Catheter-induced left main coronary artery (LMCA) dissection is a rare but life-threatening complication of coronary angiography requiring rapid recognition and expert management. We report a 72-year-old hypertensive fem...Catheter-induced left main coronary artery (LMCA) dissection is a rare but life-threatening complication of coronary angiography requiring rapid recognition and expert management. We report a 72-year-old hypertensive female who developed a National Heart, Lung, and Blood Institute (NHLBI) Type-F dissection of the LMCA extending into both the left anterior descending (LAD) and circumflex (LCx) arteries during guiding catheter engagement for left coronary angiography. The dissection resulted in abrupt LAD occlusion with TIMI 0 flow and acute ST-segment elevation. Intravascular ultrasound (IVUS) revealed that both guidewires had inadvertently tracked into the false lumen, a finding that would have led to catastrophic outcomes if unrecognized. Under real-time IVUS guidance, the operator successfully redirected the wire into the true LAD lumen, followed by drug-eluting stent deployment from LMCA to LAD with proximal optimization technique (POT), LCx balloon angioplasty to decompress the subintimal hematoma, and final kissing balloon inflation restoring TIMI-III flow in both vessels. The patient remained hemodynamically stable and was asymptomatic at 6-month follow-up. This case underscores the critical and potentially life-saving role of IVUS in achieving true-lumen re-entry and successful percutaneous management of complex LMCA dissections without the need for emergency surgical intervention.
BACKGROUND: Demand for transcatheter interventions in small neonates continues to increase. Percutaneous carotid artery access can facilitate intervention by providing a more direct wire course and/or potentially reduce...BACKGROUND: Demand for transcatheter interventions in small neonates continues to increase. Percutaneous carotid artery access can facilitate intervention by providing a more direct wire course and/or potentially reduce morbidity associated with femoral artery access in very small patients. To our knowledge, there remains limited information on the technical success and adverse events associated with carotid access in this population. METHODS: A single-center retrospective case series was performed of infants undergoing carotid access between January 6, 2020, and September 30, 2025, for catheterization procedures, describing the patients, procedures, and outcomes of these procedures, including protocolized ultrasound evaluation of carotid access sites and incidence of vascular and neurological complications. RESULTS: During the study period, 105 procedures using PCA were performed in 77 individual patients at median age of 10 days (IQR: 5-63) and median weight 3.2 kg (IQR: 2.8-3.9) for stent angioplasty of the ductus arteriosus in 84%, intervention on surgical shunts in 9%, and balloon aortic valvuloplasty in 5%. One hundred percent of procedures were technically successful. There were no neurological complications. Vascular ultrasound was performed in all subjects. Pseudoaneurysms occurred after two cases, and in one case, surgical repair was performed. Follow-up imaging was available in 74% of subjects with no pathology identified after a median follow-up of 218 days (IQR: 94-761). Similarly, no clinical events attributable to carotid access were seen during clinical follow-up (median: 785 days, IQR: 330-1336). CONCLUSION: PCA can be used to facilitate a range of transcatheter interventions, including repeated access in the same vessel. Adverse events were very rare, and no neurological complications were seen in short term follow-up.
BACKGROUND: Transcatheter patent ductus arteriosus (PDA) occlusion outcomes in premature and low birth weight infants have improved with advances in procedural technique and availability of low-profile devices. We descri...BACKGROUND: Transcatheter patent ductus arteriosus (PDA) occlusion outcomes in premature and low birth weight infants have improved with advances in procedural technique and availability of low-profile devices. We describe our clinical experience with the Azur Vascular Plug (Terumo Medical Corporation, NJ, USA) for PDA occlusion. AIMS: To assess procedural success, safety and short-term outcomes of the Azur Vascular Plug for PDA occlusion in premature and low birth weight infants. METHODS: Single-center observational study of all preterm and low birth weight infants who underwent a transcatheter PDA occlusion procedure involving the Azur Vascular Plug between June 2024 and October 2025. RESULTS: The Azur Plug was used in 13 infants. The median (range) procedural age was 44 days (17-93 days) and weight 1344 g (855-3900 g). Successful implantation with microcatheter deployment occurred in 12/13 infants. In 11 cases, the 8 mm Azure device was deployed. The ratio of the unconstrained device to the minimal PDA diameter ranged from 2:1 to 4:1 and decreased with experience. The minimal ductal length for deployment was 9.0 mm (lateral angiography). Mean (range) follow-up was 5.8 months (1.5-15.7 months). Complete ductal occlusion prior to 6-month follow-up occurred in 11/12 infants. No aortic obstruction, left pulmonary artery obstruction, or tricuspid valve injury was noted in follow-up. CONCLUSION: The Azur Vascular Plug is a safe and effective option for PDA device occlusion in premature and low birth weight infants. The sizing limits in premature ducts are under evolution. The Azur device appears suitable for ducts with a minimal length of 9.0 mm and, conservatively, a diameter up to 5.0 mm.
Directional coronary atherectomy (DCA) is an attractive option for treating bifurcation lesions, particularly when a stentless strategy is considered; however, the clinical significance of the qualitative characteristics...Directional coronary atherectomy (DCA) is an attractive option for treating bifurcation lesions, particularly when a stentless strategy is considered; however, the clinical significance of the qualitative characteristics of post-DCA residual plaque remains unclear. We report a case of a 72-year-old male undergoing percutaneous coronary intervention for a left main coronary artery (LMCA) true bifurcation lesion, in whom near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) revealed a high lipid burden. To avoid side-branch compromise, NIRS-IVUS-guided DCA was performed from the LMCA to the left anterior descending artery, observing the progressive reduction of lipid-rich plaque in real time. Adequate lumen enlargement and qualitative plaque improvement enabled a stentless strategy using drug-eluting balloons. At 7-month follow-up, angiography showed no restenosis, and NIRS-IVUS demonstrated preserved lumen dimensions and further reduction of lipid burden. This case highlights the utility of NIRS-IVUS-guided DCA in optimizing treatment decisions for bifurcation lesions by enabling real-time assessment of plaque composition and residual vulnerability, in addition to conventional indicators, including plaque burden and % plaque area.
BACKGROUND: Radial artery spasm remains a frequent procedural challenge in transradial intervention; however, its predictors may differ for severe and milder forms of spasm. This distinction is poorly characterized, part...BACKGROUND: Radial artery spasm remains a frequent procedural challenge in transradial intervention; however, its predictors may differ for severe and milder forms of spasm. This distinction is poorly characterized, particularly in contemporary distal radial access (dRA) populations. AIMS: Hereby we intend to approach the predictors of these two types of radial artery spasm. METHODS: This prospective single-center study enrolled 291 consecutive patients planned to undergo dRA (successful in 282 [96.9%] and converted to conventional access [cRA] in nine [3.1%] patients). Spasm was systematically graded via completion angiography using a 4-point scale (0: < 30%, 1: 30%-50%, 2: 50%-70%, 3: > 70% narrowing). Multivariable logistic regression was used to identify the independent predictors of severe spasm (> 70%) and any spasm (≥ 30%). RESULTS: Severe spasms occurred in 91 patients (31.3%), and spasms in 226 patients (77.7%). The predictor profiles differed substantially according to severity. For severe spasms, the independent predictors were younger age (OR: 0.949 per year; 95% CI: 0.926-0.973; p < 0.001), lower body mass index (BMI (OR: 0.915 per kg/m², 95% CI: 0.863-0.970; p = 0.003), and absence of diabetes (OR: 0.495, 95% CI: 0.253-0.970; p = 0.040). For any spasm, the predictors were: female sex (OR: 2.34, 95% CI: 1.15-4.761.15-4.76; p = 0.019), younger age (OR: 0.973, 95% CI: 0.947-0.999; p = 0.043), and interventional procedures (OR: 2.55, 95% CI: 1.11-5.87; p = 0.028). The study was not designed or powered to compare access sites (dRA vs. cRA) because of the extreme cohort imbalance (n = 9 cRA). These findings may enable operators to tailor prophylactic measures based on patient-specific risk profiles. No vascular rupture or radial artery occlusion was observed. CONCLUSIONS: In a contemporary dRA cohort, the predictors of radial artery spasm differed according to severity. While younger age is a universal risk factor, severe spasm is uniquely associated with lower BMI and non-diabetic status, whereas milder spasms are linked to female sex and procedural complexity. These findings may enable operators to tailor prophylactic measures based on patient-specific risk profiles.
A case is presented of ST-elevation myocardial infarction without shock, due to right coronary artery thrombotic occlusion, in which the unusual step was taken with the use of an intra-aortic balloon pump (IABP) followin...A case is presented of ST-elevation myocardial infarction without shock, due to right coronary artery thrombotic occlusion, in which the unusual step was taken with the use of an intra-aortic balloon pump (IABP) following coronary intervention, which was associated with prevention of further ischemia, angiographic evidence of thrombus resolution, and maintained TIMI 3 flow, in a patient with limited other apparent options. Further investigation into this strategy might be considered.
Shubietah A, Elgendy MS, Rakab MS
… +13 more, Ahmed A, Abusalah B, Murad MR, Hamed BM, Abdul-Hafez HA, Emara A, Qafisheh Q, Balbaa E, Awashra A, Mansour A, Elbataa A, Assaassa A, Mhanna M
BACKGROUND: It is unclear whether preprocedural anemia independently affects outcomes after elective PCI in men with stable CAD. METHODS: Using the TriNetX US Collaborative Network, we identified adult men undergoing fir...BACKGROUND: It is unclear whether preprocedural anemia independently affects outcomes after elective PCI in men with stable CAD. METHODS: Using the TriNetX US Collaborative Network, we identified adult men undergoing first-time elective PCI (2016-2024) and compared those with hemoglobin < 13 g/dL (1-7 days pre-PCI) to non-anemic controls. Propensity-score matching produced two balanced cohorts (n = 1424). Outcomes at 7 days, 30 days, 6 months, and 12 months were analyzed with univariate and multivariable Cox models. Residual confounding was assessed with falsification endpoints and E-values, and multiplicity with Bonferroni and Benjamini-Hochberg adjustments. RESULTS: After propensity-score matching, 7-day outcomes were similar between groups. At 30 days, anemia was associated with higher risks of AKI (HR 1.92; 95% CI 1.35-2.72) and major bleeding (HR 2.49; 95% CI 1.48-4.19); however, the 30-day association with all-cause hospitalization (HR 1.32; 95% CI 1.05-1.66) did not remain statistically significant after multiplicity adjustment. At 6 months, anemia was linked to higher risks of AKI (HR 2.34; 95% CI 1.84-2.97), mortality (HR 2.63; 95% CI 1.63-4.26), hospitalization (HR 1.56; 95% CI 1.34-1.80), major bleeding (HR 3.28; 95% CI 2.34-4.61), and transfusion (HR 5.47; 95% CI 3.31-9.06); the association with MACE (HR 1.37; 95% CI 1.10-1.70) was sensitive to multiplicity adjustment (significant under false-discovery-rate control but not Bonferroni). At 12 months, anemia remained associated with higher risks of AKI (HR 1.96; 95% CI 1.60-2.41), mortality (HR 1.88; 95% CI 1.31-2.70), hospitalization (HR 1.41; 95% CI 1.23-1.62), major bleeding (HR 2.16; 95% CI 1.66-2.81), and transfusion (HR 3.35; 95% CI 2.31-4.85); the association with MACE (HR 1.26; 95% CI 1.03-1.53) did not persist after multiplicity adjustment. Each 1 g/dL increase in hemoglobin was associated with lower risks of AKI and transfusion in univariate Cox models, with similar directionality after adjustment. CONCLUSIONS: In men undergoing first-time elective PCI for stable CAD, baseline anemia was associated with higher 12-month risks of AKI, major bleeding, transfusion, hospitalization, and death-especially with recent (≤ 1 year) bleeding or transfusion.
Paravalvular leak (PVL) is a recognized complication after surgical mitral valve replacement and may cause heart failure, pulmonary hypertension, or hemolysis when moderate or severe. Although redo surgery is the definit...Paravalvular leak (PVL) is a recognized complication after surgical mitral valve replacement and may cause heart failure, pulmonary hypertension, or hemolysis when moderate or severe. Although redo surgery is the definitive treatment, it carries substantial risk in elderly patients or those with multiple prior cardiac surgeries. Transcatheter PVL closure has therefore emerged as a valuable alternative, albeit with significant technical challenges in the mitral position. We describe the case of a 78-year-old woman with a history of two prior mitral valve replacements using bioprosthetic valves, who presented with progressive dyspnea. Echocardiography demonstrated structural valve degeneration of the mitral bioprosthesis with a large postero-medial mitral PVL causing severe regurgitation. Given the prohibitive surgical risk, percutaneous PVL closure was selected following Heart Team discussion. The procedure was performed under general anesthesia with transesophageal echocardiography and fluoroscopic guidance. An initial antegrade transseptal approach enabled deployment of the first occluder device, but significant residual regurgitation persisted. A second device could not be adequately positioned antegrade and was therefore deployed using a retrograde transaortic approach, which provided improved coaxial alignment. Final imaging showed mild residual regurgitation and a significant reduction in transmitral gradient. The patient had an uneventful recovery with rapid symptomatic improvement and remained clinically stable at 1-month follow-up. This case highlights the feasibility and effectiveness of a hybrid antegrade-retrograde strategy for complex mitral PVL closure and underscores the importance of procedural flexibility and multimodality imaging in achieving optimal outcomes in high-risk patients.
Given the complexity of the procedure, chronic total occlusion (CTO) intervention is often associated with hemodynamic fluctuations. In such cases, it is necessary to ascertain potential causes involving the target vesse...Given the complexity of the procedure, chronic total occlusion (CTO) intervention is often associated with hemodynamic fluctuations. In such cases, it is necessary to ascertain potential causes involving the target vessel, the donor vessel, and non-coronary factors promptly. In addition, the relative hypoperfusion of the target vessel caused by immediate antegrade and retrograde competitive blood flow upon guidewire crossing and establishment of the procedural trajectory is also a problem worthy of consideration.
BACKGROUND: Mechanical circulatory support (MCS) during percutaneous coronary intervention (PCI) remains controversial, particularly in high-risk procedures such as chronic total occlusion PCI (CTO-PCI), and real-world d...BACKGROUND: Mechanical circulatory support (MCS) during percutaneous coronary intervention (PCI) remains controversial, particularly in high-risk procedures such as chronic total occlusion PCI (CTO-PCI), and real-world data on its frequency, patient selection, and outcomes are limited. AIMS: To assess the frequency of MCS use during CTO-PCI, to describe the clinical and procedural characteristics of supported patients, and to synthesize the available outcome data. METHODS: A systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251044868). PubMed, Scopus, and the Cochrane Library were systematically searched. RESULTS: Nine studies were included in the qualitative synthesis. Reported rates of MCS use during CTO-PCI ranged from 0.7% to 6.4%. MCS was used more frequently in elderly patients and those with diabetes mellitus, chronic kidney disease, impaired left ventricular systolic function, greater anatomical complexity, and in procedures employing a retrograde approach. Across studies, procedural and clinical outcomes were consistently more favorable when MCS was implanted prophylactically rather than used as urgent rescue therapy. CONCLUSIONS: Overall, MCS use during CTO-PCI is infrequent and largely reserved for selected high-risk cases. In patients with a meaningful anticipated risk of hemodynamic instability, prophylactic implantation should be considered. Prospective multicenter studies are needed to refine indications and assess cost-effectiveness.
Wu EB, Leung C, Nagamatsu W
… +14 more, Mashayekhi K, Matsuno S, Harding SA, Lo S, Lim ST, Ge L, Chen JY, Qian J, Lee SW, Kao HL, Kalyanasundaram A, Muenkaew M, Luo HJ, Brilakis ES
We present a novel simple and easy-to-use 3D wiring technique for coronary chronic total occlusions (CTOs) named ZOLUTION-Zero OverLap View Universal Three dimensIONal wiring. ZOLUTION can be used for: (1) Distal cap pun...We present a novel simple and easy-to-use 3D wiring technique for coronary chronic total occlusions (CTOs) named ZOLUTION-Zero OverLap View Universal Three dimensIONal wiring. ZOLUTION can be used for: (1) Distal cap puncture, (2) CTO body wiring, (3) Retrograde wiring, and (4) Reverse controlled antegrade and retrograde tracking (reverse CART). The four steps of ZOLUTION are: (1) Find the zero-degree overlap fluoroscopic view where the wire shaft and the vessel target are overlapping. (2) Straighten the wire tip by minuscule rotation. (3) Move to a coaxial view 35-70 degrees away (Secondary view) to check that the wire is pointing toward the target (if not, rotate the wire 180 degrees and re-straighten the wire tip in ZOV). (4) In the secondary view puncture forward with the wire toward the target. ZOLUTION does not require formation of a mental map, specific angiographic views of that coronary segment, or fluoroscopic views to be 90-degree apart. It is superior to traditional 3D wiring as it provides a precise angle that is aimed at the target increasing its success rate. We believe ZOLUTION can be universally adopted due to its simplicity and could greatly improve CTO PCI efficiency and safety.
Makris A, Soulaidopoulos S, Sagris M
… +11 more, Platanias K, Kyriakoulis K, Konstantinidis D, Tatakis F, Gompos G, Dimitriadis K, Kordalis A, Tsiachris D, Kafkas N, Waliszewski M, Tsioufis K
BACKGROUND: Renal denervation (RDN) according to the latest ESH guidelines can be considered as a treatment option for patients with resistant hypertension. However, excess sympathetic nervous system activity constitutes...BACKGROUND: Renal denervation (RDN) according to the latest ESH guidelines can be considered as a treatment option for patients with resistant hypertension. However, excess sympathetic nervous system activity constitutes an underlying pathophysiological mechanism in many disorders other than arterial hypertension. AIMS: This systematic review and meta-analysis investigated the therapeutic effects of RDN beyond arterial hypertension. METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. Electronic databases (PubMed, Embase, Cochrane) were searched for studies assessing RDN effects in atrial fibrillation (AF) recurrence, obstructive sleep apnea (OSA), metabolic parameters, heart failure (HF) and diastolic heart function. Inclusion criteria encompassed randomized controlled trials and observational studies with relevant outcome measures. Effect sizes were pooled using a random-effects model. RESULTS: A total of 16 studies comprising 818 patients were included. RDN was associated with a significant increase in freedom from AF when combined with pulmonary vein isolation (RR: 1.30, 95% CI: 1.04 to 1.61, I = 5%), an improvement in OSA severity as measured by the apnea-hypopnea index (MD: -4.80, 95% CI: -12.60 to 3.01, I = 39%), and decreased fasting blood glucose (MD: -10.04, 95% CI: -26.51 to 6.43, I = 0%). Additionally, RDN led to improvements in left ventricular diastolic function in terms of E/e' reduction (MD: -1.51, 95% CI: -2.71 to -0.31, I = 94%) and improved HF-related biomarkers, specifically NT pro-BNP (MD: -438.54, 95% CI: -1658.57 to 781.49, I = 92%) and 6-min walking distance (MD: +64.58, 95% CI: 0.11 to 129.05, I = 53%). CONCLUSION: This meta-analysis suggests that RDN exerts beneficial effects beyond hypertension, particularly in AF burden, OSA severity, metabolic parameters, and cardiac function. These findings support the broader role of RDN in autonomic regulation and cardiovascular health. Further large-scale trials are warranted to confirm these effects and refine patient selection criteria.
Marked troponin elevation, indicative of myocardial injury, typically prompts evaluation for acute coronary syndrome (ACS). However, extra-cardiac pathologies can produce identical biomarker patterns, potentially diverti...Marked troponin elevation, indicative of myocardial injury, typically prompts evaluation for acute coronary syndrome (ACS). However, extra-cardiac pathologies can produce identical biomarker patterns, potentially diverting diagnostic reasoning and delaying definitive treatment. Isolated celiac artery stenosis is an uncommon cause of mesenteric ischemia that can mimic ACS. A 78-year-old woman presented with recurrent epigastric pain and significant troponin elevation (peak 2.492 ng/mL) despite non-obstructive coronary arteries. Selective abdominal angiography revealed isolated high-grade celiac artery stenosis with patent superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). The lesion was treated with a self-expanding stent, resulting in complete symptom resolution. Four years later, the patient re-presented with identical symptoms and troponin elevation. Imaging demonstrated focal in-stent restenosis, which was successfully treated with a balloon-expandable stent, achieving durable symptom relief. This case illustrates that isolated celiac artery stenosis can closely mimic ACS, producing marked troponin release in the absence of coronary obstruction. Recognition of this masquerading visceral ischemia requires careful attention to symptom patterns and a low threshold for visceral angiography. Durable outcomes can be achieved with endovascular therapy, even in cases of restenosis.
Saleh O, Valle NJ, Li S
… +5 more, Mostafa S, Saleh I, Benza R, Talreja DR, Summers MR
Catheter Cardiovasc Interv
· 2026 May · PMID 41919584
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BACKGROUND: Development of conduction abnormalities requiring pacing after transcatheter aortic valve replacement (TAVR) is relatively common. The effects of post-TAVR permanent pacemaker (PPM) implantation on mortality,...BACKGROUND: Development of conduction abnormalities requiring pacing after transcatheter aortic valve replacement (TAVR) is relatively common. The effects of post-TAVR permanent pacemaker (PPM) implantation on mortality, ischemic stroke, and cardiovascular outcomes remain incompletely characterized. AIMS: To evaluate the incidence, predictors, and cardiovascular outcomes of post-TAVR permanent pacemaker implantation, including its association with 1-year ischemic stroke risk. METHODS: Adults undergoing TAVR (2008-2019; n = 1101) were evaluated. Patients with prior PPM (n = 104) and/or valve-in-valve or redo TAVR (n = 11) were excluded. PPM placement was identified post-indexed TAVR admission based on procedure codes, including both in-hospital and post-discharge implantations. Primary outcomes included 1-year mortality, major adverse cardiovascular events (MACE), myocardial infarction (MI), and ischemic stroke. Multivariate logistic regression was performed to identify independent predictors of 1-year ischemic stroke. RESULTS: Within the TAVR cohort (N = 1101), 158 patients (14.4%) received PPM within 1-year, including 135 (12.3%) in-hospital and 23 post-discharge. PPM was not associated with a significant difference in 1-year mortality (15.8% vs. 14.7%, p = 0.816) or 1-year MACE (20.9% vs. 21.0%, p = 1.000). However, PPM was associated with significantly lower ischemic stroke rate at 1 year (1.3% vs. 4.8%, p = 0.044). In multivariate analysis adjusting for age, sex, and comorbidities, PPM was associated with 77% lower risk of 1-year ischemic stroke (adjusted OR 0.234, 95% CI 0.056-0.977, p = 0.046). Late PPM implantation (> 3 days) was associated with numerically higher 1-year mortality (30.0% vs. 14.3%, p = 0.647) and MACE (36.7% vs. 17.1%, p = 0.119) compared to early implantation, though these outcomes did not reach statistical significance. CONCLUSION: PPM after TAVR was not associated with increased mortality or MACE but was independently associated with significantly lower ischemic stroke risk. Late PPM implantation showed a trend toward worse outcomes. These findings suggest that appropriately indicated PPM may confer cerebrovascular protection, and early implantation when indicated may be preferable. These findings warrant further validation in prospective studies.
BACKGROUND: Atrial fibrillation (AF) is one of the most common clinical arrhythmias, and postoperative recurrence remains a major concern in cardiovascular medicine. However, the predictive value of atherogenic index of...BACKGROUND: Atrial fibrillation (AF) is one of the most common clinical arrhythmias, and postoperative recurrence remains a major concern in cardiovascular medicine. However, the predictive value of atherogenic index of plasma (AIP) and serum uric acid to creatinine ratio (sUA/CrR) for late non-valvular AF recurrence after catheter ablation remains unclear. AIMS: This study aimed to investigate the predictive value of AIP and sUA/CrR for late non-valvular AF recurrence after catheter ablation. METHODS: This study included 401 patients with non-valvular AF who were treated at Fujian Medical University Union Hospital between 2018 and 2022. The associations between the sUA/CrR, AIP, and late AF recurrence after catheter ablation were analyzed using univariate and multivariate Cox regression models, as well as Kaplan-Meier survival analysis. Machine learning methods were used to evaluate the predictive performance of the model. SHapley Additive exPlanations (SHAP) was employed to assess the interpretability of the model. In addition, the potential mediating roles of AIP and sUA/CrR in clinical outcomes were explored. RESULTS: Multivariable Cox regression analysis showed that both the AIP (p = 0.006, HR = 3.259, 95% CI: 1.415-7.506) and the sUA/CrR (p = 0.001, HR = 1.188, 95% CI: 1.069-1.321) were independently associated with late AF recurrence after catheter ablation. Mediation analysis revealed a bidirectional mediating effect between AIP and sUA/CrR in their associations with late AF recurrence. SHAP analysis highlighted that both AIP and sUA/CrR are important predictive indicators for AF recurrence after ablation. CONCLUSION: Both AIP and sUA/CrR are positively correlated with late AF recurrence after catheter ablation, exhibiting a bidirectional mediating effect. A clinical prediction model integrating these two indicators may facilitate risk stratification of late AF recurrence after catheter ablation.
Transcatheter aortic valve replacement (TAVR) is the preferred treatment for severe aortic stenosis (AS) in high-risk surgical patients. The transfemoral (TF) access is the gold standard due to its minimally invasive nat...Transcatheter aortic valve replacement (TAVR) is the preferred treatment for severe aortic stenosis (AS) in high-risk surgical patients. The transfemoral (TF) access is the gold standard due to its minimally invasive nature and favorable outcomes. However, peripheral artery disease (PAD), common in TAVR candidates, can complicate TF access due to calcification, tortuosity, and vessel narrowing. This literature review evaluates vascular access strategies for TAVR in patients with PAD, highlighting recent advances that support expanded use of TF access. A narrative literature review was conducted in scientific databases up to 14 April 2025. Studies reporting on access strategies for TAVR in patients with PAD were included. The SANRA scale was utilized to ensure methodological quality. TF access remains the preferred route for TAVR, associated with lower mortality and complication rates compared to alternative approaches. Tools like the Hostile Score has further strengthened pre-procedural planning by quantifying iliofemoral complexity and helping clinicians determine the safest and most feasible access route. Advances in technology have enhanced TF feasibility in patients with PAD, enabling device delivery despite complex anatomy. When TF access is not viable, alternative routes remain feasible but are linked to increased risks, including stroke and vascular complications. Expanding the eligibility for TF access through vessel preparation and imaging-guided planning can improve safety and outcomes in PAD patients undergoing TAVR. A personalized approach based on anatomy feasibility, supported with risk stratification tools and multidisciplinary collaboration is essential to selecting the optimal vascular access strategy.
Catheter Cardiovasc Interv
· 2026 May · PMID 41913083
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This patient is a 77-year-old male with non-ischemic cardiomyopathy, severe tricuspid regurgitation, and moderate mitral regurgitation who underwent simultaneous transcatheter edge-to-edge repair of both mitral and tricu...This patient is a 77-year-old male with non-ischemic cardiomyopathy, severe tricuspid regurgitation, and moderate mitral regurgitation who underwent simultaneous transcatheter edge-to-edge repair of both mitral and tricuspid valves. Post-procedure, the patient exhibited significant symptomatic improvement and reduced regurgitation severity, highlighting the feasibility of dual-valve TEER in high-risk patients.