Catheterization And Cardiovascular Interventions[JOURNAL]
Sun
200 papers
Development and Validation of NICVD-NQ Score for Predicting Short-Term Outcomes After Primary PCI.
Kumar R, Ammar A, Siddiqui MN … +17 more , Rahooja K, Samad M, Qayum D, Awan R, Mujtaba M, Naseer AB, Rasool M, Urooj A, Ahmed R, Ali MF, Shaikh AH, Mir A, Qamar N, Saghir T, Sial JA, Karim M, Hakeem A
Catheter Cardiovasc Interv · 2026 May · PMID 42129582 · Publisher ↗
BACKGROUND: Despite advances in primary percutaneous coronary intervention (PCI), patients with ST-elevation myocardial infarction (STEMI) continue to experience major adverse cardiovascular events (MACE) in the contempo...
BACKGROUND: Despite advances in primary percutaneous coronary intervention (PCI), patients with ST-elevation myocardial infarction (STEMI) continue to experience major adverse cardiovascular events (MACE) in the contemporary era. Existing risk scores (TIMI, GRACE, PAMI, CADILLAC) are outdated, mortality-focused, and largely derived in the fibrinolytic era from high-income settings, limiting their global relevance. AIMS: This prospective study aimed to develop a novel model to predict short-term (approximately 8 months) MACE after primary PCI. METHODS: STEMI patients presenting at the largest cardiac care center in Pakistan were prospectively enrolled to develop a model for predicting short-term (approximately 8 months) MACE. The predictive performance of the newly developed model was compared with the existing scores in the 20% testing cohort. RESULTS: The complete cohort comprised 2839 patients, of whom 2250 (79.3%) were men, with a mean age of 55.6 ± 11.2 years. A total of 580 patients (20.4%) were randomly assigned to the testing cohort. At a median follow-up of 244 [175-393] days, MACE was documented in 521 patients (18.4%), with 97 (16.7%) in the testing cohort and 424 (18.8%) in the training cohort. The new additive model yielded an AUC of 0.772 [95% CI: 0.72-0.83] with the NRI (net reclassification improvement) of 0.239 (p = 0.003), 0.268 (p = 0.001), 0.086 (p = 0.322), and 0.061 (p = 0.445) against TIMI, PAMI, CADILLAC, and GRACE scores, respectively. CONCLUSIONS: The NICVD predictive instrument outperformed the existing TIMI and PAMI scores and showed accuracy comparable to that of the GRACE and CADILLAC scores in predicting short-term MACE after primary PCI. And the model's enhanced predictive accuracy makes it a valuable tool for clinicians, enabling more enhanced risk stratification of STEMI patients.
Cerebrovascular Events in Aortic Stenosis: From Native Valve Disease to TAVR-Specific Risk and Prevention.
Boettger P, Sedighi J, Juenemann M … +5 more , Alhaj-Omar O, Piayda K, Arsalan M, Sossalla S, Kim WK
Catheter Cardiovasc Interv · 2026 May · PMID 42124472 · Publisher ↗
Aortic stenosis (AS) is associated with a heightened burden of cardiovascular comorbidities, atrial fibrillation (AF), and progressive valvular calcification, all of which may contribute to cerebrovascular events across...
Aortic stenosis (AS) is associated with a heightened burden of cardiovascular comorbidities, atrial fibrillation (AF), and progressive valvular calcification, all of which may contribute to cerebrovascular events across the disease continuum. However, true epidemiologic evidence establishing AS as an independent stroke risk factor remains limited, and much of the contemporary concern regarding stroke has shifted toward interventional management. Transcatheter aortic valve replacement (TAVR) has become the dominant therapy for severe AS, but periprocedural and early postprocedural stroke remain among its most clinically significant complications. This review integrates current knowledge on stroke pathways in native AS, AF, calcific embolization, hemodynamic alterations, and places them in context with procedural mechanisms unique to TAVR. We summarize evidence comparing stroke rates in TAVR versus surgical aortic valve replacement and examine anatomic, procedural, and patient-level drivers of embolic risk. Building on these mechanisms, we highlight contemporary stroke mitigation strategies including multimodality imaging for preprocedural planning, optimization of access and device selection, cerebral embolic protection devices, antithrombotic therapy tailored to individual indications, and structured postprocedural neurologic and rhythm monitoring. By integrating the natural history of AS with TAVR-specific embolic pathways, this review provides a comprehensive framework for understanding and minimizing stroke risk in patients across the spectrum of AS.
Cerebral Embolic Protection in TAVI: Mechanistic and Temporal Limitations.
Shah AH
Catheter Cardiovasc Interv · 2026 May · PMID 42121311 · Publisher ↗
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Double Barrel DCB in a Giant Ostial LAD.
Ang AS, Alimi M, Khaing T … +2 more , Junagade SS, Low RJB
Catheter Cardiovasc Interv · 2026 May · PMID 42121308 · Publisher ↗
Coronary artery ectasia is associated with adverse cardiac events. It presents significant challenges to percutaneous coronary intervention, with higher risks of no reflow. Moreover, conventional PCI strategies may not b...
Coronary artery ectasia is associated with adverse cardiac events. It presents significant challenges to percutaneous coronary intervention, with higher risks of no reflow. Moreover, conventional PCI strategies may not be suitable. In this case report, we showcase how we treated a patient with coronary artery ectasia and NSTEMI with a novel application of a "double-barrel" drug-coated balloon (DCB) strategy. The patient recovered well post PCI and has since remained chest pain-free. Relook at coronary angiography at 9 months showed a widely patent vessel with evidence of late lumen gain after DCB treatment. To our knowledge, this is the first reported case of such an approach.
Prognostic Impact of Pacemaker Implantation in Transcatheter Aortic Valve Replacement With Self-Expanding Prosthesis.
Felice F, Paolucci L, Nazzaro MS … +22 more , Musto C, Chin D, Stio R, Pennacchi M, Gabrielli D, Massussi M, Chizzolla G, Adamo M, Carlo M, Giannini C, Costa G, Sisinni A, Testa L, Bellini B, Montorfano M, Bruschi G, Merlanti B, Poli A, Ferrara E, Attisano T, Palmerini T, Regazzoli D
Catheter Cardiovasc Interv · 2026 May · PMID 42117766 · Publisher ↗
BACKGROUND: With the progressively increasing number of low-risk patients undergoing transcatheter aortic valve replacement (TAVR), the number of those who will be long-time pacemaker (PM) carriers is expected to increas...
BACKGROUND: With the progressively increasing number of low-risk patients undergoing transcatheter aortic valve replacement (TAVR), the number of those who will be long-time pacemaker (PM) carriers is expected to increase. To date, conflicting data is available regarding the association between PM and mortality following TAVR. AIMS: To investigate the association between PM and mortality in patients undergoing TAVR with self-expandable bio-prosthesis. METHODS: Patients undergoing TAVR between 2007 and 2014 in 10 Italian centers were considered. Two analyses were performed: one comparing patients with and without pre-TAVR PM (primary) and one comparing those with and without post-TAVR PM (secondary). The primary endpoint was all-cause mortality; the secondary endpoint was re-hospitalization to the cardiac ward. Clinical outcomes were assessed at the longest available follow-up. RESULTS: Overall, 1779 patients were included in the primary analysis and 1465 in the secondary one. Pre-TAVR PM implantation was not associated with an increased risk of all cause death in both the primary (adj. HR 0.93, 95% CI 0.76-1.13; p = 0.475) and secondary analysis (adj. HR 0.83, 95% CI 0.71-0.98; p = 0.029). Regarding hospitalization to cardiac ward, pre-TAVR PM was not associated with the outcome (adj. HR 1.10, 95% CI 0.85-1.42, p = 0.254), while post-TAVR PM implantation was related with an increased risk (adj. HR 1.94, 95% CI 1.56-2.41; p < 0.001). CONCLUSIONS: PM implantation is not associated with an increased risk of mortality in patients undergoing TAVR.
Impella Versus VA-ECMO in Cardiogenic Shock: An Updated Systematic Review and Meta-Analysis With Exploratory Matched-Cohort Analyses.
Mohamed AE, Elnady M, Kholeif Z … +12 more , Awashra A, Elsobky MS, Ibrahim AA, Elfeky AO, Shams M, Rashwan R, Tahhan I, Elnashar M, Ayman R, Hassanin M, Elharty H, Hakim D
Catheter Cardiovasc Interv · 2026 May · PMID 42115817 · Publisher ↗
Observational studies comparing Impella and venoarterial extracorporeal membrane oxygenation (VA-ECMO) in cardiogenic shock have reported inconsistent findings. We performed an updated systematic review and meta-analysis...
Observational studies comparing Impella and venoarterial extracorporeal membrane oxygenation (VA-ECMO) in cardiogenic shock have reported inconsistent findings. We performed an updated systematic review and meta-analysis, with exploratory matched-cohort analyses where directly reportable propensity score-matched event-level data were available. We searched PubMed, Scopus, Web of Science, and the Cochrane Library from inception through March 2026 for observational studies comparing Impella versus VA-ECMO in adult patients with cardiogenic shock. The primary outcome was in-hospital mortality. Secondary outcomes included all-cause mortality, ICU outcomes, access site bleeding requiring transfusion, peripheral vascular complications, renal outcomes, and stroke. Random-effects models using restricted maximum likelihood were applied. Fifteen observational studies including 22,618 patients were analyzed. In the primary crude analysis, Impella was not associated with a statistically significant difference in in-hospital mortality (RR 0.84, 95% CI 0.66-1.07; p = 0.15) with substantial heterogeneity (I² = 92.9%). However, leave-one-out analysis identified an influential registry study; its exclusion markedly reduced heterogeneity and favored Impella (p < 0.01). In exploratory propensity score-matched analysis, Impella was also associated with lower in-hospital mortality (RR 0.69, 95% CI 0.56-0.85, p < 0.01). Thirty-day and 6-month all-cause mortality were neutral, whereas 12-month mortality modestly favored Impella (p = 0.048). Sensitivity analyses similarly resolved heterogeneity and favored Impella for selected secondary outcomes, including 6-month mortality, acute kidney injury, and ischemic stroke. ICU mortality was neutral, while ICU length of stay was shorter with Impella (p = 0.01). Impella was also associated with lower access site bleeding requiring transfusion (p < 0.01), peripheral vascular complications (p < 0.01), and hemorrhagic stroke (p < 0.01). In this updated meta-analysis of observational studies, the primary crude analysis of in-hospital mortality was neutral overall but highly heterogeneous, whereas sensitivity and exploratory matched-cohort analyses showed a more consistent association favoring Impella. Impella was also associated with lower bleeding and vascular complications and shorter ICU length of stay, although several outcomes remained sensitive to study-level influence. These findings should be interpreted cautiously given the observational design, predominance of serious risk of bias, and strong potential for confounding by indication.
Unveiling the Microvasculature: The Index of Microcirculatory Resistance and Its Expanding Role in Cardiovascular Care.
Sohn J, Soderstrom MA, Ramirez A … +8 more , Dean JH, Shah R, Roy D, Stone K, Vinas A, Ramsey B, Lin C, Chilton R
Catheter Cardiovasc Interv · 2026 May · PMID 42108546 · Publisher ↗
Index of microcirculatory resistance (IMR) is a cutting-edge, wire-based tool that advances the capability assessment of coronary microvascular function. By utilizing distal coronary pressure and mean transit time under...
Index of microcirculatory resistance (IMR) is a cutting-edge, wire-based tool that advances the capability assessment of coronary microvascular function. By utilizing distal coronary pressure and mean transit time under maximal hyperemia, IMR delivers consistent, reproducible insights into the microvasculature's dynamic health. IMR has been shown to be of particular use as a diagnostic tool in the assessment of coronary microvascular dysfunction (CMD) allowing for diagnostic clarification in conditions like ischemia with non-obstructive coronary arteries (INOCA), acute coronary syndrome (ACS), and post-percutaneous coronary intervention (PCI) complications. In addition to its ability to be used as a powerful diagnostic tool, it also serves as a prognostic tool, helping to predict which patients are at elevated risk of major adverse cardiovascular events (MACE) and mortality. With the increasing integration of artificial intelligence into the cath lab, previous sources of error in IMR, such as technical variability and hemodynamic influences, are no longer as significant of an issue and allow for greater precision in the use of this tool. This comprehensive review discusses the physiologic basis of IMR, measurement techniques, and diagnostic and prognostic capabilities of IMR, while highlighting its therapeutic potential and future applications.
Predictive Nomogram for Prolonged Hemodynamic Instability After Carotid Artery Stenting.
Liu M, Zhou Y, Li T … +9 more , Xu Z, Li S, Chen F, Wang Y, Qu Y, Hou X, Li H, Guan Y, Wang W
Catheter Cardiovasc Interv · 2026 Jul · PMID 42071295 · Publisher ↗
BACKGROUND: Hemodynamic instability (HI), manifesting as hypotension and/or bradycardia, presents a common complication within 6 h post-CAS. The prolonged HI requires particular attention due to increased risk of neurolo...
BACKGROUND: Hemodynamic instability (HI), manifesting as hypotension and/or bradycardia, presents a common complication within 6 h post-CAS. The prolonged HI requires particular attention due to increased risk of neurologic complications. AIMS: The study aimed to determine the incidence and potential predictive factors of prolonged hemodynamic instability (HI) after carotid artery stenting (CAS). METHODS: From January 2023 to January 2025, patients diagnosed with carotid artery stenosis underwent CAS treatment were recruited. The data of peri-procedural characteristics extracted from the Hospital electronic database. Prolonged HI was defined as post-procedural HI persisting beyond 24 h, with or without associated symptoms. Logistic regression identified predictors of HI. A nomogram was developed based on the regression analysis. The receiver operating characteristic (ROC), Hosmer-Leme and decision curve analyses were used to assess predictive performance. RESULTS: The training cohort consisted of 234 cases, while the validation cohort included 100 cases. The logistic regression identified intraoperative HI (OR = 2.77, p = 0.02), Large balloon (OR = 10.53, p < 0.001), 7-10 mm stent (OR = 12.72, p < 0.001), and post balloon dilatation (OR = 2.60, p = 0.041) as significant independent predictors of HI. The external validation cohort demonstrated strong calibration curves between predicted and observed outcomes (p = 0.21). Decision curves confirmed the nomogram's superiority over the All or None scheme, particularly within threshold probabilities of > 5% to < 95%. The nomogram's performance metrics were: AUC = 0.92, accuracy = 0.89, specificity = 0.94, sensitivity = 0.94, PLR = 5.8, NLR = 0.07, and DOR = 82.25. CONCLUSION: This study confirms that intraprocedural HI, Large balloon, large-diameter stent use (7-10 mm), and post-balloon dilatation were independent risk factors for prolonged HI following CAS. The integration of these factors into a nomogram provides clinicians with a highly accurate tool for preoperative risk stratification.
Feasibility and Safety of Distal Transradial Access in Patients With Out-of-Hospital Cardiac Arrest Undergoing Emergency PCI: A Single-Center Retrospective Study.
Kawakami S, Taniguchi N, Yamada T … +7 more , Hata T, Nakajima S, Sano F, Nakano H, Yokouchi M, Ko A, Takahashi A
Catheter Cardiovasc Interv · 2026 Jul · PMID 42071294 · Full text
BACKGROUND: Distal transradial access (dTRA) has gained attention for its lower risk of vascular complications compared to conventional transradial access (TRA). However, its feasibility and safety in patients with out-o...
BACKGROUND: Distal transradial access (dTRA) has gained attention for its lower risk of vascular complications compared to conventional transradial access (TRA). However, its feasibility and safety in patients with out-of-hospital cardiac arrest (OHCA) undergoing emergency percutaneous coronary intervention (PCI) remain uncertain. AIM: To evaluate the procedural success, safety, and clinical outcomes of dTRA in OHCA patients undergoing emergency PCI. METHODS: This retrospective single-center study included 48 OHCA patients who underwent emergency PCI for presumed coronary etiology between January 2022 and December 2025. dTRA was the default access strategy unless contraindicated. Among them, dTRA was attempted in 44 patients. Patients in whom dTRA was successfully achieved were included in the main analysis. Clinical, procedural, and outcome data were comprehensively reviewed, including access-site complications and neurological status. RESULTS: dTRA was successfully achieved in 43 of 44 attempted cases (97.7%). The median door-to-balloon time was 67 min. Mechanical circulatory support was used in 38 patients (extracorporeal membrane oxygenation: 17; intra-aortic balloon pumping: 29). Access-site complications included one case of limb ischemia requiring amputation and three minor hematomas (EASY classification grade 3-5) with no major bleeding (BARC 3-5). The 30-day mortality was 51.2% (22/43), and among the 21 survivors, 14 (66.7%) achieved a favorable neurological outcome (CPC 1-2). CONCLUSIONS: In this OHCA cohort requiring emergency PCI, dTRA was feasible and safe in the majority of patients, including those receiving mechanical support. However, critical ischemic complications may still occur under unstable systemic conditions, warranting careful patient selection and vigilant post-procedural monitoring.
Prevalence and Characteristics of INOCA in Patients With Either Angiographically Normal Vessels or Non-Obstructive Coronary Atherosclerosis. Insights From the All-Comers Prospective AID-ANGIO Study.
Jerónimo A, Paredes-Vázquez JG, Lombardi M … +14 more , Paolucci L, Nardi G, Díaz-Polanco JC, Lahrifa A, Gómez-Polo JC, Olmos C, Playán J, García-Lledó A, Fernández-Rozas I, Curcio A, Travieso A, Mejía-Rentería H, Gonzalo N, Escaned J
Catheter Cardiovasc Interv · 2026 Jul · PMID 42059158 · Publisher ↗
BACKGROUND: Myocardial ischemia of non-obstructive origin (INOCA) is a prevalent cause of chronic coronary syndromes (CCS). Risk factors for atherosclerosis have also been described to promote INOCA, raising the question...
BACKGROUND: Myocardial ischemia of non-obstructive origin (INOCA) is a prevalent cause of chronic coronary syndromes (CCS). Risk factors for atherosclerosis have also been described to promote INOCA, raising the question whether these entities are clinically related. AIMS: Our aim was to compare the prevalence and clinical characteristics of INOCA in patients with and without coronary atherosclerosis. METHODS: Sub-analysis of the all-comers, prospective, multicentre AID-ANGIO study, enrolling consecutive CCS patients, referred for coronary angiography. Obstructive coronary artery disease (CAD) was investigated by angiography and pressure guidewires. In the absence of obstructive-CAD, functional coronary testing (FCT) was performed within the same procedure. All patients diagnosed with INOCA were classified according to the evidence of non-obstructive atherosclerosis (INOCA-Ath) or the presence of angiographically normal coronary arteries (INOCA-NoAth). RESULTS: In the AID ANGIO study, 89 patients presented non-obstructive coronary atherosclerosis and 104 had angiographically normal coronary arteries. Prevalence of INOCA-Ath and INOCA-NoAth was 78.7% and 70.2%, respectively (p = 0.181). Patients' symptoms, results from ischemia tests and endotype distribution were comparable in both groups. Vasomotor abnormalities were the most frequently identified (81.4% INOCA-Ath vs. 74.0% INOCA-NoAth; p = 0.285). INOCA endotype was not predicted by the presence of coronary atherosclerosis, typical anginal symptoms, a positive ischemia test or atherogenic risk factors, whereas a youger age was associated with vasomotor disorders. CONCLUSIONS: In an all-comers population of patients with CCS, prevalence of INOCA was similar in patients with and without non-obstructive CAD. Clinical features and endotype distribution were also comparable, highlighting the need for FCT to make a correct diagnosis. TRIAL REGISTRATION: The present study was conducted as a sub-analysis of the AID-ANGIO trial (ClinicalTrials.gov NCT056359949).
From Syncope to Shock: Emergency PCI Case Report in Multivessel Acute Coronary Occlusion.
Aimaierjiang N, Hendsun H, Jia X … +3 more , Jilili A, Zhang S, Xu W
Catheter Cardiovasc Interv · 2026 Jul · PMID 42059072 · Publisher ↗
Multivessel acute total occlusion (ATO) represents an exceedingly rare and catastrophic form of acute myocardial infarction (MI), characterized by complete cessation of coronary flow in multiple epicardial vessels and pr...
Multivessel acute total occlusion (ATO) represents an exceedingly rare and catastrophic form of acute myocardial infarction (MI), characterized by complete cessation of coronary flow in multiple epicardial vessels and profound ischemic burden. Such extensive coronary involvement often precipitates cardiogenic shock and carries exceptionally high mortality. This case report describes a 51-year-old male who presented with syncope and persistent chest pain following vigorous exertion. On admission, electrocardiography indicated acute anteroseptal and high lateral wall MI, and echocardiography revealed left ventricular dysfunction (LVEF 36%) with regional wall motion abnormalities. Coronary angiography demonstrated multivessel ATO involving proximal-mid left anterior descending (LAD) subtotal occlusion (TIMI 0-1), proximal left circumflex (LCx) total occlusion (TIMI 0), and mid right coronary artery (RCA) occlusion (TIMI 0). The patient developed cardiogenic shock requiring norepinephrine support. Guided by contemporary recommendations, culprit-only percutaneous coronary intervention (PCI) of the LCx was performed via right radial access, with intracoronary administration of a glycoprotein IIb/IIIa inhibitor (Prolifiban). A 2.75 × 23 mm drug-eluting stent was successfully implanted, achieving full reperfusion (TIMI 3) and rapid hemodynamic recovery. Subsequent staged LAD intervention was also successful. Post-procedural outcomes were favorable, with no recurrent syncope or chest pain and improved left ventricular ejection fraction to 46% at 30 days. This case highlights the clinical complexity and therapeutic dilemma of multivessel ATO presenting with syncope and cardiogenic shock. It underscores the importance of selective culprit-lesion revascularization, radial access, and adjunctive pharmacotherapy in achieving stabilization and favorable outcomes in this high-risk setting.
Code Stroke Activation Following Cardiac Catheterization Procedures: Contrast-Induced Encephalopathy Versus Stroke.
Dardas S, Sposato L, Ayan D … +1 more , Bagur R
Catheter Cardiovasc Interv · 2026 Jul · PMID 42057290 · Publisher ↗
BACKGROUND: Contrast-induced encephalopathy (CIE) is a rare but clinically significant complication following intra-arterial iodinated contrast administration, often mimicking acute ischemic stroke (IS). Its true inciden...
BACKGROUND: Contrast-induced encephalopathy (CIE) is a rare but clinically significant complication following intra-arterial iodinated contrast administration, often mimicking acute ischemic stroke (IS). Its true incidence following cardiac catheterization procedures remains poorly defined. AIMS: This study aimed to evaluate the incidence of CIE following cardiac catheterizationprocedures and to characterize its clinical presentation, diagnostic features and outcomes. METHODS: We conducted a single-center retrospective cohort study at an academic institution, evaluating all in-hospital code stroke activations from January 2016 to December 2022 (n = 855). Cases occurring after cardiac catheterization (n = 16) were reviewed in detail to identify those consistent with CIE based on clinical presentation, neuroimaging, and exclusion of alternative diagnoses. Diagnoses were adjudicated by a stroke neurologist. RESULTS: Among 34,760 coronary procedures performed during the study period, two cases of probable CIE were identified, yielding an incidence of 0.006%. Both patients were elderly with chronic hypertension and underwent diagnostic angiography with < 100 mL of hypo-osmolar iodinated contrast. Neurological symptoms developed within minutes to hours post-procedure. In both cases, symptoms resolved completely within 24-48 h with conservative management. CONCLUSIONS: CIE is a rare complication of cardiac catheterization procedures, but its stroke-mimicking presentation poses diagnostic and therapeutic challenges. We discuss diagnostic imaging strategies, risk factors such as hypertension and contrast volume, and propose clinical measures to enhance recognition and avoid mismanagement. Increased interdisciplinary awareness, careful risk factor mitigation, and integration into post-catheterization stroke protocols are critical to prevent misdiagnosis and inappropriate interventions. Despite the diagnostic uncertainty it may cause, CIE generally carries an excellent prognosis with complete symptom resolution in most cases. Further multicenter studies are needed to refine diagnostic criteria and guide management strategies.
Two Central Nervous System Tumors in One Catheter Lab: Time to Rethink Radiation Protection.
Bentham JR, Thomson JDR
Catheter Cardiovasc Interv · 2026 Jul · PMID 42050637 · Full text
BACKGROUND: Very little research has been done on the possible effects that repeated, frequent, and low-dose ionizing radiation exposure has on the long-term health of interventional cardiologists. AIMS: Following the di...
BACKGROUND: Very little research has been done on the possible effects that repeated, frequent, and low-dose ionizing radiation exposure has on the long-term health of interventional cardiologists. AIMS: Following the diagnosis in the same year of two central nervous system tumors in two operators working in the same catheter laboratory, we sought to compare the effect that introducing a new catheter laboratory would have on total patient dose. METHODS: We analyzed the radiation dose over an 18-year period for 9002 patients (2006-2025) as two cohorts, 2006-2019 (Lab 1, 5677 patients) and 2019-2025 (Lab 2, 3326 patients). RESULTS: We found that there was an upward trend in total exposure dose for Lab 1 before it was decommissioned (R 0.78). This reduces by 30.2% with the introduction of the new Lab 2. Although there was a significant reduction in fluoro dose between the two labs (Lab 1 mean 1221.5 cGy/cm, Lab 2 1079.8 cGy/cm, difference 11.6%, p < 0.025), most of the reduction in total dose was attributable to a significant fall in acquisition dose (Lab 1 mean 887.7 cGy/cm, Lab 2 379.2 cGy/cm, difference 57.3%, p < 0.025). CONCLUSIONS: Accepting the hypothesis that there is a linear no-threshold dose response relationship between low-dose ionizing radiation exposure and cancer risk in operators, we can understand factors that may have contributed to unnecessary excess exposure and how this could be prevented. X-ray patient doses increased steadily over time, without a change in procedure time. The significant reduction in dose following the introduction of new equipment strongly suggests that ionizing radiation doses should be closely monitored, with plans in place to routinely replace equipment on an 8 to 10-year cycle.
Efficacy and Safety of CorVad System in Coronary Intervention for Complex High-Risk and Indicated Patients.
Gao G, Li B, Pan H … +14 more , Wang X, Jiang J, Luo J, Tao L, He Y, Li Y, Bai M, Zhang Q, Cao Y, Yu S, Chen S, Feng W, Yin D, Dou K
Catheter Cardiovasc Interv · 2026 Jul · PMID 42036980 · Publisher ↗
BACKGROUND: Due to the heightened risks and complications associated with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in complex high-risk and indicated patients (CHIPs), percutane...
BACKGROUND: Due to the heightened risks and complications associated with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in complex high-risk and indicated patients (CHIPs), percutaneous ventricular assist system during PCI might offer a novel alternative. AIMS: We aimed to evaluate the efficacy and safety of the CorVad percutaneous ventricular assist system in CHIPs. METHODS: One hundred and eighteen CHIPs with left ventricular ejection fraction (LVEF) ≤ 40% were enrolled for CorVad support during elective PCI. The primary endpoint was the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) including death, new myocardial infarction, stroke, and target vessel revascularization at 30 days. Performance goal (PG) was set at 22.5%. Additionally, patients underwent CABG in Fuwai Hospital with LVEF ≤ 40% were selected as historical controls. RESULTS: In the intention to treat (ITT) cohort, there were five MACCE (4.2%, 95% CI 1.4%-9.6%) within 30 days, achieving the prespecified PG. The CorVad system was successfully implanted in all patients. Compared with baseline, the LVEF had a significant increase in 48 h (30.95 ± 4.84% vs. 35.96 ± 5.84%, p < 0.001) and 30 days after PCI (30.95 ± 4.84% vs. 39.78 ± 7.82%, p < 0.001). No patient had evidence of hemolysis after PCI. Compared with CABG historical controls, there were no significant differences in the incidence of MACCE at 30 days (after propensity score matching [PSM]: 3.8% vs. 1.3%, p = 0.341) and 90 days (after PSM: 3.8% vs. 1.3%, p = 0.307). CONCLUSIONS: The CorVad percutaneous ventricular assist system is safe and effective in assisting CHIPs-PCI.
Clinical Significance of V4R ST-Segment Elevation on a Synthesized 18-Lead Electrocardiogram in Patients With Anterior ST-Segment Elevation Myocardial Infarction.
Watanabe S, Onuma J, Ishida R … +2 more , Masuda R, Usui M
Catheter Cardiovasc Interv · 2026 Jul · PMID 42036972 · Publisher ↗
BACKGROUND: Right-sided ST-segment elevation is typically associated with inferior myocardial infarction; however, the clinical significance of synthesized right-sided ECG leads in anterior ST-segment elevation myocardia...
BACKGROUND: Right-sided ST-segment elevation is typically associated with inferior myocardial infarction; however, the clinical significance of synthesized right-sided ECG leads in anterior ST-segment elevation myocardial infarction (STEMI) remains unclear. AIMS: This study investigated the clinical implications of ST-segment elevation in the synthesized V4R lead in patients with anterior STEMI undergoing primary percutaneous coronary intervention (PCI). METHODS: We retrospectively analyzed patients with anterior STEMI who underwent primary PCI and had synthesized right-sided ECG leads recorded on admission. Patients were classified according to the presence or absence of ST-segment elevation in synthesized V4R. Clinical characteristics, angiographic findings, and in-hospital outcomes were compared between groups. RESULTS: Patients with synthesized V4R ST-segment elevation exhibited significantly higher peak creatine kinase levels, indicating larger infarct size. They also had a higher incidence of ventricular tachyarrhythmias and cardiogenic shock requiring mechanical circulatory support. In an additional stratified analysis limited to patients with higher peak creatine kinase levels, ventricular arrhythmias and cardiogenic shock remained more frequent in the V4R-positive group despite comparable peak creatine kinase levels and left ventricular ejection fraction between groups. Furthermore, a right ventricular branch originating from the left anterior descending artery was more frequently observed in patients with V4R elevation. CONCLUSIONS: Synthesized V4R ST-segment elevation in anterior STEMI is associated with larger infarct size and an increased risk of ventricular tachyarrhythmias and cardiogenic shock. This finding may help identify patients who are particularly vulnerable to acute electrical and hemodynamic instability during the early phase of myocardial infarction.
DASH Closure: A Dual Access Strategy for Hemodynamic Closure of Mitral Paravalvular Leaks.
Coppi F, Pagnoni G, Arrotti S … +12 more , Darroudi S, Galasso M, Marconi I, Stefani R, Godino C, Colombo A, Oreglia J, Mattioli AV, Boriani G, Aschieri D, Sgura FA, Fedele F
Catheter Cardiovasc Interv · 2026 Jul · PMID 42028701 · Publisher ↗
BACKGROUND: Paravalvular leaks (PVLs) are common complications following prosthetic valve implantation, significantly impacting patient outcomes due to associated heart failure and hemolysis. While percutaneous closure i...
BACKGROUND: Paravalvular leaks (PVLs) are common complications following prosthetic valve implantation, significantly impacting patient outcomes due to associated heart failure and hemolysis. While percutaneous closure is a recognized alternative to surgery, challenging anatomies and multiple leaks can be difficult to manage with traditional single-access techniques. METHODS: We present a case of a patient with a mechanical mitral prosthesis and two clinically significant mitral PVLs-one anterior and one posterolateral. The patient presented with symptoms of heart failure and was experiencing transfusion-dependent hemolytic anemia. To address the PVLs, we employed a dual-access strategy. We used a standard transseptal anterograde approach to close the anterior PVL and a retrograde transfemoral arterial approach to close the larger posterolateral defect. Two dedicated PVLs occlude devices were successfully implanted without impacting the motion of the prosthetic leaflets. The total procedural time was 95 min, comprising 38 min of fluoroscopy and a total iodinated contrast volume of 120 mL. Fortunately, no periprocedural complications occurred. Upon follow-up, the patient demonstrated sustained clinical improvement, with resolution of hemolysis and only a trivial residual mitral PVL observed on echocardiography. RESULTS: The DASH approach combines two access routes to overcome the limitations of traditional single-access methods. By using the Venturi effect, we simplify the procedure, improve device maneuverability, and increase success rates, even in complex cases. CONCLUSION: In selected patients with multiple, anatomically complex mitral PVLs-particularly when catheter alignment, stability, or prosthetic leaflet interaction limits a single-access approach, a planned dual-access strategy may represent a complementary technical option to facilitate safe device delivery. Larger series and longer follow-up are needed to define the indications, safety profile, and durability of the DASH approach.
Aortic Sinus-to-RVOT Communication Following Harmony Valve Implantation.
Morgan GJ, McCarthy KP, Downs E … +1 more , Love JC
Catheter Cardiovasc Interv · 2026 Jul · PMID 42028618 · Publisher ↗
The use of self-expanding valve platforms in the setting of regurgitant native right ventricular outflow tracts is progressing rapidly, promising the potential of lifetime percutaneous therapy for some patients who previ...
The use of self-expanding valve platforms in the setting of regurgitant native right ventricular outflow tracts is progressing rapidly, promising the potential of lifetime percutaneous therapy for some patients who previously had been committed to sternotomy with cardiopulmonary bypass surgery. These developments have been associated with some unpredicted complications whose aetiologies are now starting to develop into patterns which may be related to valve design as well as specific patient anatomic substrates. We report the case of an iatrogenic communication from the RVOT into the right coronary sinus by a Harmony valve in a patient whose original diagnosis was pulmonary stenosis with a small ventricular septal defect.
Echocardiography-Assisted Stenting of the Ductus Venosus in Infracardiac TAPVC: Report of a New Technique and Review of the Literature.
Schmid S, Hofbeck M, Nordmeyer J … +2 more , Rauch R, Michel J
Catheter Cardiovasc Interv · 2026 Jul · PMID 42026688 · Full text
Neonates with infracardiac total anomalous pulmonary venous connection (TAPVC) frequently require urgent treatment. If surgical repair is contraindicated due to extreme prematurity, interventional stenting of the ductus...
Neonates with infracardiac total anomalous pulmonary venous connection (TAPVC) frequently require urgent treatment. If surgical repair is contraindicated due to extreme prematurity, interventional stenting of the ductus venosus (DV) has been introduced successfully to postpone surgery. We report a new technique of transjugular stenting in an 890-g premature infant who presented with infracardiac TAPVC and functional closure of the DV. The DV was successfully crossed with a wire and stented under echocardiographic control. The case underlines the importance of echocardiography in diagnosing and managing DV obstruction. Different interventional strategies for DV-stenting in these complex patients are briefly reviewed.
Gender Differences in Risk Factors, Management, and Outcomes of Elderly Patients With Acute Coronary Syndrome: The Interplay of Frailty.
Yılmaz S, Uğur M, İnci SD … +15 more , Coşansu K, Çelik MO, Döner H, Solmaz S, Koç Y, Çayır K, Turhan B, Duman AB, Sağdıç B, Gençer F, Kabacı MC, Geçer S, Kıtlık EB, Turan B, Erkol A
Catheter Cardiovasc Interv · 2026 Jul · PMID 42026687 · Publisher ↗
BACKGROUNDS: Older adults constitute a growing proportion of patients presenting with acute coronary syndrome (ACS); optimal management remains uncertain due to comorbidities, frailty, procedure-related complications. AI...
BACKGROUNDS: Older adults constitute a growing proportion of patients presenting with acute coronary syndrome (ACS); optimal management remains uncertain due to comorbidities, frailty, procedure-related complications. AIM: This study aimed to identify prognostic determinants and to evaluate the impact of invasive management strategies on short- and long-term outcomes in elderly patients with ACS. METHODS: We retrospectively analyzed consecutive ACS patients aged ≥ 75 years who underwent coronary angiography. Frailty was assessed within the first 48 h of admission using the Rockwood Clinical Frailty Scale (CFS). Sex-related differences, frailty, treatment strategies (percutaneous coronary intervention [PCI] vs. conservative/medical therapy), predictors of short- and long-term outcomes were assessed. The primary endpoint was all-cause mortality; secondary endpoints included major adverse cardiac and cerebrovascular events (MACCEs). RESULTS: A total of 627 patients were included (46% women), with non-ST-elevation ACS (NSTE-ACS) as the predominant presentation (66.8%). Patients presenting with ST-elevation myocardial infarction (STEMI) experienced significantly higher in-hospital mortality (19.7% vs.5.7%) and MACCEs rates (50.5% vs. 22%; both p < 0.001) compared with those with NSTE-ACS. In-hospital and 1-year mortality did not differ by sex. Shock, frailty, contrast-induced nephropathy, peak troponin levels as independent predictors of in-hospital mortality, whereas frailty, reduced left ventricular ejection fraction, peak troponin independently predicted long-term mortality. Among patients with NSTE-ACS, PCI was associated with lower in-hospital mortality (3.5% vs. 8.4%; p = 0.040) but higher rates of in-hospital and long-term adverse events, without a significant reduction in 1-year mortality. CONCLUSIONS: Frailty is a dominant determinant of both short- and long-term mortality and should be systematically incorporated into early risk stratification. A selective, frailty-guided invasive strategy may improve early survival whereas routine intervention appears unjustified given the lack of long-term benefit and increased complication risk.
Unsupervised Agglomerative Cluster Phenotyping of Young Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.
Haisum Maqsood M, Chaaya RGB, Samimi S … +7 more , Hatab T, Qamar F, Kharsa C, Goel S, Shah AR, Kleiman NS, Khan SU
Catheter Cardiovasc Interv · 2026 Jul · PMID 42026648 · Publisher ↗
BACKGROUND: Young patients with acute coronary syndrome (ACS) exhibit diverse demographic, clinical and angiographic characteristics. We hypothesized that unsupervised machine learning (ML) can identify phenotypic cluste...
BACKGROUND: Young patients with acute coronary syndrome (ACS) exhibit diverse demographic, clinical and angiographic characteristics. We hypothesized that unsupervised machine learning (ML) can identify phenotypic clusters and predict the prognosis among young patients with ACS who undergo percutaneous coronary intervention (PCI). METHODS: We used the Houston Methodist Young-ACS PCI registry (2010-2022) and performed agglomerative clustering to analyze demographic, clinical, and angiographic variables among young patients (≤ 50 years) treated with PCI for ACS. RESULTS: Among 452 patients, cluster analysis identified three distinct phenotypes. Low risk (n = 273) exhibited the lowest proportions of heart failure (HF: 10.3%) and peripheral arterial disease (PAD): 5.9%), normal left ventricular ejection fraction (LVEF) (median = 0.60) and shorter median culprit vessel stent length (16 mm). Moderate risk (n = 101) was characterized by moderate rates of diabetes (36.6%), hypertension (77.2%), prior myocardial infarction (16.8%), and prior PCI (18.8%). High risk (n = 78) had the highest proportion of diabetes (67.9%), hypertension (93.6%), HF (65.4%), PAD (17.9%), prior MI (41.0%), prior PCI (46.2%), the lowest median LVEF (0.3) and the most frequent use of mechanical circulatory device (5.1%). All-cause mortality differed significantly, with high-risk cluster showing a fourfold increase in all-cause mortality (HR: 4.50 [1.68-12.1]) compared to low-risk cluster; however moderate and low-risk clusters did not differ significantly (HR: 1.52 [0.44-5.19]). Sensitivity analysis based on two-clusters showed similar outcomes, indicating the robustness of the analysis. CONCLUSIONS: Three distinct phenotypic clusters among young patients with ACS treated with PCI exhibited varying degrees of comorbidity burden and mortality risk, underscoring the potential for phenotype-guided therapeutic approaches.
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