Catheterization And Cardiovascular Interventions[JOURNAL]
Sun
200 papers
Acute Hypoxemic Respiratory Failure Following Mitral Transcatheter Edge-to-Edge Repair: The Role of Aortic Stenosis.
Sonbol M, Bennett S, Pu A … +10 more , Annabathula R, Chahal D, Aalaei-Andabili SH, Gupta A, Shkullaku M, Vesely M, Benitez M, Strauss E, Mysore M, Allaham H
Catheter Cardiovasc Interv · 2026 Jul · PMID 42026429 · Publisher ↗
BACKGROUND: The coexistence of severe mitral regurgitation (MR) and mild-to-moderate aortic stenosis (AS) presents diagnostic and therapeutic challenges. Limited data exists on outcomes following mitral transcatheter edg...
BACKGROUND: The coexistence of severe mitral regurgitation (MR) and mild-to-moderate aortic stenosis (AS) presents diagnostic and therapeutic challenges. Limited data exists on outcomes following mitral transcatheter edge-to-edge repair (M-TEER) therapy in this patient population. AIMS: This study is aimed to evaluate clinical outcomes following M-TEER in patients with mild-to-modearte AS compared with those without aortic stenosis. METHODS: A single-center retrospective study was conducted on 238 patients who underwent M-TEER therapy between January 2014 and December 2024. Patients with severe AS, cardiogenic shock, and failed or aborted cases were excluded. We compared patients with mild-to-moderate AS (n = 30) to those without AS (n = 208). PRIMARY OUTCOME: Acute hypoxemic respiratory failure (AHRF) within 24 h (SpO ≤ 90% ≥ 30 min or need for O/NIV/IMV, adjudicated as cardiogenic). SECONDARY OUTCOMES: Post-procedural in-hospital mortality, acute kidney injury, hospital length of stay (LOS), 30-day rate of heart failure hospitalization (HFH), and 30-day rate of all-cause readmission. Multivariable logistic regression was used to identify independent predictors of AHRF, hospital LOS, and 30-day HFH. RESULTS: Following M-TEER, the mild-to-moderate AS group experienced significantly higher rates of AHRF (16.7% vs. 3.8%, p = 0.0142; adjusted OR 4.38, 95% CI 1.36-14.61, p = 0.014). Within the parsimonious adjusted model, AS remained independently associated with AHRF, whereas the other included covariates were not. There was no significant difference in the 30-day rate of all-cause readmission, 30-day rate of HFH, AKI, LOS, or in-hospital mortality between groups. CONCLUSION: In patients undergoing M-TEER, the presence of mild-to-moderate AS is independently associated with an increased risk of early post-procedural AHRF, without differences in other short-term clinical outcomes. Given the single-center retrospective design and the limited number of clinical events, these findings should be considered hypothesis-generating and warrant validation in larger, prospective, multicenter studies.
Single Centre Experience With the Balloon-Expandable Myval Transcatheter Aortic Valve System in Patients With Bicuspid Anatomy: 1 Year Follow-Up.
Magyari B, Kittka B, Goják I … +9 more , Kasza G, Schönfeld K, Szapáry LB, Simon M, Kiss R, Bertalan A, Várady E, Szokodi I, Horváth I
Catheter Cardiovasc Interv · 2026 Jul · PMID 42021761 · Full text
BACKGROUND: Transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BAV) anatomy remains challenging due to anatomical complexity and limited trial data. New-generation balloon-expandable valves, such as...
BACKGROUND: Transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BAV) anatomy remains challenging due to anatomical complexity and limited trial data. New-generation balloon-expandable valves, such as Myval, require further evaluation in this subgroup. AIMS: To report 1-year VARC-3 outcomes following TAVI procedure with the Myval transcatheter heart valve (THV) in BAV anatomy. METHODS: From December 2019 to July 2023, 52 consecutive BAV patients at moderate-to-high surgical risk or deemed unsuitable for surgery underwent TAVI with the Myval THV. Outcomes, assessed per VARC-3 definitions, were compared to 217 trileaflet aortic valve (TAV) patients in unmatched and propensity score-matched cohorts. RESULTS: At 1 year, BAV and TAV patients showed no significant differences in all-cause mortality (3.9% vs. 10.2%, p = 0.185), cardiac mortality (0% vs. 2.3%, p = 0.587), or stroke (3.9% vs. 2.8%, p = 0.654) regarding an unmatched comparison. In the matched analysis, all-cause mortality and stroke were 3.9% and 1.9%, respectively, with no cardiac deaths. Endocarditis was rare (1.9% vs. 1.4%, p = 0.579); no valve thrombosis occurred. At 1 year, 94% of matched patients were in NYHA class I. Echocardiographic parameters remained stable; no moderate/severe paravalvular regurgitation was observed in BAV patients. Kaplan-Meier analysis revealed no differences in survival or composite outcomes. Technical and device success rates exceeded 95%; early safety was limited by a high incidence of non-vascular type 2-4 bleeding events. Based on the analyses, the relatively high postprocedural PPI rate (unmatched BAV vs. TAV: 34.0% vs. 30.4%, p = 0.429; matched: 34.0% vs. 24.0%, p = 0.274) is more likely attributable to patient-related characteristics rather than device-related complications, and remained unchanged following hospital discharge. CONCLUSIONS: TAVI with the Myval THV in real-world BAV patients is safe and effective with excellent hemodynamic performance at 1 year follow-up. This may reinforce the use of this device in this anatomically complex population.
Evacuation of a Large Intracardiac Thrombus at Cavoatrial Junction Using a Coaxial Aspiration System Through an ŌNŌ Retrieval Device in a Pediatric Patient.
Trivedi SK, Jaile JC, Hao MA … +1 more , Mejia E
Catheter Cardiovasc Interv · 2026 Jul · PMID 42020963 · Publisher ↗
Intracardiac thrombus in the right heart has a great risk of embolizing to the pulmonary circulation leading to great morbidity and mortality. Removal of large thrombi incurs an increased risk of embolization, especially...
Intracardiac thrombus in the right heart has a great risk of embolizing to the pulmonary circulation leading to great morbidity and mortality. Removal of large thrombi incurs an increased risk of embolization, especially if the clot is more acute and not fully adherent. We present a case of transcatheter removal of a thrombus at the right atrial and superior vena cava (RA-SVC) junction using a novel technique in a patient with transfusion-dependent Fanconi anemia status, bone marrow transplant, and steroid-resistant graft-versus-host disease using a coaxial system of a Penumbra Thrombectomy catheter with a ŌNŌ Retrieval Device. Systemic anticoagulation or thrombolysis may be ineffective in treating large and organized thrombi, and most surgical management techniques require cardiopulmonary bypass in these often fragile patients. The combined use of multiple intravascular techniques to stabilize and extract the thrombus can be utilized in unstable patients when the threat of pulmonary embolism is high. Critically ill and unstable patients with large, complex, and organized thrombi can benefit from the use of the presented novel, efficient, and safe approach, guarding against thrombus embolization during thrombectomy.
Impact of Plaque Eccentricity on the Diagnostic Performance of Murray-Law Based Quantitative Flow Ratio Computed From a Single Angiographic View.
Ding D, Wang X, Li G … +9 more , Weng T, Pan M, Yang X, He R, Guan S, Qu X, Li M, Wijns W, Tu S
Catheter Cardiovasc Interv · 2026 Jul · PMID 42020959 · Publisher ↗
BACKGROUND: Murray-law based quantitative flow ratio (μFR) enables rapid fractional flow reserve (FFR) computation from invasive coronary angiography (ICA) using a single projection, but the influence of plaque eccentric...
BACKGROUND: Murray-law based quantitative flow ratio (μFR) enables rapid fractional flow reserve (FFR) computation from invasive coronary angiography (ICA) using a single projection, but the influence of plaque eccentricity on its diagnostic accuracy remains unclear. AIMS: To investigate whether eccentric plaque impacts the diagnostic accuracy of single-view μFR. METHODS: We performed a blinded analysis of the prospective CAREER trial database, enrolling patients with 30%-90% diameter stenosis on coronary computed tomography angiography (CCTA) who underwent μFR and FFR assessments within 30 days. ICA were acquired using standardized, protocol-specified projections. CCTA images were analyzed using dedicated software and co-registered with ICA. For each μFR-identified lesion, plaque eccentricity index (PEI) and lumen asymmetry index (LAI) were computed across all cross-sections and averaged to yield PEI and LAI per-vessel. Vessels were classified as having eccentric/concentric plaques using median PEI, and subclassified as having asymmetric/symmetric lumens using median LAI. RESULTS: Among 231 vessels (201 patients), median μFR and FFR were 0.84 and 0.83, respectively. PEI and LAI moderately correlated (ρ = 0.46, p < 0.001). Limits of agreement between μFR and FFR were wider in eccentric versus concentric plaques (standard deviation 0.08 vs. 0.06; p = 0.003), mainly driven by presence of asymmetric lumens (standard deviation 0.09 vs. 0.06 in symmetric lumens; p = 0.029). μFR had comparable AUC for predicting FFR ≤ 0.80 between concentric plaques and eccentric plaques with symmetric lumens (0.94 vs. 0.95; p = 0.909). CONCLUSIONS: The diagnostic accuracy of single-view μFR, derived from standardized angiographic projections, was moderately affected by eccentric plaques, with the effect primarily attributable to asymmetric lumens.
Transapical TAVI in Left Ventricular Apical Aneurysm.
Helal A, Ing LY, Bilak J … +3 more , Sangaraju S, Blazejova Z, Lloyd C
Catheter Cardiovasc Interv · 2026 Jul · PMID 42020925 · Publisher ↗
Transcatheter aortic valve implantation (TAVI) was the preferred intervention for patients with severe aortic stenosis at high surgical risk and recently included intermediate and even low surgical risk patients. The tra...
Transcatheter aortic valve implantation (TAVI) was the preferred intervention for patients with severe aortic stenosis at high surgical risk and recently included intermediate and even low surgical risk patients. The transfemoral (TF) route is the standard approach, with alternative access reserved for patients with challenging peripheral artery disease. The transapical (TA) approach is rarely performed, especially in patients with left ventricular (LV) apical aneurysm due to risk of myocardial rupture and bleeding secondary to fibrosed myocardial tissue. We are presenting the first reported case, to our knowledge, of a TA TAVI performed from an LV apical aneurysm despite fibrosed myocardium after failed TF access with severe bicuspid aortic stenosis, advanced ischemic cardiomyopathy, peripheral vascular disease, and chronic obstructive pulmonary disease (COPD). A 29 mm Edwards Sapien S3 Ultra valve was successfully implanted with residual trivial paravalvular regurgitation and stable postoperative recovery. This case highlights the feasibility of TA TAVI in the presence of LV apical aneurysm when no other vascular access route is possible, contrary to the perceived view of the LV aneurysm being thin and friable, which should not preclude a case being done with TA access.
Impact of End-Stage Renal Disease on Outcomes of Rotational Atherectomy-Assisted Percutaneous Coronary Interventions: Insights From a National Inpatient Cohort.
Amin R, Khlidj Y, Ayoobkhan FS … +4 more , Johal P, Singla R, Ramphul K, Mittal V
Catheter Cardiovasc Interv · 2026 Jul · PMID 42017412 · Publisher ↗
BACKGROUND: Rotational atherectomy (RA) has become one of the most popular percutaneous coronary intervention (PCI) modalities for the management of patients with calcified coronary artery disease. However, the impact of...
BACKGROUND: Rotational atherectomy (RA) has become one of the most popular percutaneous coronary intervention (PCI) modalities for the management of patients with calcified coronary artery disease. However, the impact of end-stage renal disease (ESRD) on the post-RA outcomes is not fully determined. METHODS: We implemented the National Inpatient Sample (NIS) data of a propensity-score matched sample of adult cases who underwent RA from 2016 to 2021 to retrospectively compare their in-hospital outcomes according to the ESRD status. Multivariable regression models explored their complications. RESULTS: A 1:1 matched cohort of 11,555 with underlying ESRD and 11,555 without undergoing RA was generated. In terms of post-RA outcomes and complications, multivariate regression revealed increased adjusted odds ratios (aOR) for death (aOR: 1.514; 95% CI: 1.308-1.752; p < 0.001), major bleeding (aOR: 3.845; 95% CI: 3.595-4.113; p < 0.001), postoperative sepsis (aOR: 1.819; 95% CI: 1.517-2.183; p < 0.001), cardiac arrest (aOR: 1.169; 95% CI: 1.015-1.347; p = 0.03), cardiogenic shock (aOR: 1.212; 95% CI: 1.084-1.354; p < 0.001), and vasopressor use (aOR: 1.511; 95% CI: 1.249-1.828; p < 0.001) in the ESRD cohort. CONCLUSION: The in-hospital morbimortality after RA differs significantly in patients with and without ESRD. Notably, this comorbidity is independently associated with poorer outcomes and complications post RA. Therefore, the ESRD status should be considered for preoperative stratification of patients undergoing RA-guided PCI.
Correction to "Microcatheter Tip Fracture and Acute Vessel Occlusion Rescued With Subintimal Tracking and Re-Entry: Move the Tip".
Catheter Cardiovasc Interv · 2026 May · PMID 42015756 · Publisher ↗
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Pre-Existing and New-Onset Atrial Fibrillation in Patients Undergoing Transcatheter Aortic Valve Implantation.
Hemelrijk KI, van Nieuwkerk AC, Vojacek PJ … +21 more , Gheorge L, Tchétché D, Brito FS, Barbanti M, Kornowski R, Latib A, D'Onofrio A, Ribichini F, Bowden GY, Dumonteil N, Leite RS, Sartori S, D'Errigo P, Tarantini G, Andreaggi S, Orvin K, Pagnesi M, Asmarats L, Dangas G, Mehran R, Delewi R
Catheter Cardiovasc Interv · 2026 Jul · PMID 42013298 · Full text
BACKGROUND: Atrial fibrillation (AF) is a frequent comorbidity in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI). In addition, new-onset AF can occur after TAVI. Howe...
BACKGROUND: Atrial fibrillation (AF) is a frequent comorbidity in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI). In addition, new-onset AF can occur after TAVI. However, data on how AF affects outcomes in patients undergoing TAVI remain conflicting. AIMS: To assess clinical outcomes in patients with severe aortic valve stenosis with AF who undergo TAVI in a large real-world global cohort. METHODS: The CENTER2-study includes 25,771 patients that underwent TAVI between 2007 and 2022. The database consists of patient-level pooled data from 10 clinical studies. Objectives were rates of new-onset AF ≤ 30 days, and differences in mortality and stroke according to AF status. RESULTS: A total of 23,320 patients were included in the current analysis (56.1% female; mean age 81.5 ± 6.7 years). Pre-existing AF was present in 28.2% (n = 6579) of patients. Mortality rates after TAVI were higher in patients with pre-existing AF (19.0% vs. 14.2%, adjusted HR: 1.39, 95% CI: 1.26-1.53, p < 0.001). Strokes at Day 3-30 after TAVI were more frequent in patients with pre-existing AF (1.6% vs. 1.1%, p = 0.004). New-onset AF occurred in 6.2% (n = 681) of patients without pre-existing AF. Mortality rates after TAVI were higher in patients with new-onset AF (adjusted HR 1.75, 95% CI 1.24-2.49, p = 0.002). One-year stroke was more frequently observed in patients with new-onset AF after exclusion of acute periprocedural stroke (6.1% vs. 3.4%, p = 0.04). Major bleeding was also more frequent in patients with new-onset AF (12.0% vs. 6.7%, p < 0.001). CONCLUSIONS: Patients with pre-existing or new-onset AF had higher mortality compared with patients without AF undergoing transfemoral TAVI. After the acute postprocedural period, 1-year stroke rates were higher in patients with new-onset AF. TRIAL REGISTRATION: ClinicalTrials.gov. Unique identifier NCT03588247.
Endothelial Activation and Stress Index (EASIX) as a Predictor of No-Reflow in Patients Undergoing Saphenous Vein Graft Percutaneous Coronary Intervention.
Hancıoğlu E, Özcan S, Faideci EM … +4 more , Bekler Ö, Karaçöp E, Enhoş A, Okuyan E
Catheter Cardiovasc Interv · 2026 Jul · PMID 42013289 · Publisher ↗
BACKGROUND: No-reflow phenomenon (NRP) is a significant complication of percutaneous coronary intervention (PCI) in saphenous vein grafts (SVGs). The Endothelial Activation and Stress Index (EASIX), derived from LDH, cre...
BACKGROUND: No-reflow phenomenon (NRP) is a significant complication of percutaneous coronary intervention (PCI) in saphenous vein grafts (SVGs). The Endothelial Activation and Stress Index (EASIX), derived from LDH, creatinine, and platelet count, is a marker of endothelial dysfunction and inflammation. AIMS: To assess the association between EASIX and NRP in patients undergoing SVG PCI. METHODS: A total of 343 patients with non-ST elevation myocardial infarction who underwent SVG PCI between March 2020 and June 2025 were retrospectively enrolled. Patients were categorized according to the development of NRP. Multivariate logistic regression identified independent predictors, and the discriminative performance of EASIX was assessed using receiver operating characteristic (ROC) curves. RESULTS: NRP occurred in 71 patients (20.7%). Patients with NRP had higher EASIX scores (1.61 ± 1.43 vs. 0.73 ± 0.36, p < 0.001), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII). EASIX (OR: 3.151, p = 0.001), NLR, and reduced left ventricular ejection fraction were independent predictors of NRP. ROC analysis indicated that EASIX predicted NRP with an AUC of 0.779 (95% CI: 0.711-0.847, p < 0.001). The optimal EASIX cut-off was 0.79, with 70% sensitivity and 68% specificity. CONCLUSION: EASIX, a simple and easily calculated score, is independently associated with no-reflow in patients undergoing SVG PCI.
Analysis of Long-Term Effects of Percutaneous Balloon Mitral Valvotomy (PBMV) in 90 Patients With Rheumatic Mitral Stenosis: A Retrospective Analysis.
Xu J, Liang N, Xiao Y … +5 more , Wu X, Lu D, Li C, Zeng Y, Luo X
Catheter Cardiovasc Interv · 2026 Jul · PMID 42013245 · Publisher ↗
BACKGROUND: Analysis of the long-term effects of percutaneous balloon mitral valvotomy (PBMV) intervention in patients with rheumatic mitral stenosis. AIMS: To evaluate the long-term efficacy, safety, and hemodynamic out...
BACKGROUND: Analysis of the long-term effects of percutaneous balloon mitral valvotomy (PBMV) intervention in patients with rheumatic mitral stenosis. AIMS: To evaluate the long-term efficacy, safety, and hemodynamic outcomes of PBMV in patients with rheumatic heart disease and mitral stenosis through a 6-year retrospective clinical follow-up. METHODS: Ninety patients with rheumatic mitral stenosis treated in our hospital from January 2012 to 2017 were selected retrospectively. The changes of cardiac function grade before and 1, 3, and 6 years after intervention, left atrial diameter (LADd), mitral valve area (MVA), transvalvular pressure difference (MVG), pulmonary artery systolic pressure (PAPs), left ventricular ejection fraction (LVEF), and restenosis 1, 3, and 6 years after intervention were observed. RESULTS: Post-procedural NYHA functional class improved significantly compared with baseline (p < 0.05). NYHA class remained stable across 1-, 3-, and mid-term (6-year) follow-up visits, with no statistically significant differences between these time points. After 6 years of intervention, MVA and LVEF were still higher than those before intervention, while LADd, MVG, and PAPs were still lower than those before intervention (p < 0.05). There was no significant difference between the study cohort in terms of restenosis, complications, and cardiac adverse events at 1, 3, and 6 years after intervention (p > 0.05). CONCLUSIONS: The long-term effect of PBMV is good in patients with rheumatic mitral stenosis.
Transcatheter Repair of Sinus Venosus Defect Using a 12-zig Covered Cheatham-Platinum Stent in Large Superior Vena Cava-Right Atrium Junctions: Early Multicenter Experience.
Fuensalida A, Rosenthal E, Kabir S … +5 more , Szantho G, Yong S, Taliotis D, Turner M, Bedair R
Catheter Cardiovasc Interv · 2026 Jul · PMID 42013244 · Publisher ↗
Sinus venosus defect (SVD) is a rare congenital heart anomaly characterised by an abnormal communication between the atria, often associated with partial anomalous pulmonary venous connection (PAPVC). Traditional surgica...
Sinus venosus defect (SVD) is a rare congenital heart anomaly characterised by an abnormal communication between the atria, often associated with partial anomalous pulmonary venous connection (PAPVC). Traditional surgical repair carries significant risks, prompting exploration into less invasive transcatheter approaches. This study aims to evaluate the efficacy and safety of a 12-zig covered Cheatham-platinum stent for the correction of SVD, particularly in patients with enlarged superior vena caval-right atrial (SVC-RA) junctions unsuitable for standard stenting techniques. A retrospective analysis was conducted on five symptomatic patients treated with the 12-zig CP stent across two institutions. Preprocedural imaging, including echocardiograms, cardiac MRIs, and CT angiograms was performed to assess right ventricular function and define anatomical relationships. The procedures were guided by transoesophageal echocardiography (TOE) and involved balloon sizing to ensure optimal stent placement. All five patients (80% male, median age 59 years) successfully underwent stent implantation. A second stent was required in three cases due to residual leaks, which were effectively sealed, and in one case for stent stability. No procedural complications were reported, and all patients experienced symptomatic improvement at follow-up, with imaging confirming stable stent positions. The 12-zig CP stent demonstrates feasibility in the percutaneous treatment of highly selected patients with SVD, allowing for effective closure in complex anatomies, including large SVC-RA junctions. This study underscores the potential of advanced imaging techniques and tailored interventions in enhancing patient outcomes with complex congenital heart disease previously unsuitable for standard transcatheter approaches.
Comparing Clinical Outcomes of Intravascular Lithotripsy Versus Rotational Atherectomy in Coronary Artery Calcification: A Meta-Analysis.
Motawea KR, Makky E, Abdelwahab AM … +3 more , Khattab O, Tanas Y, Hafez W
Catheter Cardiovasc Interv · 2026 Jul · PMID 42013230 · Publisher ↗
BACKGROUND: Coronary calcification poses a significant challenge during percutaneous coronary intervention (PCI) with intravascular lithotripsy (IVL) and rotational atherectomy (RA), which are common plaque-modifying str...
BACKGROUND: Coronary calcification poses a significant challenge during percutaneous coronary intervention (PCI) with intravascular lithotripsy (IVL) and rotational atherectomy (RA), which are common plaque-modifying strategies. AIMS: This meta-analysis aimed to compare the clinical and procedural outcomes of IVL and RA in patients with calcified coronary lesions. METHODS: Following PRISMA and Cochrane guidelines, PubMed, Scopus, and Web of Science were searched through January 4, 2025, for randomized and cohort studies comparing IVL and RA in patients with coronary calcification. Outcomes included mortality, myocardial infarction (MI), stroke, major adverse cardiovascular events (MACE), dissection, slow reflow, coronary perforation, stent thrombosis, revascularization, minimal stent area, lumen area gain, procedure time, and post-dilation balloon size lumen gain. Pooled estimates are reported as risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: Twelve studies comprising 1247 patients (612 with IVL and 635 with RA) were included. IVL was associated with a significantly lower mortality risk (RR = 0.51; 95% CI, 0.28-0.93; p = 0.03), reduced MACE (RR = 0.43; 95% CI, 0.19-0.98; p = 0.05), and lower incidence of slow reflow (RR = 0.27; 95% CI, 0.11-0.65; p = 0.004). No significant differences were found in MI, stroke, dissection, perforation, stent thrombosis, revascularization, or procedural parameters including lumen area gain and procedure time. Although post-dilation balloon size lumen gain initially favored IVL, the significance was lost after the sensitivity analysis. CONCLUSION: IVL demonstrates favorable safety and efficacy outcomes compared with RA, with lower rates of mortality, MACE, and slow reflow. These findings support the role of IVL in the treatment of calcified coronary lesions.
Influence of the Residual Gensini Score on Prognosis of Patients With ST-Elevation Myocardial Infarction.
Popovic B, Djaballah N, Tomic M … +6 more , Fay R, Fraichot V, Eggenspieler F, Metzdorf PA, Varlot J, Camenzind E
Catheter Cardiovasc Interv · 2026 Jul · PMID 42013226 · Full text
BACKGROUND: The residual Gensini score (rGS) was developed to quantify the severity of coronary atheroma burden after coronary revascularisation. The predictive value of the rGS for clinical outcomes in patients with ST-...
BACKGROUND: The residual Gensini score (rGS) was developed to quantify the severity of coronary atheroma burden after coronary revascularisation. The predictive value of the rGS for clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) remains unexplored. METHODS: Our retrospective study included 1034 consecutive patients who presented with STEMI between 2016 and 2020. Patients were stratified based on the third tertile of rGS values: rGS ≤ 16 (Group 1) and rGS > 16 (Group 2). RESULTS: Compared with patients in group 1, epicardial and microvascular perfusion were significantly impaired in group 2 as evidenced by poorer final flow grade TIMI 3 (89% vs. 74%, p < 0.0001) and lower complete ST resolution (STR) rates > 70% (56% vs. 49%, p = 0.007). In the unadjusted analysis, excess mortality in group 2 was observed early (45-day mortality rate: 6% vs. 12%, p = 0.0005) and persisted during the 2-year follow-up (9% vs. 18%, p < 0.0001). After stabilized Inverse Exposure Probability Weighting (sIEPW) adjustment, the early mortality of the patients was similar in both groups: 45-day mortality: 10% vs. 9%, p = 0.45, Harrell's c-index 40%. However, the rGS remained associated with worse prognosis thereafter: 1 year mortality: 11% versuss 21%, Harrell's c-index: 61%, p < 0.0001. CONCLUSION: In a real-world cohort of patients with STEMI, rGS is associated with a worse long-term prognosis as from 1 year follow-up, but without significantly stratifying early follow-up. These findings provide important insight with regard to the optimal use of angiography scoring system as prognostic factor. (ClinicalTrials.gov Identifier: NCT05679843).
Association of Proximal Neck Angulation and Diameter With Endoleak After Endovascular Aneurysm Repair of Abdominal Aortic Aneurysms.
Tan L, Hu X, Hu Z … +2 more , He Y, Miao J
Catheter Cardiovasc Interv · 2026 Jul · PMID 42013212 · Publisher ↗
BACKGROUND: Abdominal aortic aneurysm (AAA) is a life-threatening aortic dilation with high rupture mortality. Endovascular aneurysm repair (EVAR) is the preferred minimally invasive treatment, but post-EVAR endoleaks re...
BACKGROUND: Abdominal aortic aneurysm (AAA) is a life-threatening aortic dilation with high rupture mortality. Endovascular aneurysm repair (EVAR) is the preferred minimally invasive treatment, but post-EVAR endoleaks remain a major challenge. AIMS: To investigate the predictive value of suprarenal angle, infrarenal angle, and proximal neck diameter for endoleak following EVAR in AAA patients and their relationships. METHODS: In this retrospective study, 643 consecutive patients undergoing elective EVAR for non-ruptured AAA were grouped into endoleak (n = 179) and non-endoleak (n = 464) groups. For endoleak distribution, type Ia accounted for 10.06% (n = 18), type Ib 4.47% (n = 8), type II 64.25% (n = 115), type III 14.53% (n = 26), type IV 2.79% (n = 5), and type V 3.91% (n = 7). The association between potential predictors and endoleak of any type and the predictive value of suprarenal/infrarenal angle and proximal neck diameter were assessed using logistic analyses and ROC curves. RESULTS: Maximum aneurysm diameter, suprarenal angle, infrarenal angle, and proximal neck diameter were independent predictors for post-EVAR endoleak of any type. The AUCs of suprarenal angle, infrarenal angle, and proximal neck diameter were 0.647, 0.691, and 0.801, respectively. The optimal clinically rounded cut-off values were > 36° (sensitivity: 0.726, specificity: 0.500), > 58° (sensitivity: 0.514, specificity: 0.788), and > 22 mm (sensitivity: 0.704, specificity: 0.761). Combined prediction yielded a superior AUC of 0.851 (sensitivity: 0.816; specificity: 0.746). Greater proximal neck angulation and larger proximal neck diameter increased endoleak risk. CONCLUSION: Suprarenal angle, infrarenal angle, and proximal neck diameter are independent predictors of post-EVAR endoleak. Their combination demonstrates high predictive performance, suggesting that an integrated anatomical assessment can improve preoperative risk stratification.
Comparative Outcomes of Transcatheter Edge-to-Edge Repair and Surgical Mitral Valve Repair or Replacement for Degenerative Mitral Regurgitation: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis.
Kurmasha YH, Hamzah KA, Aljubori E … +9 more , Mohammed G, Khan M, Shweliya MA, Eladl HH, Al-Dhayani KM, Al-Waeli ARA, Zainy HJ, Al-Shammari AS, Sattar Y
Catheter Cardiovasc Interv · 2026 Jul · PMID 42008639 · Publisher ↗
Traditionally, surgical mitral valve repair or replacement (SMVR) has been the mainstay of treatment for mitral regurgitation (MR), providing a long-lasting way to restore valve competence. On the other hand, transcathet...
Traditionally, surgical mitral valve repair or replacement (SMVR) has been the mainstay of treatment for mitral regurgitation (MR), providing a long-lasting way to restore valve competence. On the other hand, transcatheter edge-to-edge repair (TEER) has emerged as an option, especially for high surgical risk patients, demonstrating favorable results from short-term to intermediate-term follow-up. This study aims to evaluate and compare the clinical outcomes of TEER versus SMVR in patients with degenerative mitral regurgitation (DMR). This systematic review was conducted in accordance with the PRISMA guidelines. A comprehensive literature search was conducted until February 2, 2025. Relevant randomized controlled trials (RCTs) and cohort studies were included in the analysis. The data were extracted, and analysis was conducted using Review Manager (RevMan) version 5.3. Eight studies involving a total of 13,308 patients were included in the analysis. TEER showed a statistically significantly higher risk of 1-year mortality (RR 1.82, 95% CI: 1.04-3.19) and mitral reintervention at ≥ 1-year follow-up (RR 4.52, 95% CI: 3.46-5.91). However showing lower risk of new-onset AF (0.21, 95% CI: 0.07-0.67), blood transfusion (RR 0.21, 95% CI, 0.13-0.34), septicemia (RR 0.13, 95% CI: 0.02-0.70), AKI (RR 0.45, 95% CI: 0.24-0.86), shorter hospital stay (MD -4.44 days, 95% CI: -6.60 to -2.27), and ICU stay (MD -1.00 days, 95% CI: -1.13 to -0.88), when compared to the SMVR group. Survival at ≥ 2-year follow-up was significantly favored in the surgery group (RR 0.72, 95% CI: 0.56-0.93). No significant differences were observed regarding 30-day mortality (RR 0.99, 95% CI: 0.77-1.27), MR grade 1 (RR 1.16, 95% CI: 0.60-2.21), stroke (RR 1.06, 95% CI: 0.37-3.03), HF rehospitalization (RR 2.36, 95% CI: 0.82-6.81), and wound infection (RR, 0.45, 95% CI: 0.05-4.27). TEER was associated with a significantly lower rate of postoperative MR grade 0 (RR 0.20, 95% CI: 0.08-0.49), and significantly higher rates of MR grades 2 (RR 4.82, 95% CI: 1.87-12.40), 3 (RR 8.39, 95% CI: 3.69-19.09), and 4 (RR 4.20, 95% CI: 1.45-12.18), indicating inferior MR resolution. Although TEER is associated with a lower risk of septicemia and may reduce the risk of new-onset AF, hospital stay, and ICU stay, current evidence doesn't support the use of TEER as a substitute for surgery in patients with SMVR, as TEER may be associated with higher 1-year mortality and reduced long-term survival. Further controlled trials are needed to validate these findings and identify patient subgroups that may derive the greatest benefit from TEER.
First Validation of the "Bite-In" Technique for Retrograde Chronic Total Occlusion Revascularization.
Tan Y, Zhang W, Cheng J … +3 more , Yang Y, Zhang T, Zhao L
Catheter Cardiovasc Interv · 2026 Jul · PMID 41987589 · Publisher ↗
BACKGROUND: Failure in manipulating the retrograde guidewire (RGW) or advancing the retrograde microcatheter (MC) is a common challenge in the retrograde approach to chronic total occlusion (CTO). Effective strategies to...
BACKGROUND: Failure in manipulating the retrograde guidewire (RGW) or advancing the retrograde microcatheter (MC) is a common challenge in the retrograde approach to chronic total occlusion (CTO). Effective strategies to overcome the limited control of the RGW deformation have not yet been developed. AIMS: This study aimed to evaluate the predictive performance of five CTO scoring systems for time-efficient guidewire (GW) crossing. METHODS: From May 2024 to June 2025, the "bite-in" technique was employed in 40 out of 60 consecutive patients due to failure of the "tip-in." In this approach, the RGW is first advanced into the Guidezilla catheter, followed by controlled antegrade rotation of the MC to facilitate spontaneous capture of the RGW at the coaxial interface. This technique eliminates the need for active RGW manipulation during this critical step. RESULTS: The right coronary artery was the most common CTO site (24/40, 60%). The mean J-CTO, PROGRESS, and JR-CTO scores were 2.5 ± 1.0, 0.7 ± 0.7, and 1.5 ± 0.9, respectively. A primary retrograde strategy was employed in 30% of all procedures. The mean duration of the retrograde approach was 111.1 ± 45.6 min. Limited RGW control and failed retrograde MC advancement occurred in 88% and 75% of cases, respectively. Bite-in technical success was achieved in all patients. No procedural complications were adjudicated to bite-in. CONCLUSIONS: The bite-in technique is a feasible and safe method in the retrograde approach to CTO by facilitating connection between the retrograde and antegrade lumens. Larger multicenter studies are warranted to validate its long-term efficacy compared with the tip-in approach, despite its acceptable short-term performance.
Percutaneous Stenting of LVAD Outflow Graft Obstruction: A Multimodality Imaging Case Series.
Ahmed A, Eid F, Eid M … +6 more , Joshi A, Abtahian F, Bitar A, Lydonz R, Feitell S, Khodjaev S
Catheter Cardiovasc Interv · 2026 Jul · PMID 41979066 · Publisher ↗
BACKGROUND: Outflow graft obstruction (OGO) is an increasingly recognized complication of continuous-flow left ventricular assist devices (CF-LVADs), particularly the HeartMate 3. Surgical revision is often high risk, an...
BACKGROUND: Outflow graft obstruction (OGO) is an increasingly recognized complication of continuous-flow left ventricular assist devices (CF-LVADs), particularly the HeartMate 3. Surgical revision is often high risk, and percutaneous alternatives are emerging. AIMS: To evaluate the feasibility, safety, and outcomes of endovascular stenting for the treatment of LVAD OGO using a multimodality imaging approach. METHODS: We retrospectively reviewed all HeartMate 3 patients undergoing percutaneous treatment of OGO at our institution between September 2023 and April 2025. Clinical presentation, multimodality imaging findings, procedural characteristics, and outcomes were analyzed. RESULTS: Eight patients underwent endovascular intervention. All presented with persistent low-flow alarms and variable syncope or neurologic symptoms. Technical success was achieved in all cases. Median LVAD flow improved from 2.8 L/min pre-intervention to 4.4 L/min post-intervention. Two access-related bleeding complications and one hemothorax occurred, all managed successfully. At a median follow-up of 7 months, no recurrent OGO was observed. CONCLUSIONS: Endovascular stenting guided by multimodality imaging is a feasible and effective alternative to surgical revision for LVAD OGO in selected patients.
Malposition of a Port Catheter in the Azygos Vein: Endovascular Repositioning Using a Long Loop Snare Technique.
Rentzsch A, Wagner A, Pfeifer J … +1 more , Abdul-Khaliq H
Catheter Cardiovasc Interv · 2026 Jul · PMID 41978514 · Full text
Port catheters provide a reliable, long-term venous access option in children for repeated administration of medications or parenteral nutrition. A cardiac catheterization procedure was performed in a 7-year-old girl in...
Port catheters provide a reliable, long-term venous access option in children for repeated administration of medications or parenteral nutrition. A cardiac catheterization procedure was performed in a 7-year-old girl in whom lateral chest radiography revealed posterior deviation suggestive of azygos vein malposition. To avoid surgical replacement, a long loop snare technique was employed to safely withdraw the catheter into the superior vena cava with restoration of catheter function. This case highlights that endovascular long loop snare repositioning offers a feasible, minimally invasive alternative to surgical intervention for rare port catheter malpositions in pediatric patients.
A Case of Venous Tissue Dissection During Transcatheter MitraClip Surgery.
Ouyang S, Zhou Y, Yao Y … +3 more , Liang G, Liao M, Guo S
Catheter Cardiovasc Interv · 2026 Jul · PMID 41975242 · Full text
The MitraClip system has been widely used to treat mitral regurgitation. The complications associated with MitraClip surgery typically include clip detachment and mitral valve injury. However, cases of venous tissue diss...
The MitraClip system has been widely used to treat mitral regurgitation. The complications associated with MitraClip surgery typically include clip detachment and mitral valve injury. However, cases of venous tissue dissection during surgery are relatively rare. This article reports a case of venous tissue dissection during transcatheter MitraClip surgery, aiming to provide a new direction for diagnosing newly formed abnormal structures in the central atrium during MitraClip surgery.
Left Main Stem Perforation: Management Strategies in a Potentially Catastrophic Event.
Khan H, Farag M, Wilkes S … +1 more , Egred M
Catheter Cardiovasc Interv · 2026 Jul · PMID 41975238 · Full text
Left main stem coronary perforation is a potentially fatal complication of percutaneous coronary intervention if not recognized early and treated emergently. Treating left main stem perforation can be challenging due to...
Left main stem coronary perforation is a potentially fatal complication of percutaneous coronary intervention if not recognized early and treated emergently. Treating left main stem perforation can be challenging due to the significant hemodynamic effect of one of the important steps, namely balloon tamponade. Managing such perforation requires speed, precision, and a clear systematic approach to help save lives. We present a case of left main stem perforation that occurred during chronic total occlusion percutaneous coronary intervention which was treated with a covered stent across the left main stem into the left anterior descending artery. Restoration of flow into the circumflex was achieved by using a penetrating wire to cross into the circumflex, achieving hemostasis and preserving coronary flow into both epicardial coronary arteries. We describe further bailout strategies for dealing with left main stem perforations, including left main covered stenting with jailed side branch balloon and the simultaneous kissing stent technique.
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