Catheterization And Cardiovascular Interventions[JOURNAL]
Sun
200 papers
Angioscopy Visualized a Residual Free-Floating Thrombus in Mild Carotid Artery Stenosis Following Acute MCA Occlusion: A Case Report.
Matsubara H, Egashira Y, Enomoto Y … +1 more , Izumo T
Catheter Cardiovasc Interv · 2026 Jul · PMID 41969276 · Full text
Carotid free-floating thrombus (CFFT) is a rare yet severe cause of the ischemic stroke. Early identification and appropriate management are crucial to prevent recurrent embolic events. A 76-year-old man experienced sudd...
Carotid free-floating thrombus (CFFT) is a rare yet severe cause of the ischemic stroke. Early identification and appropriate management are crucial to prevent recurrent embolic events. A 76-year-old man experienced sudden left-sided hemiparesis and dysarthria. Magnetic resonance imaging revealed a high-intensity diffusion area in the right frontal and temporal cortices and occlusion of the right middle cerebral artery (MCA). Digital subtraction angiography (DSA) confirmed the right MCA occlusion with suspected CFFT at the internal carotid artery bifurcation. Mechanical thrombectomy with an aspiration catheter achieved successfully recanalized the right MCA. Following conservative antithrombotic therapy, the CFFT had gradually decreased over 3 weeks. Carotid artery stenting was performed to prevent recurrent stroke. The CFFT disappeared on pre-stenting DSA, although angioscopy identified residual mild stenosis with vulnerable plaque that was not initially detected by DSA. This case highlights the importance of multimodal imaging in diagnosing and managing carotid thrombi associated with mild stenosis. Meticulous examination using several different imaging modalities enables identification of the pathology.
Conservative Management of Iatrogenic Type a Aortic Dissection Occurring During Percutaneous Coronary Intervention.
El Mallouli M, Liu C, Van Der Linden R … +2 more , Berdaoui B, Pintea Bentea G
Catheter Cardiovasc Interv · 2026 Jul · PMID 41968895 · Publisher ↗
BACKGROUND: Iatrogenic type A aortic dissection (TAAD) during percutaneous coronary intervention (PCI) is a rare but life-threatening complication, usually managed surgically. CASE PRESENTATION: We report the case of a 5...
BACKGROUND: Iatrogenic type A aortic dissection (TAAD) during percutaneous coronary intervention (PCI) is a rare but life-threatening complication, usually managed surgically. CASE PRESENTATION: We report the case of a 59-year-old patient who developed an ascending aortic dissection extending to the proximal arch during left circumflex (LCX) chronic total occlusion (CTO) recanalization. Stenting of the LCX and left main coronary artery successfully sealed the entry site and stabilized the patient. Computed tomography revealed a false lumen occupying 51% of the aortic diameter, without involvement of supra-aortic branches. Conservative management was initiated with strict anti-impulse therapy and staged dual antiplatelet therapy. At 24 h, the false lumen regressed to 37%, with complete resolution by Day 7. CONCLUSION: In selected cases of iatrogenic TAAD during PCI, conservative management following successful sealing of the entry tear may represent a safe alternative to sugery.
Clinical and Physiological Predictors of Acetylcholine-Induced Coronary Spasm in ANOCA/INOCA Patients: A Retrospective Cohort Study.
Buri J, Zimmerli A, Mahendiran T … +5 more , Salihu A, Weerts V, Muller O, Meier D, Fournier S
Catheter Cardiovasc Interv · 2026 Jul · PMID 41968532 · Full text
BACKGROUND: A substantial proportion of patients with angina and/or ischemia are found to have non-obstructive coronary arteries (ANOCA/INOCA). Their symptoms can sometimes be explained by coronary microvascular dysfunct...
BACKGROUND: A substantial proportion of patients with angina and/or ischemia are found to have non-obstructive coronary arteries (ANOCA/INOCA). Their symptoms can sometimes be explained by coronary microvascular dysfunction and/or vasospasm. Selecting patients for acetylcholine testing remains challenging, and the procedure is not trivial in terms of logistics, cost, and risk. AIMS: The aim of this single-center retrospective study was to identify predictors of coronary spasm and define features that may help avoid unnecessary testing. METHODS: All consecutive ANOCA/INOCA patients who underwent intracoronary acetylcholine testing between February 2022 and June 2025 at a tertiary university hospital were included. Baseline clinical variables were analyzed using multivariable logistic regression. A 3-variable exploratory model was then constructed to identify independent predictors of unnecessary acetylcholine testing. RESULTS: Among the study population (n = 47), 46.8% demonstrated a positive spasm response. In the multivariable model, age ≥ 60 years (OR = 0.11, 95% CI [0.02-0.80]; p = 0.029) and dyslipidaemia (OR = 0.12, 95% CI [0.01-0.99]; p = 0.049) were independently associated with lower odds of spasm, whereas IMR ≥ 25 showed a non-significant association with lower odds of spasm (OR = 0.10, 95% CI [0.005-1.9]; p = 0.128). The 3-variable exploratory model showed good discrimination (AUC 0.83, 95% CI 0.68-0.97) and was associated with a reduction in overall ACh testing by 45.2% in complete-case analysis, with a sensitivity of 85.7%. CONCLUSIONS: Dyslipidaemia and age ≥ 60 years are independently associated with lower odds of acetylcholine-induced spasm. This model showed good discrimination and may help inform strategies to reduce unnecessary acetylcholine testing, although these findings require external validation.
Successful Percutaneous Revascularization for Acute Myocardial Infarction From Left Main Occlusion and Concomitant Right Coronary Artery Chronic Total Occlusion: A Case Report.
Zhou Z, He Y, Pan Y … +1 more , Duan J
Catheter Cardiovasc Interv · 2026 Jul · PMID 41968504 · Publisher ↗
Despite its rarity, acute occlusion of the left main coronary artery is associated with an exceedingly high mortality rate. This report describes a critical case of acute myocardial infarction (AMI) caused by acute total...
Despite its rarity, acute occlusion of the left main coronary artery is associated with an exceedingly high mortality rate. This report describes a critical case of acute myocardial infarction (AMI) caused by acute total occlusion of the left main (LM) artery, complicated by a chronic total occlusion (CTO) of the proximal right coronary artery (RCA). A 55-year-old Chinese male with hypertension and a heavy smoking history presented with sudden chest pain. The initial electrocardiogram (ECG) showed ST-segment elevation in leads V1-V6 and aVR, indicative of anterior wall AMI, and the patient was in cardiogenic shock. Emergency coronary angiography revealed total occlusion of the LM artery and a CTO of the proximal RCA. Primary percutaneous coronary intervention (PCI) was successfully performed on the LM artery, with three stents implanted to restore TIMI grade 3 flow. An intra-aortic balloon pump (IABP) was inserted for circulatory support. Post-procedurally, the patient experienced ventricular fibrillation but was successfully resuscitated. The hospital course was complicated by acute renal failure, gastrointestinal bleeding, and severe sepsis. After 55 days of intensive care, the patient was discharged with marked clinical improvement, albeit with severely impaired left ventricular function (ejection fraction 25%). The patient survived at the 6-month follow-up.
Artificial Intelligence-Empowered Image Fusion of Coronary Computed Tomography Angiography and Invasive Angiography for Guiding Chronic Total Occlusion Percutaneous Coronary Intervention.
Huang B, He Y
Catheter Cardiovasc Interv · 2026 Jul · PMID 41968491 · Publisher ↗
Coronary computed tomography angiography (CCTA) provides qualitative and quantitative characteristics of atherosclerotic plaques, quantified percentages of myocardial perfusion from target vessels, and functional informa...
Coronary computed tomography angiography (CCTA) provides qualitative and quantitative characteristics of atherosclerotic plaques, quantified percentages of myocardial perfusion from target vessels, and functional information-key insights that lend critical guidance to pre-percutaneous coronary intervention (PCI) planning, particularly for complex coronary interventional procedures. Advances in artificial intelligence-enabled CCTA imaging analysis and CT-angiography image fusion technology have facilitated the translation of CT imaging into clinical practice for PCI operators. This case report describes a PCI procedure for a chronic total occlusion of right coronary artery performed under the guidance of CT-coronary angiography fusion technology, serving as a practical example for the application of CCTA in pre-PCI planning for complex coronary lesions.
The Impact of Vascular Access Complications in Patients Undergoing Transcatheter Aortic Valve Replacement.
Mesar T, Jackson A, Chachati G … +8 more , Jacquemyn X, Ahmad D, Kliner D, Serna-Gallegos D, Toma C, West D, Makani A, Sultan I
Catheter Cardiovasc Interv · 2026 Jun · PMID 41968274 · Publisher ↗
BACKGROUND: Vascular complications remain a significant concern in transfemoral transcatheter aortic valve replacement (TAVR). AIMS: Determine the incidence of vascular complications following TAVR and evaluate their imp...
BACKGROUND: Vascular complications remain a significant concern in transfemoral transcatheter aortic valve replacement (TAVR). AIMS: Determine the incidence of vascular complications following TAVR and evaluate their impact on short- and long-term clinical outcomes. METHODS: We conducted a retrospective observational analysis of patients undergoing transfemoral TAVR at a single institution. Patients were stratified into three groups: Group 0 (no perioperative complications), Group 1 (vascular complications), and Group 2 (non-vascular complications). The primary outcome was early- and late-mortality. Propensity score matching was performed to compare outcomes between Group 0 and Group 1. RESULTS: Among 5230 patients, 4391 (84.0%) were in Group 0, 154 (2.9%) in Group 1, and 685 (13.1%) in Group 2. In Group 1, 36.4% experienced intraoperative bleeding requiring intervention, 27.3% had intraoperative limb ischemia or dissection, and 16.2% required postoperative takeback for limb ischemia. In-hospital mortality was 12/154 (7.8%) in Group 1, compared with 7/4391 (0.2%) in Group 0 and 45/685 (6.6%) in Group 2 (p < 0.001). Thirty-day mortality was 16/154 (10.4%) in Group 1 versus 117/4391 (2.7%) in Group 0 and 70/685 (10.2%) in Group 2 (p < 0.001). Propensity-matched analysis showed Group 1 had fourfold higher 30-day mortality (OR 4.02, 95% CI 1.98-8.18, p < 0.001). One-year mortality was 29/148 (19.6%) for Group 1 compared with 72/592 (12.2%) for Group 0, with 5-year survival similar between groups (Group 1: 51.1%, Group 0: 50.9%, log-rank p = 0.214), while unmatched Group 2 had 43.1% 5-year survival. CONCLUSION: While vascular complications after TAVR are uncommon, they are linked to substantially worse early outcomes, whereas long-term survival among patients who survive the initial postoperative period remains comparable, emphasizing the critical impact during the early phase.
Transcatheter Aortic Valve Replacement in a Perceval Valve: Pitfalls, Tips, and Outcomes.
El-Andari R, Hassanabad AF, Wang S … +3 more , Eckstein J, Mathew A, Nagendran J
Catheter Cardiovasc Interv · 2026 Jun · PMID 41960659 · Publisher ↗
The Perceval valve (Corcym, Milan, Italy) is the only sutureless surgical aortic valve replacement (SAVR) on the market. With widespread use of the Perceval valve, valve-in-valve (ViV) transcatheter aortic valve replacem...
The Perceval valve (Corcym, Milan, Italy) is the only sutureless surgical aortic valve replacement (SAVR) on the market. With widespread use of the Perceval valve, valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) have been increasingly reported. While the Perceval provides a favorable initial valve choice for ViV TAVR, specific challenges exist. The Perceval stent design poses a risk of the guidewire and catheter becoming misplaced between the valve stent and the aortic wall which can be mitigated by confirming wire location on multiple imaging views, using a stiff pigtail catheter, and advancing a wire through a septal puncture and antegrade through the valve and snare the wire to guide it into the ventricle. TAVR valve positioning should aim to align the inflow of the TAVR valve with the inflow of the Perceval valve for self-expanding valves. For balloon expandable valves, the outflow of the TAVR should be aligned proximally to the distal stent taper of the Perceval. Finally, coronary obstruction risk should be considered on preoperative imaging with intraoperative wire access, prophylactic snorkel stent placement, or leaflet modification techniques to mitigate the risk of coronary obstruction in high-risk patients. Previously published literature has demonstrated high rates of successful ViV TAVR in Perceval. The outcomes have also been favorable with low rates of major bleeding, coronary obstruction, annular rupture, and mortality. Future studies should aim to better characterize aortic root anatomy following SAVR to determine the suitability of specific surgical valves for future ViV TAVR.
Anatomy of the Pulmonary Circulation and Outcomes in Tetralogy of Fallot With Major Systemic-to-Pulmonary Collaterals and Unilateral Pulmonary Artery of Ductal Origin.
Ortega J, Adamson GT, Jaggi A … +4 more , Gifford CA, Asija R, Hanley FL, McElhinney DB
Catheter Cardiovasc Interv · 2026 Jun · PMID 41957907 · Publisher ↗
BACKGROUND: In patients with tetralogy of Fallot (TOF) and multiple aortopulmonary collaterals (MAPCAs), the presence of a ductus arteriosus (DA) supplying all flow to 1 lung and MAPCAs providing all flow to the other lu...
BACKGROUND: In patients with tetralogy of Fallot (TOF) and multiple aortopulmonary collaterals (MAPCAs), the presence of a ductus arteriosus (DA) supplying all flow to 1 lung and MAPCAs providing all flow to the other lung is a distinct phenotype that has not been well characterized. AIMS: To characterize the anatomy of the pulmonary circulation and report long-term surgical outcomes in patients with this subtype of TOF/MAPCAs. METHODS: From our institutional experience with TOF/MAPCAs, we ascertained patients with unilateral ductal origin of a PA who underwent surgery from 11/01 through 4/25. The study was limited to patients who (1) had no prior surgery or a shunt only without modification of MAPCAs or PAs, and (2) had adequate preoperative angiography. The anatomy of the PAs and MAPCAs was characterized in detail from preoperative angiography, and outcomes were assessed. RESULTS: During the study period, 880 patients with TOF and MAPCAs underwent surgery, 61 (6.9%) in whom the native anatomy comprised a DA to 1 lung and MAPCAs to the contralateral lung. The study cohort consisted of 42 eligible patients. The DA supplied the left PA in 39 patients (91%), but there was no association with aortic arch laterality. MAPCAs to the contralateral lung connected to a fully (n = 12) or partially (n = 9) arborizing central PA in 21 patients. MAPCA origins were similar to the broader TOF/MAPCAs population, except that MAPCAs arising from a coronary artery were more common (14% vs. 5%, p = 0.019). The DA had been stented prior to surgery in 18 patients. At the first surgery (median age 5.1 months), 74% of patients underwent complete repair, and all but 1 ultimately achieved complete repair. During a median follow-up of 6.2 years (2.6, 13.0), 6 patients died. Ten-year transplant-free survival was 86% ± 6%. Freedom from any PA reintervention was 63% ± 9% at 5 years and 59% ± 9% at 10 years. CONCLUSIONS: The presence of with a DA supplying all flow to 1 normally arborizing PA, almost always the left PA, and MAPCAs providing all flow to the other lung, is a distinct anatomic subset of TOF/MAPCAs. In our practice, stenting of the DA in the neonatal period is the most appropriate therapy, typically followed by PA reconstruction and repair in early infancy, depending on the anatomy of the MAPCAs to the contralateral lung. Outcomes in these patients are generally excellent.
Outcomes of Left Atrial Appendage Occlusion in Heart Failure With Reduced Ejection Fraction.
Ubaid A, Bagga A, Kennedy K … +2 more , Saxon JT, Huded CP
Catheter Cardiovasc Interv · 2026 Jun · PMID 41947349 · Publisher ↗
BACKGROUND: Patients with heart failure with reduced ejection fraction (HFrEF) were excluded from major trials of left atrial appendage occlusion (LAAO). AIM: The objective of this study was to describe this population a...
BACKGROUND: Patients with heart failure with reduced ejection fraction (HFrEF) were excluded from major trials of left atrial appendage occlusion (LAAO). AIM: The objective of this study was to describe this population and evaluate outcomes after LAAO in patients with and without HFrEF. METHODS: Patients with and without HFrEF undergoing LAAO were identified in the Nationwide Readmissions Database from 2016 to 2020. Outcomes of interest were major in-hospital adverse events (death, stroke, pericardial effusion, tamponade, pericardial window, transfusion) and 6-month readmissions (any readmission, heart failure readmission, death/stroke readmission). To account for differences between patients with and without HFrEF, outcomes were evaluated using risk-adjusted logistic regression models and risk-adjusted Cox proportional hazards models. RESULTS: Of 50,526 encounters for LAAO, 5895 (11.7%) patients had HFrEF. The HFrEF group had a lower proportion of women and a higher proportion of major cardiovascular comorbidities. CHADS-VASC score was 3.8 ± 1.3 in the HFrEF group and 3.7 ± 1.4 in those without HFrEF. HFrEF was associated with a higher risk of composite in-hospital major adverse events (6.0% vs. 5.0%, adjusted OR 1.23 [95% CI 1.09-1.40], p = 0.001) and a higher risk of 6-month all-cause readmission (adjusted HR 1.18 [95% CI 1.08-1.28], p < 0.001), heart failure readmission (adjusted HR 1.59 [95% CI 1.46-1.72], p < 0.001), and readmission with death or stroke (adjusted HR 1.27 [95% CI 1.03-1.57], p = 0.001). CONCLUSION: One out of nine patients treated with LAAO in the United States has HFrEF, which is associated with a higher risk of major in-hospital complications and hospital readmission.
Index of Device Efficiency: IVUS-Based Metric to Quantify Cutting Balloon Performance in Calcified Coronary Lesions.
Ungureanu C, Leibundgut G, Colletti G … +15 more , Dumitrascu S, Spano A, Cocoi M, Avran A, Gasparini G, Agostoni P, Spratt J, Achim A, Arain S, Jossart A, Boutaleb AM, Poletti E, Mangieri A, Brilakis ES, Boukhris M
Catheter Cardiovasc Interv · 2026 Jun · PMID 41947029 · Publisher ↗
BACKGROUND: Calcified coronary artery disease complicates percutaneous coronary intervention (PCI), yet no standardized parameter quantifies the efficiency of plaque-modifying devices. AIMS: To introduce and evaluate the...
BACKGROUND: Calcified coronary artery disease complicates percutaneous coronary intervention (PCI), yet no standardized parameter quantifies the efficiency of plaque-modifying devices. AIMS: To introduce and evaluate the Index of Device Efficiency (IDE), a novel intravascular ultrasound (IVUS)-derived metric quantifying the mechanical efficiency of cutting balloon (CB) angioplasty during the RODIN-CUT technique. METHODS: In this multicenter retrospective study, 50 heavily calcified lesions (47 patients) underwent 270 IVUS pullbacks. The IDE was defined as the ratio of maximal luminal diameter achieved to the nominal CB diameter ×100. Stepwise IDE dynamics were assessed after sequential high-pressure CB inflations. A plateau phase was defined as ≤ 0.3 mm further luminal diameter gain or ≤ 0.5 mm² area gain between inflations. The relationship between IDE ≥ 100% and post-stent expansion was evaluated. Safety outcomes were systematically recorded. RESULTS: Mean age was 75 ± 8 years; 46% of lesions were in the left anterior descending artery and 30% in the left main bifurcation. Minimal lumen area increased from 4.0 ± 1.5 mm² at baseline to 5.8 ± 2.1 mm² after one inflation and to 8.8 ± 2.6 mm² after four inflations (p < 0.001). IDE ≥ 100% was reached in 40% of lesions after one inflation versus 92% after four, with no further gain thereafter (plateau). Lesions with IDE ≥ 100% more frequently achieved optimal stent expansion (82% vs. 10%, p = 0.007). No major procedural complications occurred. CONCLUSIONS: IDE is a simple, reproducible IVUS-derived metric that quantifies CB efficiency, identifies a reproducible plateau after four inflations, and predicts optimal stent expansion.
Elevated Maresin-1 Levels in Pericardial Fluid of Patients Undergoing Coronary Artery Bypass Grafting.
Dikme R, Padak M
Catheter Cardiovasc Interv · 2026 Jun · PMID 41940573 · Publisher ↗
BACKGROUND: Chronic inflammation plays a critical role in the pathophysiology of cardiovascular diseases. Specialized pro-resolving mediators derived from omega-3 fatty acids, such as Maresin-1 (MaR1), have been shown to...
BACKGROUND: Chronic inflammation plays a critical role in the pathophysiology of cardiovascular diseases. Specialized pro-resolving mediators derived from omega-3 fatty acids, such as Maresin-1 (MaR1), have been shown to promote inflammation resolution and exert cardioprotective effects. However, the clinical significance of MaR1 in coronary artery bypass grafting (CABG) patients remains unclear. AIMS: This study aimed to investigate MaR1 levels in plasma and pericardial fluid of patients undergoing elective coronary artery bypass grafting and to evaluate its potential as a biomarker of localized cardiac inflammatory resolution. METHODS: This cross-sectional analytic study included 50 patients undergoing elective CABG and 50 age- and sex-matched healthy controls. Plasma and pericardial fluid were collected from patients,and plasma from controls. MaR1 levels were quantified by ELISA. Group comparisons were performed using Kruskal-Wallis and Mann-Whitney U tests. Diagnostic performance was evaluated by receiver operating characteristic (ROC) analysis, and independent predictive value was assessed using multivariablelogistic regression. RESULTS: MaR1 levels were significantly higher in pericardial fluid (97.03 pg/mL) compared with patient plasma (61.02 pg/mL) and controls (42.45 pg/mL) (p < 0.001). ROC analysis demonstrated high discriminative performance (AUC = 0.975; sensitivity 93%, specificity 100%). Logistic regression confirmed MaR1 as an independent predictor of patient status after adjustment for age and sex (OR = 1.88, p < 0.001). CONCLUSION: The marked elevation of MaR1 in pericardial fluid reflects a localized resolution response in the cardiac microenvironment, underscoring its potential as a distinctive biomarker in cardiovascular disease. These findings suggest that MaR1 may serve as a novel biomarker reflecting localized cardiac inflammatory resolution in patients with coronary artery disease.
Acute Stent Thrombosis During Glycoprotein IIb/IIIa Inhibitor Infusion.
Zdzierak B, Dziewierz A, Gruszka K … +1 more , Rakowski T
Catheter Cardiovasc Interv · 2026 Jun · PMID 41940503 · Publisher ↗
Acute stent thrombosis (ST) represents an infrequent but critical complication occurring within 24 h post-percutaneous coronary intervention (PCI). It is most associated with inadequate antiplatelet therapy, stent undere...
Acute stent thrombosis (ST) represents an infrequent but critical complication occurring within 24 h post-percutaneous coronary intervention (PCI). It is most associated with inadequate antiplatelet therapy, stent underexpansion, or malapposition. We report the case of a patient with acute coronary syndrome treated with PCI under optical coherence tomography guidance, who developed recurrent chest pain and ST-segment elevation 7 h after the initial procedure. Urgent coronary angiography revealed acute ST within the newly implanted stent, despite intravascular imaging-guided PCI and optimal antiplatelet therapy. The most probable cause was an untreated, hemodynamically significant stenosis at the crux of the right coronary artery, distal to the implanted stent. This critical downstream lesion impaired coronary flow, leading to stasis within the long proximal stent and creating a highly prothrombotic environment, ultimately overwhelming even potent glycoprotein IIb/IIIa inhibition. Post-dilatation of the distal coronary stenosis resulted in improved coronary flow and complete resolution of symptoms, with no recurrence observed during the remainder of the hospitalization. Optimization of PCI using intracoronary imaging and adequate antiplatelet therapy is essential for reducing the incidence of acute ST. However, untreated residual stenoses that significantly impair distal flow may also play a pivotal role in ST formation and should be addressed during the primary procedure.
Can the T and Minimal Protrusion (TAP) Technique be Considered as an Up-Front 2-Stent Strategy for True Distal Left Main Stem Bifurcation?
Athukorala S, Mitomo S, Cortese B … +11 more , Sharma V, Choudhry A, Nakamura S, Bhatia G, Freestone B, Lee K, Pulikal G, Kumar N, Ment J, Pitt M, Basavarajaiah S
Catheter Cardiovasc Interv · 2026 Jun · PMID 41940470 · Publisher ↗
BACKGROUND: The commonly used upfront 2-stent strategies for distal LMS bifurcation are culotte and DK-crush, whereas TAP was designed to convert a provisional to a 2-stent strategy if there was any issue with the side-b...
BACKGROUND: The commonly used upfront 2-stent strategies for distal LMS bifurcation are culotte and DK-crush, whereas TAP was designed to convert a provisional to a 2-stent strategy if there was any issue with the side-branch following main-branch stenting. Technically, TAP is much simpler, and the angle in distal-LMS favors the technique. AIM: The aim of this study was to compare the long-term clinical outcomes between TAP versus non-TAP techniques in distal LMS bifurcation. METHODS AND RESULTS: All patients treated with 2-stent techniques for distal LMS between 2014 and 2020 at highly experienced centers were included, the patients were divided into two groups: TAP versus non-TAP. The clinical outcomes measured were cardiac death, TVMI, TLR, TVR, and MACE (composite of cardiac death, TVMI, and TLR). During the study period, 541 patients with a mean age of 70.5 ± 10.5 years had PCI to distal-LMS with two stents. Two hundred and eighteen were treated with TAP technique, and 323 patients with non-TAP techniques. Demographic, clinical, and procedural characteristics were well matched except for a higher number of ACS in the TAP group (36% vs. 25%; p = 0.006). In regard to procedural characteristics, use of intravascular imaging was higher in the non-TAP group (64% vs. 51%; p = 0.003). During a median follow-up of almost 5 years, there were no significant differences between the two groups in regards to hard endpoints (death, cardiac death, and TVMI), TLR, and MACE. However, TVR was significantly higher in the non-TAP group. However, in the propensity-matched group, even the TVR did not appear to be significant. CONCLUSIONS: This multicenter registry shows that there were no differences in the long-term clinical outcomes between TAP and non-TAP bifurcation techniques, with an advantage of the former in terms of need for TVR.
Successful Revascularization of Chronic Total Occlusions in Patients With Chronic Thromboembolic Pulmonary Disease.
Stein EJ, Leary PJ, Carlozzi LN … +2 more , Rayner SG, Steinberg ZL
Catheter Cardiovasc Interv · 2026 Jun · PMID 41940463 · Publisher ↗
BACKGROUND: Chronic thromboembolic pulmonary disease (CTEPD) leads to chronic total occlusions (CTOs) of the pulmonary arteries in a minority of patients. Treatment of CTOs with balloon pulmonary angioplasty (BPA) may su...
BACKGROUND: Chronic thromboembolic pulmonary disease (CTEPD) leads to chronic total occlusions (CTOs) of the pulmonary arteries in a minority of patients. Treatment of CTOs with balloon pulmonary angioplasty (BPA) may substantially improve patient hemodynamics but presents unique technical challenges and has previously been associated with a low success rate. METHODS: A prospective registry of CTEPD patients who underwent CTO BPA at the University of Washington from August 2019 to July 2024 was included. Rates of technical success, methods of successful revascularization, and hemodynamic outcomes are reported. Outcomes were compared to a cohort of non-CTO BPA interventions, evaluating differences in hemodynamic outcomes and overall complications. RESULTS: Eighty-four CTO lesions were intervened upon in 37 patients. On a per-lesion basis, 94% of CTOs were revascularized, with an 80% success rate on the first attempt. Most cases of subintimal and/or extravascular entry were treated with the novel Microcatheter Injection, Retraction, and Reentry (MIRaR) technique. Follow-up patency rate was 96%, and the total per-procedure complication rate was 10%, the majority of which were clinically insignificant. Although mean pulmonary artery pressure, cardiac index, pulmonary vascular resistance, and pulmonary vascular compliance were significantly worse in the CTO group at baseline, no significant differences persisted after intervention. Both total and clinically meaningful complication rates were similar between cohorts. CONCLUSIONS: We report the highest rate of successful CTO revascularization to date with a low overall intra-procedural complication rate. Novel technical approaches to managing subintimal wire entry may be responsible for our observed success.
Percutaneous Mechanical Mobilization of a Thrombosed Mechanical Tricuspid Valve After Failed Thrombolysis.
Yavuz ST, İnan D, Aggül B … +2 more , Şahin KK, Kılıçgedik A
Catheter Cardiovasc Interv · 2026 Jun · PMID 41937278 · Publisher ↗
Mechanical prosthetic tricuspid valve thrombosis is a rare but potentially life-threatening condition. Evidence guiding management is limited, particularly in patients who are poor surgical candidates or who fail thrombo...
Mechanical prosthetic tricuspid valve thrombosis is a rare but potentially life-threatening condition. Evidence guiding management is limited, particularly in patients who are poor surgical candidates or who fail thrombolytic therapy. We report an 83-year-old woman with a mechanical tricuspid valve who presented with progressive right-sided heart failure due to obstructive valve thrombosis. After failure of anticoagulation and low-dose thrombolytic therapy, a percutaneous catheter-based approach was performed. Using a steerable sheath and electrophysiology catheter, mechanical mobilization of the stuck leaflet was achieved, followed by thrombus aspiration. Leaflet mobility was restored, and transvalvular gradients significantly improved without complications. In carefully selected patients with mechanical tricuspid valve thrombosis who are not candidates for surgery and fail thrombolytic therapy, percutaneous mechanical mobilization may represent a feasible and effective bailout strategy.
Challenges of Managing Acute Coronary Syndromes in Patients With Congenital Single Coronary Artery.
Elghrabawy M, Helal A, Alama M … +2 more , Wassef N, Farooq M
Catheter Cardiovasc Interv · 2026 Jun · PMID 41937277 · Publisher ↗
Single coronary artery (SCA) is a rare congenital disorder representing 0.024%-0.066% of the population. Patients with SCA presenting with acute coronary syndromes (ACS) pose diagnostic and treatment challenges. This cas...
Single coronary artery (SCA) is a rare congenital disorder representing 0.024%-0.066% of the population. Patients with SCA presenting with acute coronary syndromes (ACS) pose diagnostic and treatment challenges. This case series demonstrates the clinical diversity and management challenges of three patients with SCA. The first patient is a 58-year-old gentleman who presented with non-ST-elevation myocardial infarction (NSTEMI) and was found to have an anomalous right coronary artery (RCA) originating from the left coronary artery, he had percutaneous coronary intervention (PCI) to a severe lesion in the left circumflex artery (LCX). The second patient is a 77-year-old male admitted with type 2 NSTEMI. His CT coronary angiogram (CTCA) demonstrated a Lipton Group II SCA with an inter-arterial course; this patient was treated medically. The third patient is a 55-year-old man who was admitted with inferior ST-elevation myocardial infarction (STEMI). The RCA as a possible culprit artery could not be visualized. He had primary PCI to an occluded LCX which continue to supply the RCA (Lipton Group I SCA, congenitally absent RCA). SCA can manifest with a wide range of clinical presentations. And can be very challenging; particularly in STEMI. CTCA has an essential role in providing a definitive diagnosis and anatomical classification in non-urgent presentations. Treatment should be individualized according to presentation and anatomical variation.
Cardiovascular Outcomes of Drug-Coated Balloon Versus Drug-Eluting Stents for Femoropopliteal Peripheral Arterial Disease Interventions: A Meta-Regression Analysis.
Sattar Y, Hamza M, Oberoi M … +14 more , Patel N, Manasrah N, Bahar Y, Anwar RU, Fakhra S, Aziz S, Syed M, Daggubati R, Jagadeesan V, Paul TK, Mamas MA, Elgendy IY, Banerjee S, Chadi Alraies M
Catheter Cardiovasc Interv · 2026 Jun · PMID 41937275 · Publisher ↗
BACKGROUND: Outcomes comparing drug-coated balloons (DCB) versus drug-eluting stents (DES) have not been sufficiently studied in femoropopliteal peripheral arterial disease (PAD). AIMS: This meta-analysis aims to compare...
BACKGROUND: Outcomes comparing drug-coated balloons (DCB) versus drug-eluting stents (DES) have not been sufficiently studied in femoropopliteal peripheral arterial disease (PAD). AIMS: This meta-analysis aims to compare outcomes of DES versus DCBs in femoropopliteal PAD and uses regression to rule out effect modifiers. METHODS: An online literature search was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis search strategy from inception till November 2022. STATA v.17 was used for statistical analysis to calculate odds ratios and for univariate meta-regression to rule out effect modifiers, including baseline characteristics and comorbidities. RESULTS: A total of eight studies with 1261 patients underwent femoropopliteal peripheral arterial intervention (DCB, n = 670; DES, n = 591). There was no difference in the primary outcome of all-cause mortality and primary patency at 1 year and 2 years between DCB and DES. One-year clinically-driven target lesion revascularization (CD-TLR) was significantly lower in the DCB group (OR: 0.68; 95% CI = 0.47-0.98; p = 0.04); however, no significant difference was found in 2-year CD-TLR. Regarding secondary outcomes' analysis, major amputation, procedural success, and post-procedure ankle-brachial index (ABI) failed to reach statistical significance. Univariate meta-regression results showed no effect modification based on demographics, comorbidities, and lesion characteristics (p > 0.05) for all outcomes except 1-year CD-TLR and major amputation. CONCLUSION: There was no significant difference in all-cause mortality and primary patency between DCB and DES for up to 2 years. DCB was associated with lower CD-TLR at 1 year, which was lost at 2 years of follow-up.
Variability in ACT Response to Standard UFH Bolus During PCI: A Prospective Study on Determinants of Subtherapeutic Anticoagulation.
Vu MC, Trimaille A, Granier A … +7 more , Carmona A, Elidrissi A, Kibler M, Jesel L, Ohlmann P, Sattler L, Morel O
Catheter Cardiovasc Interv · 2026 Jun · PMID 41937264 · Publisher ↗
BACKGROUND: Unfractionated heparin (UFH) remains the standard anticoagulant during percutaneous coronary intervention (PCI), with guidelines recommending a target activated clotting time (ACT) of ≥250 s. However, despite...
BACKGROUND: Unfractionated heparin (UFH) remains the standard anticoagulant during percutaneous coronary intervention (PCI), with guidelines recommending a target activated clotting time (ACT) of ≥250 s. However, despite receiving a standardized bolus dose, many patients fail to achieve this target. AIMS: To evaluate the effectiveness of standard UFH bolus dose in achieving the target ACT and to identify patient-related factors associated with suboptimal anticoagulant response. METHODS: This single-center, prospective observational study included 171 patients undergoing PCI between October 2024 and April 2025. All patients received a 100 IU/kg intravenous UFH bolus immediately before PCI. ACT was measured 5 min after administration, and additional 50 IU/kg boluses were given as needed to achieve an ACT ≥ 250 s. The primary endpoint was the proportion of patients achieving this target after the initial bolus. The secondary endpoint was the identification of factors associated with suboptimal anticoagulation. RESULTS: Among 171 patients (mean age 68 years; 26.3% women), the target ACT was achieved in 35.7% (n = 61), while 64.3% (n = 110) did not. Active smoking was independently associated with failure to reach the target ACT (adjusted OR, 6.06; 95% CI, 1.41 to 43.8; p = 0.032), although the confidence interval was wide. Despite similar weight-adjusted UFH dosing and timing to ACT measurement, smokers had significantly lower ACT values (p < 0.001) and required higher cumulative UFH dose during PCI (p = 0.043). Propensity-score matching confirmed this association (p = 0.004). CONCLUSION: In this prospective cohort, nearly two-thirds of patients did not achieve the recommended ACT target after a standard 100 IU/kg UFH bolus during PCI. Active smoking was independently associated with failure to reach therapeutic ACT levels, although this association should be interpreted cautiously. These findings underscore the variability of UFH response and reinforce the importance of ACT monitoring.
The HALP Score and Its Association With Coronary Collateral Circulation Development in Chronic Total Occlusion Patients.
Süleymanoğlu C, Polat F, Paçacı E … +1 more , Terzi S
Catheter Cardiovasc Interv · 2026 Jun · PMID 41937261 · Publisher ↗
BACKGROUND: Coronary collateral circulation plays a crucial compensatory role in patients with chronic total occlusion (CTO) by providing alternative blood flow pathways. The HALP score (hemoglobin, albumin, lymphocyte,...
BACKGROUND: Coronary collateral circulation plays a crucial compensatory role in patients with chronic total occlusion (CTO) by providing alternative blood flow pathways. The HALP score (hemoglobin, albumin, lymphocyte, and platelet) integrates systemic inflammation and nutritional status, but its relationship with collateral development in CTO patients remains unexplored. AIMS: This study aimed to evaluate the association between HALP score and coronary collateral circulation quality assessed by Werner classification in CTO patients. METHODS: This retrospective cross-sectional study included 240 consecutive CTO patients who underwent coronary angiography. HALP score was calculated using the formula: hemoglobin (g/L) × albumin (g/L) × lymphocytes (/μL)/platelets (/μL). Collateral circulation was graded using the Werner classification (CC0-CC3), with good collateral defined as a CC score ≥ 2. Correlation analysis, ROC curve analysis, and multivariate logistic regression were performed to assess the relationship between HALP score and collateral circulation. RESULTS: The median HALP score was 4.20 (IQR: 2.68-5.68). A significant positive correlation was observed between HALP score and Werner grade (r = 0.807, p < 0.001, R² = 0.652). Median HALP scores increased progressively across Werner grades: CC0 (1.62), CC1 (3.20), CC2 (4.80), and CC3 (7.70). In multivariate analysis, the HALP score was significantly associated with good collateral circulation (OR: 3.762, 95% CI: 2.182-6.486, p < 0.001). The optimal cutoff of 3.509 demonstrated good diagnostic performance with 90.7% sensitivity and 66.7% specificity (AUC: 0.885). CONCLUSIONS: HALP score is significantly associated with coronary collateral circulation development in CTO patients. This simple, cost-effective biomarker appears promising for risk stratification in this population based on this preliminary analysis, though prospective validation is needed before clinical application.
Implementing Intravascular Imaging-Guided Percutaneous Coronary Intervention: A Scoping Review Using the Consolidated Framework for Implementation Research.
Khan FR, Ullah A, Alishan S … +2 more , Akbar F, Aslam K
Catheter Cardiovasc Interv · 2026 Jun · PMID 41937248 · Publisher ↗
Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can improve percutaneous coronary intervention (PCI) by refining the sizing, lesion preparation, and stent optimization; however, their adoption vari...
Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can improve percutaneous coronary intervention (PCI) by refining the sizing, lesion preparation, and stent optimization; however, their adoption varies widely across health systems. Map determinants, strategies, and implementation outcomes for IVUS/OCT-guided PCI using the Consolidated Framework for Implementation Research (CFIR) and Proctor's taxonomy. Map determinants, strategies, and implementation outcomes for IVUS/OCT-guided PCI using the Consolidated Framework for Implementation Research (CFIR) and Proctor's taxonomy. We conducted a PRISMA-ScR-aligned scoping review through March 15, 2025. Eligible primary studies (randomized trials, pre-specified substudies, registries, and prospective cohorts) evaluated IVUS and/or OCT during PCI and reported at least one CFIR determinant or one Proctor outcome (adoption/penetration, feasibility, fidelity, sustainability, and cost). Two reviewers screened and charted the data in duplicate, and the clinical outcomes were treated as contextual. We narratively synthesized the findings and organized them by era, modality, and policy setting. From 1218 records, 17 studies were included (14 primary and 3 contextual/workflow sources). The recurrent facilitators were explicit quantitative optimization thresholds, protocolized use, operator training/mentorship, and audit/feedback. Policy/reimbursement consistently enabled higher penetration and sustained usage. Minimal-contrast IVUS protocols are feasible in high-risk cohorts, achieving large reductions in contrast without compromising the procedural success. Quantitative expansion indices (e.g., minimal stent area or area-based expansion) functioned as fidelity targets and were associated with clinical events across data sets. Cost signals were nuanced; early randomized economics favored IVUS-guided strategies via fewer reinterventions and lower cumulative costs, whereas physiology-first strategies were more efficient than OCT-first strategies for intermediate lesions. Successful imaging programs appear bundle-dependent: pairing access to IVUS/OCT with explicit thresholds, standardized pre-/post-deployment runs, team training, and feedback within supportive policies yields more reliable performance and scalable value. Priorities include hybrid effectiveness-implementation studies, standardized fidelity dashboards, cross-vendor validation of thresholds, equity-minded rollout pathways, and prospective evaluation of AI-enabled OCT to test whether workflow gains translate into patient benefits.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe