BACKGROUND: Percutaneous femoral access serves as the cornerstone of endovascular therapy of lower extremity arterial disease. In complex cases, the arterial disease of lower extremity are involve in ipsilateral iliac ar...BACKGROUND: Percutaneous femoral access serves as the cornerstone of endovascular therapy of lower extremity arterial disease. In complex cases, the arterial disease of lower extremity are involve in ipsilateral iliac artery pathology, which conventional treatment strategies typically require multiple punctures or staged procedures. AIMS: This study aimed to explore the bilateral lower extremity endovascular intervention of patients with coexisting ipsilateral iliac artery stenosis using the long sheath-assisted access conversion technique (LS-ACT) via a single puncture. METHODS: This is a retrospective cohort study of 18 patients with arteriosclerosis obliterans of the lower extremity who were treated between April 2023 and July 2025. The cohort included 13 males and 5 females, with a mean age of 70.4 ± 7.2 years. After retrograde femoral access, contralateral interventions were performed using the LS-ACT protocol. RESULTS: The LS-ACT was performed in all 18 patients, achieving successful transition from femoral retrograde to antegrade access. Seven of these patients underwent simultaneous bilateral lower extremity arterial interventions. In 11 patients, the LS-ACT was utilized following failed antegrade puncture due to obesity, scarred puncture sites, or a high bifurcation of the profunda femoris artery. Notably, 8 patients presented with hemodynamically significant improvement of ipsilateral iliac artery stenosis, including 2 who had undergone prior stenting. No LS-ACT relevant complications occurred. CONCLUSION: The LS-ACT demonstrates substantial clinical utility in real-world practice. It is particularly valuable for patients with ipsilateral iliac artery stenosis or those requiring single-session bilateral lower extremity interventions, and represents a reliable alternative in cases of failed antegrade puncture or when managing bilateral disease.
BACKGROUND: Moderate/severe mitral regurgitation (MR) can affect the prognosis of patients with transcatheter aortic valve replacement (TAVR). However, few studies have focused on the role played by papillary muscles (PM...BACKGROUND: Moderate/severe mitral regurgitation (MR) can affect the prognosis of patients with transcatheter aortic valve replacement (TAVR). However, few studies have focused on the role played by papillary muscles (PMs). AIMS: We intend to explore the relationship between PMs and MR outcome after TAVR. METHODS: This retrospective cohort study included 1159 consecutive patients who underwent TAVR. The 125 patients who had MR ≥ 3+ grade were divided into improved MR (IMR) group and non-improved (NMR) group according to the grading of MR at 6 months after operation. MSCT was used to analyze the shape and locate the attachment of PMs. The deformation and synchrony of the PMs attachment were analyzed using two-dimensional speckle tracking. Associations with MR improvement after TAVR were explored. RESULTS: A total of 125 patients (IMR 93 and NMR 32; mean age, 72 years ± 8) were included. There was no significant difference in the deformation and synchrony of myocardium at attachment and in the PMs morphology between groups. However, the range of PM attachment was increased in the NMR group compared to the IMR group (1.94 ± 0.91 vs. 1.40 ± 0.65, p = 0.004; 2.16 ± 0.88 vs. 1.80 ± 0.80, p = 0.035). Inferior displacement of PMs (OR: 5.629; 95% CI: 1.421, 22.293; p = 0.014) was found to be an independent predictor of less MR improvement after TAVR. CONCLUSION: The PMs in the NMR group had no significant morphological tendency, but their attachment range was significantly increased and more toward apical. Inferior displacement of PMs was an independent risk factor for unalleviated MR. TRIAL REGISTRATION: ChiCTR 2000033419.
BACKGROUND: In patients with myocardial infarction (MI), quantifying expression of platelet FcɣRIIa (pFCG) stratifies risk of subsequent MI, stroke, and death. AIMS: Assess the prognostic implications of clinical risk al...BACKGROUND: In patients with myocardial infarction (MI), quantifying expression of platelet FcɣRIIa (pFCG) stratifies risk of subsequent MI, stroke, and death. AIMS: Assess the prognostic implications of clinical risk alone and in combination with the pFCG test. METHODS: Patients (n = 749) were enrolled in a prospective non-interventional trial during hospitalization with type 1 MI (ST elevation and non-ST elevation). Inclusion criteria included ≥ 2 of the following clinical risk factors: age ≥ 65, multi-vessel coronary artery disease, prior MI, chronic kidney disease, or diabetes mellitus. High and low pFCG (quantified by flow cytometry at a core laboratory) were defined by a prespecified threshold. The primary endpoint was the composite of MI, stroke, and death. RESULTS: Distribution of clinical risk factors was 346 patients (45%) with 2 factors, 272 patients (36%) with 3 factors, and 131 patients (17%) with 4 or 5 factors. A greater number of risk factors was associated with a greater risk of the composite of MI, stroke, and death after 1 year. The event rate with 2 risk factors was 10.2%, with 3 factors it was 14.4%, and with 4/5 factors it was 35.6%. Across all cohorts of clinical risk, the pFCG test identified a higher-risk and a lower-risk cohort. CONCLUSIONS: Both clinical risk and the pFCG test assess prognosis. Results of the pFCG test refine the prognosis defined by clinical risk. The prognostic implications suggest that the pFCG test may be a useful tool to balance ischemic risk with that of bleeding to define treatment strategy. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT05175261.
The dedicated radial ventriculography pigtail catheter was originally engineered to facilitate left ventriculography through the radial arterial approach by incorporating a multi-angulated design optimized for rapid aort...The dedicated radial ventriculography pigtail catheter was originally engineered to facilitate left ventriculography through the radial arterial approach by incorporating a multi-angulated design optimized for rapid aortic valve traversal. This report describes a novel, descriptive application of this catheter for selective engagement of the left and right pulmonary arteries during percutaneous thrombectomy in acute pulmonary embolism. The catheter's angulation, shaft support, and torque characteristics enable simplified navigation of the right ventricular outflow tract and pulmonary artery bifurcation. This report outlines the rationale, technical approach, and early procedural observations supporting this technique.
BACKGROUND: The buddy balloon technique facilitates transcatheter heart valve (THV) crossing the native aortic valve. CASE SUMMARY: An 80-year-old female, with previous ascending aorta replacement and aortic valve replac...BACKGROUND: The buddy balloon technique facilitates transcatheter heart valve (THV) crossing the native aortic valve. CASE SUMMARY: An 80-year-old female, with previous ascending aorta replacement and aortic valve replacement with bioprosthesis, was admitted to our hospital to undergo transcatheter aortic valve implantation due to bioprosthetic valve dysfunction. The self-expandable Allegra 23 mm, advanced through the right femoral artery, got stuck at the point of passage between the aortic arch and the prosthetic tube in the ascending aorta. A peripheral balloon was advanced from the left femoral artery and simultaneously inflated at the stalemate point, while pushing the valve toward the implantation site. Following failure with 5 mm and 7 mm balloons, crossing was successful with a 9 mm balloon. DISCUSSION: The standard buddy balloon technique involves the use of a single balloon diameter. Herein, we propose an escalating approach to increase chances of success and prevent potential complications, such as vessel rupture. TAKE HOME MESSAGE: The "escalating diameter" buddy balloon technique represents a safe and effective exit-strategy in case of challenges in advancing the THV system.
BACKGROUND: Hybrid stage I palliation (HS1P) has developed as an alternative to the Norwood stage I palliation for neonates with hypoplastic left heart and related left-sided obstructive lesions. HS1P is currently used i...BACKGROUND: Hybrid stage I palliation (HS1P) has developed as an alternative to the Norwood stage I palliation for neonates with hypoplastic left heart and related left-sided obstructive lesions. HS1P is currently used in various clinical settings, such as single ventricle palliation, bridge to decision, bridge to biventricular repair, or destination therapy. The procedure comprises bilateral pulmonary artery banding and duct stenting, thus avoiding the need for cardiopulmonary bypass surgery, which may be particularly beneficial in high-risk patients. AIMS: The aim of this multicenter retrospective observational study was to evaluate the feasibility, procedural safety, and clinical effectiveness of percutaneous deployment of the self-expanding sinus-SuperFlex-DS (SSF-DS) stent for duct stenting as part of HS1P in neonates weighing ≤ 2.5 kg. METHODS: All neonates weighing ≤ 2.5 kg who underwent percutaneous SSF-DS implantation as part of HS1P at five German centers between August 2011 and 2019 were included. Procedural characteristics, complications, reinterventions, and outcomes were analyzed until stent explantation or death. RESULTS: Thirty-two patients with a median age of 11 days (range 2-37 days) and a median weight of 2200 g (1600-2500 g) at stent implantation were included. Of those, 50% were preterm and 25% had known chromosomal abnormalities. Percutaneous stent implantation was successful in all patients. It was performed exclusively via femoral access, with retrograde arterial access used in 62.5% of procedures, including infants with a minimal weight of 1900 g. No procedure-related deaths occurred. In 25% of patients, two SSF-DS stents were implanted during the index procedure to achieve complete duct coverage. Twelve stent-related reinterventions were performed in 10 patients (31%), with a median time to first reintervention of 42 days (18-135 days). Implantation of more than one duct stent as part of the index procedure was associated with a higher reintervention rate (63% vs. 29%). The mean time to the subsequent surgical step did not differ between patients with and without stent-related reintervention. The overall reintervention rate until stent removal was 63% (20/32 patients). Twenty-five patients (78%) were successfully bridged to surgery (72% univentricular surgery, 28% biventricular repair). Median time to stent removal was 127 days (25-500 days), with a median weight of 4300 g (2800-7000 g) and a median weight gain of 2200 g (500-5400 g). In one patient, HS1P was the destination therapy. Six patients (19%) died before the subsequent surgical step. Mortality was related to severe comorbidities and the high-risk nature of the cohort rather than the stenting procedure itself. Procedure-related complications included atrial arrhythmias (6%) and stent migration/embolization (6%), all managed successfully without conversion to open-heart surgery. Occlusion of the primary access vessel occurred in two patients (6%; one femoral artery, one femoral vein). CONCLUSIONS: Percutaneous deployment of the SSF-DS stent as part of HS1P in neonates weighing ≤ 2.5 kg is feasible and associated with acceptable procedural and access-related complication rates. This strategy successfully bridges most patients to the next planned surgical stage despite the high-risk characteristics of this population. Close clinical monitoring during the interstage period is warranted because of the substantial rate of reinterventions, including treatment of stent stenosis and restrictive atrial communications.
Tagliafierro M, Kanade R, Kirilina D
… +12 more, Soliman F, Anzai I, Kodali S, Vahl T, Hahn R, Nazif T, Geirsson A, Takayama H, Argenziano M, Kurlansky P, George I, Pirelli L
BACKGROUND: Bioprosthetic aortic valves require reinterventions once they degenerate. Options include redo-surgical aortic valve replacement (redoSAVR) and Valve-in-Valve transcatheter aortic valve replacement (ViV). Wom...BACKGROUND: Bioprosthetic aortic valves require reinterventions once they degenerate. Options include redo-surgical aortic valve replacement (redoSAVR) and Valve-in-Valve transcatheter aortic valve replacement (ViV). Women with valvular disease have historically demonstrated higher procedural risks and worse outcomes compared to men. There is a knowledge gap regarding outcomes of aortic valve reinterventions in women. AIMS: We sought to compare outcomes of ViV versus redoSAVR in women with degenerated bioprosthetic surgical valves. METHODS: Consecutive female patients with prior SAVR undergoing isolated ViV or redoSAVR between 2015 and 2025 were included. Primary endpoints were 30-day all-cause mortality, stroke, and major adverse cardiac events (MACE). Secondary (1-year) endpoints included mortality, stroke, MACE, pacemaker implantation, and cardiac rehospitalization. Propensity score matching (PSM), Cox regression for survival, and Kaplan-Meier for MACE were performed. RESULTS: Forty redoSAVR and 92 ViV female patients were included. ViV females were older, had lower BMI, and higher STS-PROM. Primary endpoints were not significantly different between ViV and redoSAVR: mortality 1 (1.1%) versus 1 (2.5%), p = 0.303; stroke 3 (3.3%) versus 2 (5.0%), p = 0.480; MACE 3 (3.3%) versus 3 (7.5%), p = 0.272. 1-year endpoints were also comparable: mortality 8 (8.7%) versus 3 (7.5%), p = 0.867; stroke 4 (4.3%) versus 2 (5.0%), p = 0.834; MACE 11 (12.0%) versus 5 (12.5%), p = 0.888; pacemaker 3 (3.3%) versus 1 (2.5%), p = 0.792; rehospitalization 10 (10.9%) versus 2 (5.0%), p = 0.265). Results were consistent before and after PSM. CONCLUSIONS: ViV and redoSAVR in women yielded similar short-term outcomes. Both represent valid options for treatment of degenerated aortic bioprosthesis.
Rojas-Perdomo JD, Uribe-Díaz S, Hurtado-Ordóñez EF
… +5 more, Jaramillo-Villegas C, Fuentes-Pérez CA, Perez-Garzon M, Robayo-Amortegui H, Mendoza-Beltran F
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become an established therapy for severe aortic stenosis (AS) across all surgical risk categories. However, data from Latin America remain scarce, particularl...BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become an established therapy for severe aortic stenosis (AS) across all surgical risk categories. However, data from Latin America remain scarce, particularly using standardized outcome definitions such as those from the Valve Academic Research Consortium-3 (VARC-3). AIMS: To describe baseline characteristics, technical and device success, and early clinical outcomes over a 12-year period at a single established TAVR program in Colombia. METHODS: We conducted a retrospective observational case series of consecutive patients with severe symptomatic AS who underwent TAVR between January 2012 and December 2023. Data were collected from institutional databases and electronic health records. Outcomes were defined according to VARC-3 criteria and assessed at 30 days. Procedural success and secondary endpoints were analyzed using the Wilson score method for 95% confidence intervals to account for the sample size. Exploratory temporal trend and multivariable logistic regression analyses were performed. RESULTS: A total of 134 patients were included (median age 80 years; 52.2% female). Technical success was achieved in 95.5%, and device success at 30 days in 81.3%. Thirty-day mortality was 7.4%; acute kidney injury (19.4%), permanent pacemaker implantation (18.7%), and vascular complications (12.7%) were the most common adverse events. In an exploratory multivariable model, diabetes mellitus was associated with increased 30-day mortality (AOR 1.25, 95% CI 1.07-2.41; p = 0.021), although this finding is limited by the low absolute number of events and should be interpreted with caution. CONCLUSIONS: In this 12-year single-center experience, TAVR demonstrated high technical and device success with complication rates comparable to international benchmarks. These findings support the feasibility and safety of TAVR in a Latin American setting.
BACKGROUND: It was still unclear whether sex-related differences in the prevalence and clinical outcomes of patients with moderate-to-severe coronary artery calcification (MSCAC) who underwent percutaneous coronary inter...BACKGROUND: It was still unclear whether sex-related differences in the prevalence and clinical outcomes of patients with moderate-to-severe coronary artery calcification (MSCAC) who underwent percutaneous coronary intervention (PCI). AIMS: We aimed to evaluate sex-related differences in the prevalence and clinical outcomes in patients who underwent MSCAC-PCI. METHODS: We analyzed 10,681 consecutive patients with or without MSCAC from the prospective Fuwai PCI Registry. The primary outcome was the major adverse cardiovascular and cerebrovascular event (MACCE, a composite of cardiovascular death, myocardial infarction, and stroke). RESULTS: Among 10,681 patients who underwent PCI, 18.24% of patients had MSCAC. The prevalence of MSCAC was 19.81% in women and 17.99% in men. Before age 62, MSCAC prevalence predominated in men, whereas after age 62, women exhibited higher prevalence. For individuals aged ≥ 62 years, females again showed a higher prevalence of MSCAC compared to males (adjusted OR, 1.24; 95% CI, 1.01-1.52), and there was no significant difference between sexes in patients aged < 62 years. Among patients with MSCAC, relative to men, women have a higher risk of MACCE (adjusted HR, 2.89; 95% CI, 1.56-5.34), primarily coming from the increased risk of cardiovascular death and stroke. CONCLUSION: In this study, women with MSCAC faced higher long-term cardiovascular risks compared with men. An age-dependent divergence in MSCAC prevalence was observed, with higher prevalence in women after age 62.
We report on an adult patient with severe bioprosthesis stenosis and patient-prosthesis mismatch who was treated by percutaneous pulmonary valve implantation (PPVI) preceded by covered stent implantation and valve cracki...We report on an adult patient with severe bioprosthesis stenosis and patient-prosthesis mismatch who was treated by percutaneous pulmonary valve implantation (PPVI) preceded by covered stent implantation and valve cracking, using a high-pressure balloon, 5 mm larger than the internal bioprosthesis valve diameter. Although the hemodynamic result was satisfactory, the patient developed pericardial and right pleural hematoma, which was treated successfully by surgical emergency means. Caution is advised when the fracture of a dysfunctional surgical bioprosthesis is intended with high-pressure dilatations using significantly bigger balloons than the labeled valve size.
Paravalvular leak (PVL) occurs in up to 17% of prosthetic valve replacements, mainly in the mitral position. Surgery is the gold standard but carries high morbidity in patients with a history of previous sternotomies. Tr...Paravalvular leak (PVL) occurs in up to 17% of prosthetic valve replacements, mainly in the mitral position. Surgery is the gold standard but carries high morbidity in patients with a history of previous sternotomies. Transcatheter closure of PVL offers a minimally invasive alternative with a very high success rate. Device migration, while uncommon, can be catastrophic when impinging on mechanical prosthetic valve performance. We report the case of a 37-year-old woman with prior mechanical mitral and aortic valve replacements, complicated by recurrent heart failure due to a mitral PVL resulting from suture dehiscence. Initial transcatheter closure with two Amplatzer Vascular Plug III devices achieved a substantial reduction of regurgitation. Four months later, she presented with acute pulmonary edema caused by migration of one device into the left ventricular outflow tract, intermittently obstructing a mechanical aortic valve leaflet. Given her prohibitive surgical risk, percutaneous retrieval was undertaken, followed by immediate re-closure of the PVL during the same procedure, successfully restoring valve function and hemodynamic stability. This case illustrates the complexity of late PVL management after mechanical mitral valve replacement and highlights the potential risk of device migration. While surgery remains the gold standard, percutaneous intervention represents the only viable option in patients at prohibitive surgical risk. To our knowledge, this is the first reported case of successful percutaneous retrieval of an embolized device through a mechanical prosthesis, followed by re-closure of the PVL within the same procedure. This experience underscores the feasibility of advanced bailout strategies in carefully selected patients.
BACKGROUND: Paravalvular leak (PVL) is a complication after prosthetic valve implantation, leading to issues like hemolysis and heart failure. While redo surgery is the standard treatment, it poses significant risks for...BACKGROUND: Paravalvular leak (PVL) is a complication after prosthetic valve implantation, leading to issues like hemolysis and heart failure. While redo surgery is the standard treatment, it poses significant risks for high-risk patients. Transcatheter PVL closure has become a less invasive option, with improved efficacy from advanced imaging and device technologies. AIMS: This study aims to evaluate the safety, efficacy, and technical strategies of transcatheter PVL closure, including novel approaches like the reverse loop and arteriovenous (AV) rail techniques in a prospective single-center cohort. METHODS: Twenty-eight high-risk patients (mean age 57.2 ± 10.1 years) with significant aortic or mitral PVLs underwent transcatheter closure. Procedures were guided by multimodal imaging, assessing technical, procedural, and clinical success rates, along with 6-month outcomes in NYHA functional class and echocardiographic parameters. RESULTS: Out of 28 procedures, 27 were technically successful (96.4%), with clinical success achieved in 92.9% of patients. Most procedures used transfemoral access, treating aortic PVLs retrogradely and mitral PVLs through various routes. Advanced techniques like reverse loop (n = 4) and AV rail (n = 3) were utilized in complex cases. NYHA functional class improved significantly (p < 0.001), with no significant change in left ventricular ejection fraction. One patient required redo surgery, and one died from sepsis. CONCLUSION: Transcatheter PVL closure is a safe and effective alternative to redo surgery for selected high-risk patients. Advanced imaging and access techniques enhance procedural success, particularly in complex mitral PVLs. Further multicenter studies with long-term follow-up are needed to confirm these results and refine technique selection.
Single coronary artery (SCA) is a rare congenital coronary anomaly arising from a solitary ostium, supplying the entire myocardium. Often asymptomatic and incidental, those with inter-arterial courses carry an increased...Single coronary artery (SCA) is a rare congenital coronary anomaly arising from a solitary ostium, supplying the entire myocardium. Often asymptomatic and incidental, those with inter-arterial courses carry an increased risk of arrhythmia or sudden cardiac death (SCD). We report a case of SCA in an elderly woman with recurrent chest pain and left bundle branch block (LBBB). Angiogram revealed an anomalous Lipton type R-IIb SCA arising from the right coronary sinus with a malignant inter-arterial course confirmed by coronary CTA. She was referred for surgery due to the risk of SCD and malignant arrhythmia. SCA represents a rare but clinically significant coronary anomaly, particularly those with a malignant course. Early recognition and detailed anatomical characterization using noninvasive and invasive imaging techniques are crucial for accurate diagnosis and risk assessment.
BACKGROUND: Early identification and targeted treatment of coronary lesions at higher risk of future events remains a major unmet need in coronary artery disease research. Invasive treatment of such plaques is controvers...BACKGROUND: Early identification and targeted treatment of coronary lesions at higher risk of future events remains a major unmet need in coronary artery disease research. Invasive treatment of such plaques is controversial. The third-generation bioresorbable magnesium scaffold (DREAMS 3G) may provide a valuable alternative, but it has not been evaluated in this setting. The BIOMAG-I study, with comprehensive OCT and IVUS imaging, offers a unique opportunity to investigate high-risk plaque morphology and its vascular response. AIMS: We aimed to assess the association between lesions with high-risk plaque features treated with the DREAMS 3G scaffold and late lumen loss (LLL) at follow-up. METHODS: This post-hoc analysis included patients with stable coronary artery disease and high-quality intravascular imaging. High-risk plaque was defined as μFR > 0.80 with PB ≥ 70%. Subgroups were further stratified by the presence of MLA < 4 mm², TCFA < 80 μm, lipid arc >90°, or all combined PB was assessed by IVUS or estimated by OCT when IVUS was unavailable. LLL was measured at 6 and 12 months. RESULTS: Of 83 patients, 42 (50.6%) met the definition of μFR > 0.80 with PB ≥ 70%. Within this cohort, 41 also had MLA < 4 mm², 23 had TCFA < 80 μm, 16 had lipid arc ≥ 180°, and 16 presented all four features. LLL remained low in the overall PB ≥ 70% group (0.21 ± 0.29 mm at 6 months; 0.27 ± 0.44 mm at 12 months) and was similarly low or even lower across the additional subgroups, including those with all features combined (0.19 ± 0.21 mm and 0.16 ± 0.19 mm). CONCLUSIONS: In this sub-analysis of the BIOMAG-I trial, the DREAMS 3G bioresorbable magnesium scaffold demonstrated favorable performance, with low LLL and a low rate of clinical outcomes during the resorption period. These findings support DREAMS 3G as a promising "leave-nothing-behind" strategy for selected high-risk plaques, warranting confirmation in larger prospective studies.
This case report describes the successful management of a complex percutaneous coronary intervention (PCI) in a 78-year-old man with a history of coronary artery bypass grafts. The patient presented with refractory angin...This case report describes the successful management of a complex percutaneous coronary intervention (PCI) in a 78-year-old man with a history of coronary artery bypass grafts. The patient presented with refractory angina symptoms and underwent PCI to the obtuse marginal (OM) vessel. The lesion proved to be balloon and microcatheter uncrossable and subsequent entrapment of a dislodged microcatheter tip, completely occluding vessel flow. Conventional retrieval methods failed, necessitating the use of the antegrade dissection and re-entry (ADR) technique with a Stingray balloon. This approach successfully recanalized the vessel, bypassing both the original lesion and the entrapped microcatheter tip. The case highlights the importance of advanced interventional strategies, typically associated with chronic total occlusion (CTO) interventions, in resolving complex coronary complications. It emphasizes the need for interventional cardiologists to be proficient in diverse techniques to address rare but potentially serious complications during PCI.
Michelone M, D'Ascenzo F, Cho YK
… +25 more, Kang J, De Luca L, Cimino AR, Choi KH, Di Pietro G, Bertello E, Mattesini A, Wanha W, Lee SY, Gili S, Kim HK, Capoccia S, Greco A, Iannaccone M, Lee HJ, Cortese B, Song YB, Capodanno D, Gwon HC, Bruno F, Tuttolomondo D, Koo BK, De Ferrari GM, Nam CW, De Filippo O
BACKGROUND: Whether strut thickness influences clinical outcomes after percutaneous coronary intervention (PCI) for bifurcation lesions remains debated. AIMS: To compare the safety and efficacy of ultrathin (< 70 µm) dru...BACKGROUND: Whether strut thickness influences clinical outcomes after percutaneous coronary intervention (PCI) for bifurcation lesions remains debated. AIMS: To compare the safety and efficacy of ultrathin (< 70 µm) drug-eluting stents (DES) with thicker DES in coronary bifurcations. METHODS: We pooled patient-level data from the ULTRA and BIFURCAT registries. Stents were classified as thick (≥ 100 µm), thin (70-100 µm), or ultrathin (< 70 µm). The primary endpoint was target-lesion revascularization (TLR). Inverse probability of treatment weighting (IPTW) balanced baseline characteristics overall and within procedural subgroups (provisional vs. planned two-stent strategy). RESULTS: Among 6753 patients (median follow-up 800 days, IQR 400-900), 514 (8%) received thick, 5139 (76%) thin, and 1100 (16%) ultrathin stents. Crude TLR rates were 3.3%, 2.8%, and 1.1%, respectively (p = 0.001). After IPTW adjustment, ultrathin DES significantly reduced TLR compared with thick DES (HR 0.38, 95% CI = 0.16-0.89, p = 0.03) and with thin DES (HR 0.41, 95% CI 0.21-0.81, p = 0.01). In provisional-stenting cases, TLR risk did not differ across groups (HR: 0.53 vs. thick, p = 0.27; HR: 0.49 vs. thin, p = 0.07). Conversely, in planned two-stent procedures ultrathin DES resulted associated with TLR reduction versus thick DES (HR: 0.21, 95% CI 0.04-0.93, p = 0.04), with a nonsignificant trend for thin DES (HR: 0.31, p = 0.07). CONCLUSIONS: In contemporary bifurcation PCI, ultrathin DES are associated with a clinically and statistically significant reduction in repeat revascularization compared with thicker-strut platforms, a benefit driven predominantly by lesions treated with an upfront two-stent approach.
We present the case of a 19-year-old man admitted with cardioembolic stroke and rapidly evolving cardiogenic shock as the first manifestation of arterial tortuosity syndrome (ATS). Severe biventricular dysfunction, extre...We present the case of a 19-year-old man admitted with cardioembolic stroke and rapidly evolving cardiogenic shock as the first manifestation of arterial tortuosity syndrome (ATS). Severe biventricular dysfunction, extreme left atrial enlargement, and new-onset atrial fibrillation explained the embolic event. However, the management was dominated by the profound arterial abnormalities characteristic of ATS. Marked hypoplasia and tortuosity of the iliofemoral arteries (3 mm), ascending aorta (19 mm), and thoracic aorta rendered both mechanical thrombectomy and peripheral VA-ECMO implantation technically unfeasible. Multimodality imaging, cranial CTA, aortic angiography, and cardiac MRI were essential in defining procedural risk and ruling out vascular access options. A temporary intra-aortic balloon pump was selected as the only feasible mechanical support strategy, allowing clinical stabilization. Finally, genetic testing confirmed a pathogenic SLC2A10 variant consistent with ATS. This case highlights the importance of detailed vascular imaging in young patients with shock and unexplained vascular anatomy and illustrates how arterial hypoplasia can directly limit life-saving interventions.
BACKGROUND: No head-to-head trials have directly compared GLP-1 receptor agonists (GLP‑1 RAs) and SGLT2 inhibitors (SGLT2is) in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary interventio...BACKGROUND: No head-to-head trials have directly compared GLP-1 receptor agonists (GLP‑1 RAs) and SGLT2 inhibitors (SGLT2is) in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). AIMS: To compare short-, mid-, and long-term clinical outcomes of GLP-1 RAs versus SGLT2 inhibitors in adults with AMI undergoing PCI, using a multicenter propensity score-matched real-world cohort from the TriNetX US Collaborative Network. METHODS: This multicenter, retrospective cohort study used de-identified data from the TriNetX US Collaborative Network. Adults with AMI who underwent PCI and initiated either GLP‑1 RAs (n = 7201) or SGLT2is (n = 4252) within 14 days were included. One-to-one greedy nearest-neighbor propensity score matching (caliper 0.1) yielded balanced cohorts across > 50 covariates, resulting in 1752 patients per group. Kaplan-Meier and Cox models assessed mortality, heart failure, hospitalization, recurrent myocardial infarction (RMI), stroke, atrial fibrillation, major adverse cardiovascular events (MACE), acute kidney injury (AKI), and cardiac arrest. RESULTS: Compared with SGLT2is, GLP-1 RAs were associated with lower 1-year risks of acute heart failure (HR 0.415 [0.343-0.501]), all-cause hospitalization (HR 0.559 [0.495-0.631]), RMI (HR 0.799 [0.710-0.899]), stroke (HR 0.800 [0.667-0.959]), atrial fibrillation (HR 0.804 [0.693-0.932]), MACE (HR 0.788 [0.706-0.881]), and AKI (HR 0.534 [0.444-0.643]). At 30 days, absolute risk reduction was lower with GLP-1 RAs for acute heart failure (7.19% [5.66%-8.72%]) and all-cause hospitalization (16.61% [14.24%-18.98%]). All-cause mortality did not differ at 30 or 90 days but was lower at 1 year (HR 0.700 [0.507-0.967]). Cardiac arrest did not differ significantly. CONCLUSIONS: In this real-world, propensity score-matched study of patients with AMI undergoing PCI, GLP-1 RA initiation linked to lower risk of short- and long-term adverse outcomes than SGLT2i. These are observational findings needing confirmation in randomized trials.