rates (11.8%, 15.9%, and 22.9%; p = 0.2). The study indicated that 10.3% of patients in protocol A, 7.2% in protocol B, and 22.9% in protocol C reported bleeding during the first hour from starting the protocol, with a significant difference (p = 0.01). In the second hour, 1.4% of protocol B patients had small hematomas (< 5 cm). No incidence of radial artery occlusion was observed in any group. CONCLUSION: The early protocol appears to be the most effective in reducing the incidence of bleeding complications, while the routine protocol offers a faster approach but is associated with earlier bleeding complications.
Impact of Iron Deficiency Anemia on Outcomes After Transcatheter Aortic Valve Implantation: Insights From the Nationwide Readmission Database From 2016 to 2021.
Agrawal SP, Pawar S, Dey D … +4 more , Joshi DK, Raval M, Jain H, Siddiq S
Catheter Cardiovasc Interv · 2026 May · PMID 41691445 · Publisher ↗
BACKGROUND: Transcatheter aortic valve implantation (TAVI) has become an established intervention for severe symptomatic aortic stenosis, particularly in high-risk and elderly patients. Although anemia is frequently enco...
BACKGROUND: Transcatheter aortic valve implantation (TAVI) has become an established intervention for severe symptomatic aortic stenosis, particularly in high-risk and elderly patients. Although anemia is frequently encountered in this population, the specific role of iron deficiency anemia (IDA) in influencing outcomes following TAVI remains underexplored. AIMS: This study aims to evaluate the impact of iron deficiency anemia on clinical outcomes, resource utilization and readmission rates following TAVI using a large national database. METHODS: We conducted a retrospective, observational study using the Nationwide Readmission Database (NRD) from 2016 to 2021. Patients undergoing TAVI were identified by relevant ICD-10-Procedure Coding System (PCS) codes, and IDA was defined using ICD-10-Clinical Modification (CM) codes. Outcomes included in-hospital mortality, 30-day readmission, length of stay (LOS), transfusion requirements, and a range of complications. A 1:1 propensity score-matched analysis was performed to account for potential confounders (e.g., demographics, comorbidities, hospital characteristics). RESULTS: Among 213,453 patients who underwent TAVI, 8993 (4.2%) had a documented diagnosis of IDA. Compared with non-IDA patients, those with IDA experienced significantly higher rates of blood transfusion (14.75% vs. 5.33%; adjusted OR: 3.12, 95% CI: 2.78, 3.51; p < 0.001) and a greater incidence of post-procedure bleeding (14.38% vs. 11.62%; adjusted OR: 1.29, 95% CI: 1.17, 1.41; p < 0.001). Although in-hospital mortality did not differ significantly between the two groups (1.31% vs. 1.47%; p = 0.42), IDA was associated with a longer median LOS and higher 30-day readmission rates (11.95% vs. 9.84%; adjusted OR: 1.27, 95% CI: 1.15, 1.41; p < 0.001). Advancing age, the presence of heart failure, and greater comorbidity burden (Elixhauser comorbidity index ≥ 7) emerged as key predictors of in-hospital death. CONCLUSION: Baseline IDA in patients undergoing TAVI is associated with increased transfusion requirements, prolonged hospitalization, and higher rates of 30-day readmission, underscoring the clinical and economic burden of this modifiable risk factor. Its association with greater resource utilization and complications supports the need for more proactive identification and management of iron deficiency in TAVI candidates. Future randomized trials are needed to clarify whether preprocedural correction of IDA can reduce adverse events and improve long-term outcomes in this population.
Very Young Adults With Myocardial Infarction Undergoing PCI: Insights From the Houston Methodist Young-MI PCI Registry.
Samimi S, Chaaya RGB, Kharsa C … +7 more , Hatab T, Qamar F, Maqsood MH, Goel SS, Kleiman NS, Khan SU, Shah AR
Catheter Cardiovasc Interv · 2026 May · PMID 41677020 · Publisher ↗
BACKGROUND: Cardiovascular risk prediction models and prevention guidelines, which primarily target adults > 40 years, may underestimate risk in very young patients (≤ 40 years). Data on angiographic characteristics and...
BACKGROUND: Cardiovascular risk prediction models and prevention guidelines, which primarily target adults > 40 years, may underestimate risk in very young patients (≤ 40 years). Data on angiographic characteristics and clinical outcomes in this population remain limited. AIMS: To compare angiographic characteristics and long-term outcomes in very young adults (≤ 40 years) with ACS treated with PCI versus adults aged 41-50 years. METHODS: We analyzed the Houston Methodist Young ACS-PCI Registry, a retrospective cohort of adults aged ≤ 50 years undergoing PCI for acute coronary syndrome (ACS) from 2010 to 2022, excluding those with known coronary artery disease. Clinical variables and angiographic findings were abstracted from electronic health records and catheterization review. Outcomes were major adverse cardiovascular events (MACE: all-cause mortality, myocardial infarction, or stroke) and all-cause mortality. Cox proportional hazards models estimated adjusted hazard ratios (HR) with 95% confidence intervals (CI), adjusting for sex, race, hypertension, dyslipidemia, diabetes, smoking, and obesity. RESULTS: Among 469 patients (median age 46 [42-50] years; 25% women), 78 (17%) were very young (≤ 40 years) and 391 (83%) were 41-50 years. Very young adults had lower hypertension prevalence (67% vs. 81%) and higher ST-elevation MI rates (33% vs. 15%). Multivessel disease prevalence was similar (28% vs. 25%), and the left anterior descending artery was the most common culprit (50%). Over a median follow-up of 3.0 years, mortality was 11% in very young adults and 9% in young adults (p = 0.62). There were no significant differences in adjusted all-cause mortality (HR 1.15; 95% CI 0.25-5.16) or MACE (HR 1.22; 95% CI 0.51-2.96). CONCLUSION: Very young adults comprised ~1 in 6 ACS patients undergoing PCI, presented more often with STEMI, and had a comparable angiographic burden and long-term outcomes to adults aged 41-50 years.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe