Catheterization And Cardiovascular Interventions[JOURNAL]
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200 papers
Intravascular Lithotripsy Is Associated With Superior Clinical Outcomes Compared to Atherectomy: A Large-Scale, Propensity-Matched Analysis.
Miks CD, Ozaki GK, Shukla CR … +1 more , Sharma V
Catheter Cardiovasc Interv · 2026 May · PMID 41837695 · Full text
BACKGROUND: Coronary artery disease (CAD) with severe calcification remains a growing challenge in percutaneous coronary intervention (PCI). Atherectomy (ATH) has long been used for plaque modification, whereas intravasc...
BACKGROUND: Coronary artery disease (CAD) with severe calcification remains a growing challenge in percutaneous coronary intervention (PCI). Atherectomy (ATH) has long been used for plaque modification, whereas intravascular lithotripsy (IVL) has emerged as a promising alternative. Large-scale comparative data on long-term outcomes are limited. AIMS: To compare 1-year clinical outcomes, 30-day procedural complications, and temporal trends between IVL and ATH use. METHODS: We conducted a retrospective cohort study using the TriNetX Research Network, analyzing de-identified data from 47 health care organizations. Adults with CAD undergoing single-vessel PCI with drug-eluting stent (DES) and either IVL or ATH were included. Outcomes were assessed after propensity matching, and annual utilization trends were evaluated from 2013 to 2024. RESULTS: We identified 13,499 patients who underwent DES with IVL (n = 7026) or ATH (n = 6473). After matching, 5768 patients remained in each cohort. At 1 year, IVL was associated with lower risk of all-cause mortality (RR 0.64; 95% CI 0.58-0.72; p < 0.0001), myocardial infarction (RR 0.80; 95% CI 0.66-0.96; p = 0.0166), and MACE (RR 0.71; 95% CI 0.62-0.82; p < 0.0001). IVL also reduced 30-day procedural complications (RR 0.77; 95% CI 0.61-0.97; p = 0.0271), with less bleeding (RR 0.44; 95% CI 0.31-0.62; p < 0.0001) and CA-AKI (RR 0.71; 95% CI 0.55-0.91; p = 0.0068). IVL use increased rapidly and surpassed ATH after 2022. CONCLUSION: In this large, real-world registry, IVL was associated with more favorable 1-year outcomes and fewer 30-day complications than ATH. These findings support IVL as a safe and effective alternative for complex coronary lesions, emphasizing the need for validation in randomized trials to assess for causality.
Revolutionizing Modern Percutaneous Coronary Intervention: Drug-Coated Balloons for Diabetics With Small Vessel Disease. A Narrative Review.
Tsiamis N, Tsakirian F, Papanikolaou A … +9 more , Afendoulis D, Toulgaridis F, Dimitriadis K, Tolis I, Tzortzis S, Triantis G, Aghayan S, Tsioufis K, Toutouzas K
Catheter Cardiovasc Interv · 2026 May · PMID 41833545 · Publisher ↗
Diabetic patients with small-vessel coronary artery disease represent a challenging population in interventional cardiology. Conventional drug-eluting stents (DES) show limited efficacy due to enhanced neointimal prolife...
Diabetic patients with small-vessel coronary artery disease represent a challenging population in interventional cardiology. Conventional drug-eluting stents (DES) show limited efficacy due to enhanced neointimal proliferation, microvascular dysfunction, and impaired endothelial healing. This narrative review synthesizes contemporary evidence on drug-coated balloon (DCB) angioplasty efficacy, safety, and procedural strategies in diabetic small vessel disease (SVD). A comprehensive literature search of PubMed, Scopus, and Web of Science was conducted through October 2025, focusing on randomized controlled trials, meta-analyses, registries, and physiological studies comparing DCBs and DES in diabetic SVD. Recent trials (BELLO, Dissolve-SVD, BASKET-SMALL 2, PICCOLETO II) and meta-analyses indicate DCBs achieve non-inferior or superior angiographic outcomes versus DES in diabetic SVD, particularly regarding late lumen loss, restenosis, and vessel thrombosis. Procedural advantages include endothelial function preservation, reduced inflammation, and significantly shorter dual antiplatelet therapy duration-crucial for high-bleeding-risk diabetic populations. DCB angioplasty represents a promising "leave-nothing-behind" revascularization strategy for diabetic small vessels, combining efficacy with enhanced vascular healing and safety. Ongoing sirolimus-coated technology developments and future diabetes-focused trials are expected to refine its interventional role.
Plaque Morphology-Dependent Regression of Tandem Coronary Plaques Under Intensive Lipid-Lowering Therapy.
Kim YL, Noh HW, Seo CO … +7 more , Park JR, Kim K, Kim HR, Hwang JY, Kang MG, Kim H, Koh JS
Catheter Cardiovasc Interv · 2026 May · PMID 41820773 · Full text
We report a 54-year-old woman with stable angina who exhibited heterogeneous responses of tandem left anterior descending artery (LAD) plaques to intensive lipid-lowering therapy. Coronary CT angiography performed at ano...
We report a 54-year-old woman with stable angina who exhibited heterogeneous responses of tandem left anterior descending artery (LAD) plaques to intensive lipid-lowering therapy. Coronary CT angiography performed at another hospital suggested diffuse disease, and she presented to our clinic for a second opinion. Intravascular ultrasound revealed a lipid-rich proximal LAD lesion and a fibrous-predominant distal lesion, along with a smaller intermediate lesion. Fractional flow reserve (FFR) pullback showed distal LAD FFR of 0.50, increasing to 0.73 across the distal lesion (ΔFFR + 0.23) and to 0.95 across the proximal lesion (ΔFFR + 0.22). Although PCI was considered, in accordance with the patient's preference and guideline recommendations, medical therapy with high-intensity statin, ezetimibe, aspirin, nebivolol, and isosorbide dinitrate was initiated. LDL-C decreased to < 35 mg/dL and remained consistently suppressed. After 2 years, serial CT and intravascular ultrasound (IVUS) demonstrated near-complete regression of the lipid-rich proximal lesion with lumen enlargement, a marked reduction in IVUS features consistent with a lipid-rich core, and attenuation of its lesion-specific physiological contribution (ΔFFR + 0.02), whereas the distal fibrous lesion remained stable (ΔFFR + 0.20) (lesion-specific functional improvement defined as attenuation of lesion-specific ΔFFR contribution on FFR pullback). The intermediate lesion also regressed morphologically, although it was not assessed functionally. The patient remained asymptomatic with preserved exercise capacity. This case suggests that plaque morphology may influence the response to lipid-lowering therapy and highlights the value of multimodality imaging with lesion-specific physiological assessment in individualized management of stable coronary disease.
One-Year Clinical Outcomes of Endovascular Revascularization in Patients With Acute Limb Ischemia: Results of the Multicenter SKYLINE3 Study.
Miwa H, Hayakawa N, Tobita K … +15 more , Ogata K, Koyama E, Yamamoto K, Tsurumaki T, Tsuchida Y, Ichihara S, Hirano S, Maruta S, Miyaji K, Tanemura H, Kumagai K, Sawada S, Kai M, Miyashita H, Kushida S
Catheter Cardiovasc Interv · 2026 May · PMID 41820270 · Publisher ↗
BACKGROUND: Acute limb ischemia (ALI) is a critical vascular emergency associated with high risks of mortality and amputation. AIMS: This study aimed to investigate the 1-year outcomes of Endovascular revascularization (...
BACKGROUND: Acute limb ischemia (ALI) is a critical vascular emergency associated with high risks of mortality and amputation. AIMS: This study aimed to investigate the 1-year outcomes of Endovascular revascularization (EVR) in patients with ALI. METHODS: We retrospectively analyzed 304 EVR procedures in 280 patients with ALI between January 2018 and April 2025 in three cardiovascular centers. The primary endpoint was 1-year amputation-free survival (AFS). Secondary endpoints were 1-year clinically driven target lesion revascularization (CD-TLR) and procedural success. The association of baseline characteristics with 1-year AFS was also investigated. RESULTS: The estimated 1-year AFS rate was 65.2%, and freedom from CD-TLR was 83.9%. Procedural success was achieved in 285 (93.8%) cases. Independent predictors of reduced 1-year AFS included frailty (multivariable hazard ratio [mHR] 2.73; 95% confidence interval (CI), 1.62-4.61; p < 0.001), hemodialysis (mHR 2.76; 95% CI, 1.55-4.90; p = 0.001), severe ALI (mHR 1.70; 95% CI, 1.03-2.80; p = 0.037), and peak creatine phosphokinase (CPK) > 7000 IU/L (mHR 2.95; 95% CI, 1.80-4.83; p < 0.001). In contrast, preserved flow in one below-the-knee (BTK) artery (mHR 0.44; 95% CI, 0.22-0.91; p = 0.026) or in two or more BTK arteries (mHR 0.34; 95% CI, 0.17-0.69; p = 0.003) was independently associated with improved 1-year AFS. CONCLUSIONS: EVR may be an acceptable treatment for ALI. Frailty, hemodialysis, severe ALI, and peak CPK > 7000 IU/L are associated with poor prognosis. However, achieving adequate BTK arterial flow after EVR may correlate with improved patient outcomes.
Chronic Limb-Threatening Ischemia Owing to Popliteal Artery Aneurysms With Repeated Occlusion After Stent Graft Placement That was Successfully Treated With Supera Stent Reinforcement: A Case Report.
Miwa H, Hayakawa N, Tsurumaki T … +4 more , Tsuchida Y, Ichihara S, Maruta S, Kushida S
Catheter Cardiovasc Interv · 2026 May · PMID 41820254 · Publisher ↗
Popliteal artery aneurysms (PAAs) can cause serious symptoms and are difficult to treat. Endovascular PAA repair (EPAR) using stent grafts (SGs) has demonstrated favorable clinical outcomes for treating PAAs. However, to...
Popliteal artery aneurysms (PAAs) can cause serious symptoms and are difficult to treat. Endovascular PAA repair (EPAR) using stent grafts (SGs) has demonstrated favorable clinical outcomes for treating PAAs. However, tortuous arteries and huge PAAs may result in distortion of SGs, which may cause re-occlusion of the revascularized vessels. This report describes the successful use of EPAR to treat PAA and the use of lining Supera stents to deal with bent SGs. A 55-year-old woman with mixed connective tissue disease, antiphospholipid antibody syndrome, and chronic deep venous thrombosis presented with an ulcer on the right toe. Computed tomography revealed bilateral PAAs and occlusion from the right popliteal artery to all below-the-knee (BTK) arteries. EPAR was performed and two SGs were deployed for the PAAs. The BTK occlusion was treated using intravascular ultrasound-guided wiring. However, the SGs occluded within 2 weeks. A massive thrombus was aspirated using the Indigo system (CAT8; Asahi Intecc Co. Aichi, Japan), and catheter-directed thrombolysis was initiated owing to the large size of the thrombus. However, the SGs became occluded within 2 days. Aspiration was performed, and the Supera stent was deployed at the distal edge of the restenosis. The BTK runoff was recanalized, and catheter-directed thrombolysis was continued. However, the BTK runoff occluded the following day. Aspiration was performed, and the Eluvia stent was deployed at the proximal edge of the restenosis. The BTK runoff was recanalized and stayed open. An additional treatment was conducted 2 months later using an inline Supera stent to straighten the bent Viabahn SG and ensure the BTK flow. The ulcer fully healed after this procedure. Using the Supera stent to line and straighten the SG to obtain enhanced blood flow may facilitate improved management following EPAR of PAA.
Successful Management of a Complex Coronary Bifurcation Lesion in Acute Coronary Syndrome Using a Free-Metal Approach.
Gherasie FA, Ungureanu C
Catheter Cardiovasc Interv · 2026 May · PMID 41816924 · Full text
We present the case of a 56-year-old male with non-ST elevation myocardial infarction (NSTEMI) and a complex thrombotic lesion at the ostial left circumflex artery (LCX), extending into bifurcating marginal branches. Due...
We present the case of a 56-year-old male with non-ST elevation myocardial infarction (NSTEMI) and a complex thrombotic lesion at the ostial left circumflex artery (LCX), extending into bifurcating marginal branches. Due to the high risk of side branch occlusion, a stentless strategy using thrombus aspiration, the reverse wire technique, and sequential plaque modification with a cutting balloon (Rodin-CUT technique) was employed. Following optimal lesion preparation, a drug-coated balloon (DCB) was deployed, achieving excellent angiographic and intravascular ultrasound (IVUS) results, with sustained vessel patency at 6-month follow-up. This case highlights the efficacy of a free-metal strategy in managing challenging bifurcation lesions while preserving side branches and avoiding the risks associated with permanent metallic implants.
Excessive Ostial Stent Protrusion: Evaluation of Management Strategies and Clinical Outcomes of the Side Flap Technique.
Leibundgut G, Bilal Iqbal M, Ungureanu C … +5 more , Barmpas A, Boeddinghaus J, Buliga T, Toth GG, Achim A
Catheter Cardiovasc Interv · 2026 May · PMID 41808303 · Full text
BACKGROUNDS: Accurate stent positioning in aorto-ostial lesions remains challenging due to complex three-dimensional anatomy, lack of optimal fluoroscopic projections, and high rates of geographic miss. Stent overhang im...
BACKGROUNDS: Accurate stent positioning in aorto-ostial lesions remains challenging due to complex three-dimensional anatomy, lack of optimal fluoroscopic projections, and high rates of geographic miss. Stent overhang impairs guide catheter re-engagement and complicates future revascularization. Despite its frequency, no standardized approach exists for managing excessive stent protrusions. AIMS: This study systematically evaluated management strategies for excessive aorto-ostial stent protrusion, integrating comprehensive bench testing with clinical case experience, and assessed the feasibility, mechanics, and outcomes of the Side Flap technique. METHODS: Bench experiments assessed multiple corrective strategies in two scenarios, guidewire crossing through the central stent lumen and through a side cell, across contemporary DES platforms. Mechanical feasibility, force transmission, stent deformation and expansion, and structural integrity were evaluated using high-pressure ballooning, catheter-assisted maneuvers, and intracoronary imaging. A retrospective multicenter series provided complementary real-world clinical outcomes of the Side Flap technique. RESULTS: Longitudinal stent compression using guide catheters, large balloons, or telescoping maneuvers proved mechanically ineffective and frequently produced severe stent deformation or malapposition. In contrast, intentional side-cell recrossing with creation of a neo-lumen was consistently feasible, structurally stable, and reproducible. All DES platforms tolerated large-diameter side-cell expansion without strut fracture, yielding circular neo-lumens with excellent apposition on OCT. Clinically, the Side Flap technique achieved high procedural success with no technique-related adverse events during follow-up. CONCLUSIONS: The Side Flap technique offers a controlled and reproducible alternative strategy when true-lumen access is not achievable or fails, and represents a valuable addition to the interventional armamentarium. Longitudinal stent crush techniques are unreliable for managing excessive aorto-ostial protrusion.
BeGraft Aortic Stent for Treatment of Aortic Coarctation: Acute and Intermediate Results.
Barak-Corren Y, Fried E, Dagan T … +4 more , Steiner K, Amir G, Birk E, Bruckheimer E
Catheter Cardiovasc Interv · 2026 May · PMID 41808293 · Publisher ↗
BACKGROUND: Covered stent implantation is an effective treatment for coarctation of the aorta (CoA) and can reduce aortic wall injury; however, stent-related complications, including recoil, restenosis, infolding, and ac...
BACKGROUND: Covered stent implantation is an effective treatment for coarctation of the aorta (CoA) and can reduce aortic wall injury; however, stent-related complications, including recoil, restenosis, infolding, and access site injury, are of concern. AIMS: Report our institutional experience using the BeGraft Aortic covered stent for native and recurrent CoA. METHODS: Retrospective review of consecutive patients treated for CoA from January 2017 to April 2025 [IRB RMC 389-22]. RESULTS: Eighty-five patients [61 male], median age 14.1 years, median weight 50 kg, underwent implantation of 92 BeGraft Aortic stents, 71 (84%) through a 9 Fr sheath. CoA diameter increased by 170% (IQR 150%-270%) and pressure gradient decreased by 16 mmHg (IQR 10-23 mmHg) to a median of 4 mmHg (IQR 0-6 mmHg). Final stent-to-balloon diameter ratio was 0.94 ± 0.05 (5.6% recoil, IQR 2.8%-9.4%). During median follow-up of 2.7 years (IQR 1.0-4.3 years, max 7.3 years), 38 patients underwent re-imaging (CT, angiography), which demonstrated two new aneurysms. Eight aneurysms present prior to BeGraft aortic implantation completely resolved, and one patient had an asymptomatic femoral artery occlusion. Of the 24 patients who underwent additional catheterizations, 19 had re-interventions, 13 balloon dilations, and 6 stent implantations: 10 restenosis, 7 somatic growth, and 2 aneurysms. CONCLUSIONS: In this single-center experience, BeGraft Aortic covered stents were associated with favorable technical results, including minimal stent recoil and low rates of reintervention for restenosis or aneurysm formation. The low-profile delivery system affords treatment of CoA for smaller children with low risk for vascular damage.
Balloon Versus Self-Expandable TAVI in Patients With Left Ventricular Dysfunction: A Real-World Comparative Study.
Dababneh E, Matta MG, Niranjan S … +3 more , Jones M, Sinhal A, Singh K
Catheter Cardiovasc Interv · 2026 May · PMID 41807280 · Publisher ↗
BACKGROUND: In severe aortic stenosis with reduced left ventricular ejection fraction (LVEF), transcatheter aortic valve implantation (TAVI) improves systolic function. Self-expanding valves (SEV) show haemodynamic advan...
BACKGROUND: In severe aortic stenosis with reduced left ventricular ejection fraction (LVEF), transcatheter aortic valve implantation (TAVI) improves systolic function. Self-expanding valves (SEV) show haemodynamic advantages over balloon-expandable valves (BEV), but whether this yields greater recovery of left ventricular function remains uncertain. OBJECTIVES: To compare change in ejection fraction between BEV and SEV in adults with LVEF < 40% undergoing TAVI, and to assess haemodynamics and clinical outcomes at 30 days and 12 months. METHODS: Observational cohort using a national registry of adults with LVEF < 40% and no prior myocardial infarction, coronary bypass, or more-than-moderate mitral regurgitation. Nearest-neighbor matching balanced annular perimeter, diameters, and calcification. Echocardiographic outcomes and major adverse cardiac and cerebrovascular events (MACCE) were assessed at 30 days and 12 months. Subgroup analyses stratified patients by annular perimeter ≤ 73.5 or > 73.5 mm. RESULTS: Of 922 patients, 574 received a BEV and 348 a SEV. Ejection fraction improved by 30 days and was maintained at 12 months, with no between-group difference. Haemodynamics favored SEV, with lower mean gradients at 30 days and 12 months (both p < 0.001). Clinical outcomes, including MACCE, were similar at 30 days and 12 months, and findings were consistent in small and large annulus strata. CONCLUSIONS: In patients with reduced LVEF, TAVI produced sustained improvement in ejection fraction irrespective of valve platform, and SEV conferred a haemodynamic advantage without differences in ejection fraction or clinical outcomes.
Is It Time to Adopt the LM-View Fluoroscopic Projection in Balloon-Expandable TAVR?
Jelisejevas J, Webb JG
Catheter Cardiovasc Interv · 2026 May · PMID 41803000 · Full text
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Long-Term Outcomes After Percutaneous Coronary Intervention With the Polymer-Free Biolimus-Coated BioFreedom Stent Versus the Biodegradable-Polymer Sirolimus-Eluting Orsiro Stent in Patients With Acute Coronary Syndromes.
Noori M, Christiansen EH, Hougaard M … +11 more , Eftekhari A, Jakobsen L, Ellert J, Jensen RV, Hansen KN, Støttrup NB, Raungaard B, Lassen JF, Kahlert J, Junker A, Jensen LO
Catheter Cardiovasc Interv · 2026 May · PMID 41802992 · Publisher ↗
BACKGROUND: The polymer-free biolimus A9-coated BioFreedom stent (BF-BCS) releases a lipophilic drug that may provide a potent anti-inflammatory effect in patients with acute coronary syndromes (ACS). Five-year efficacy...
BACKGROUND: The polymer-free biolimus A9-coated BioFreedom stent (BF-BCS) releases a lipophilic drug that may provide a potent anti-inflammatory effect in patients with acute coronary syndromes (ACS). Five-year efficacy and safety of BF-BCS were compared to the ultrathin strut biodegradable polymer sirolimus-eluting Orsiro stent (O-SES) in ACS patients. METHODS: From SORT OUT IX, 1672 ACS patients were analyzed (821 treated with BF-BCS and 851 with O-SES); 764 (46%) presented with ST-segment-elevation myocardial infarction (STEMI) and 907 (54%) with non-STEMI. Endpoints were target lesion failure (TLF) (a composite of cardiac death, target lesion myocardial infarction [MI], target lesion revascularization [TLR]) and definite stent thrombosis (ST) at 5-years. RESULTS: At 5-years, TLF in ACS patients did not differ significantly between BF-BCS and O-SES (12.5% vs. 10.8%; rate ratio (RR) 1.12; 95% confidence interval (CI): 0.84-1.49). Cardiac death, target lesion MI, and definite ST rates were similar. TLR was higher with BF-BCS compared to O-SES within the first year (2.9% vs. 1.2%, RR 2.37; 95% CI: 1.13-4.99), but this difference was not maintained at 5-year follow-up (6.2% vs. 4.3%; RR 1.42; 95% CI: 0.92-2.18). The increased risk of TLR within the first year was driven by increased risk of TLR in STEMI patients treated with BF-BCS compared to O-SES (2.5% vs. 0.3%, RR 9.96; 95% CI: 1.26-79.0), while there were no differences in TLR rates in NSTEMI patients. CONCLUSION: At 5-year follow-up, TLF did not differ significantly in BF-BCS or O-SES treated ACS patients. The increased risk of early TLR in STEMI patients treated with BF-BCS was not maintained at 5-year follow-up.
Impact of Peri-Procedural Red Blood Cell Transfusion on Clinical Outcomes in Transcatheter Aortic Valve Replacement: A Propensity-Matched Cohort Study.
Qadeer A, Fouad M, Khawar M … +13 more , Khan MH, Gohar N, Ikbariah K, Bashir Q, Ishaq MU, Muhammad A, Iqbal Ghuman S, Shenawa E, Khawar MMH, Gaalema D, Jneid H, Shalaby M, Mortada I
Catheter Cardiovasc Interv · 2026 May · PMID 41800524 · Publisher ↗
BACKGROUND: Red blood cell (RBC) transfusion is common after transcatheter aortic valve replacement (TAVR) to manage peri-procedural bleeding and has been associated with adverse outcomes in various studies. However, the...
BACKGROUND: Red blood cell (RBC) transfusion is common after transcatheter aortic valve replacement (TAVR) to manage peri-procedural bleeding and has been associated with adverse outcomes in various studies. However, the prognostic impact of peri-procedural transfusion in TAVR patients remains unclear. This study aimed to assess the impact of peri-procedural RBC transfusion on cardiovascular outcomes in TAVR patients compared to those without transfusion. METHODS: A retrospective cohort study was conducted using the TriNetX US Collaborative Research Network, including adults undergoing TAVR until August 31, 2025. Patients were divided into those receiving RBC transfusion (n = 3,176) and those without (n = 79,664) on the day of receiving TAVR. Propensity score matching (1:1) balanced cohorts (n = 3161 each) for demographics, comorbidities, medications, and laboratory values. Relative risks (RR) and hazard ratios (HR) were calculated using propensity-matched and Cox proportional hazard models. RESULTS: Transfused patients had significantly higher all-cause mortality (RR 3.933; 95% CI: 2.27-6.92; p < 0.001 at 7 days; RR 1.824; 95% CI: 1.466-2.268; p < 0.001 at 3 months). Secondary outcomes showed elevated risks for MACE (RR 1.324; 95% CI: 1.073-1.633; p = 0.009 at 7 days; RR 1.199; 95% CI: 1.060-1.358; p = 0.004 at 3 months), hemodynamic instability (RR 2.063; 95% CI: 1.655-2.571; p < 0.001 at 7 days; RR 1.638; 95% CI: 1.368-1.962; p < 0.001 at 3 months), acute kidney injury (RR 1.615; 95% CI: 1.295-2.013; p < 0.001 at 7 days; RR 1.379; 95% CI: 1.196-1.591; p < 0.001 at 3 months), and post-TAVR sepsis (RR 1.184; 95% CI: 0.771-1.819; p = 0.439 at 30 days; RR 0.899; 95% CI: 0.667-1.211; p = 0.483 at 3 months). Ischemic stroke/TIA risk was modestly increased in unadjusted analyses but attenuated post-matching (RR 1.123; 95% CI: 0.823-1.534; p = 0.464 at 7 days; RR 1.219; 95% CI: 0.995-1.493; p = 0.056 at 3 months). Cox models showed statistically significant risk elevations for most outcomes, including heart failure exacerbation (HR 1.418; 95% CI: 1.311-1.533; p < 0.001). CONCLUSIONS: Peri-procedural RBC transfusion was associated with increased risks of mortality and complications after TAVR, with attenuation over time. These findings support consideration of restrictive transfusion strategies.
Pulmonary Artery Denervation for Refractory Sjögren's Syndrome-Associated Pulmonary Arterial Hypertension: A Case Report of Combined Hemodynamic and Renal Recovery.
Hu J, Yao F
Catheter Cardiovasc Interv · 2026 May · PMID 41800494 · Publisher ↗
A 31-year-old woman with primary Sjögren's syndrome presented with severe pre-capillary pulmonary arterial hypertension (mean pulmonary arterial pressure 51 mmHg, pulmonary vascular resistance 14.7 Wood units) and active...
A 31-year-old woman with primary Sjögren's syndrome presented with severe pre-capillary pulmonary arterial hypertension (mean pulmonary arterial pressure 51 mmHg, pulmonary vascular resistance 14.7 Wood units) and active renal impairment (24-hour urinary protein 1290 mg). Despite initial immunosuppressive therapy and dual oral PAH-targeted treatment with ambrisentan and tadalafil, she remained at high risk. She subsequently underwent pulmonary artery denervation (PADN) using a 45-mm ablation catheter with 120-second radiofrequency applications at three sites on the main pulmonary artery. At 2-month follow-up, she demonstrated significant symptomatic improvement to WHO functional class I, with a 6-minute walk distance of 320 meters, improved hemodynamics (mean pulmonary arterial pressure 35 mmHg, pulmonary vascular resistance 5.63 Wood units), and a reduced NT-proBNP level of 320 pg/mL, achieving an intermediate-low risk status according to the 2022 ESC/ERS guidelines. Renal function also improved (24-hour urinary protein 158 mg). This case suggests that PADN may be an effective adjunctive interventional strategy for refractory autoimmune PAH, even with concurrent renal involvement, facilitating simultaneous cardiopulmonary and renal recovery.
Real-World Experience With a Suprannular Self-Expanding Transcatheter Aortic Valve: The ALLOW Study.
Cruz-González I, Antúnez-Muiños P, Galeote G … +13 more , Jiménez Díaz VA, Rubio C, Trillo R, Romaguera R, Ruiz-Nodar JM, Sanz Sánchez J, Alonso-Briales JH, Gheorghe LL, Jiménez-Quevedo P, Guerreiro CE, Moreno R, Moreu J, Baz JA
Catheter Cardiovasc Interv · 2026 May · PMID 41782350 · Publisher ↗
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has evolved significantly, expanding its indication to lower surgical risk patients. However, challenges remain, including conduction disorders or paravalvular le...
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has evolved significantly, expanding its indication to lower surgical risk patients. However, challenges remain, including conduction disorders or paravalvular leak (PVL). The ALLEGRA TAVI system (Biosensors International) is a supra-annular self-expanding prosthesis designed to optimize implantation and hemodynamic performance. AIMS: The objective of this study was to analyze short-term outcomes following the implantation of the Allegra valve in real-world practice. METHODS: This multicenter retrospective study included 500 patients who underwent TAVR with the Allegra valve across 11 Spanish centers between 2017 and 2024. Success rates, complications, and 30-day clinical outcomes were analyzed. RESULTS: The median age was 82.1 ± 5.5 years. The overall success rate was 96.8% (95% CI 94.8%-98.0%), with complications in 11.6% (95% CI 8.0%-13.0%) of cases. The need for permanent pacemaker implantation (PPI) was 19.2% (95% CI 16.0%-22.9%), while moderate-to-severe PVL occurred in 4.1% (95% CI 2.7%-6.3%). The in-hospital mortality rate was 1.0% (95% CI 0.5%-2.6%). Hemodynamic performance was favorable, with post-implant mean gradients of 4.0 mmHg (IQR 2.0-5.0 mmHg) in native aortic stenosis and 7.0 mmHg (IQR 5.0-10.0 mmHg) in valve-in-valve procedures. A reduction in complications was observed, but not significantly, with increased experience (15.2% vs. 10.4%, p 0.147), though without impact on success rates. CONCLUSIONS: This study confirms that the Allegra valve is a safe and effective TAVR option, with outcomes comparable to other self-expanding prostheses. Further design optimization could reduce PVL and PPI rates. Long-term studies are needed to assess durability.
One-Year Outcomes of Drug-Coated Balloon Angioplasty With and Without the Blades-Up Function of the JETSTREAM Atherectomy Device in Femoropopliteal Calcified Lesions.
Takei T, Tokuda T, Yoshioka N … +7 more , Ogata K, Tanaka A, Kojima S, Yamaguchi K, Yanagiuchi T, Nakama T, LEADers PAD Investigators
Catheter Cardiovasc Interv · 2026 May · PMID 41773459 · Publisher ↗
BACKGROUND: The JETSTREAM atherectomy device, particularly in its blades-up mode, enables extensive debulking of calcified femoropopliteal (FP) lesions but may increase the risk of distal embolization, and its effect on...
BACKGROUND: The JETSTREAM atherectomy device, particularly in its blades-up mode, enables extensive debulking of calcified femoropopliteal (FP) lesions but may increase the risk of distal embolization, and its effect on patency after drug-coated balloon (DCB) angioplasty remains unclear. AIMS: The present study aimed to evaluate the efficacy and safety of the blades-up function in JETSTREAM-assisted DCB treatment for calcified FP lesions. METHODS: Between October 2021 and December 2024, 240 patients underwent JETSTREAM atherectomy for calcified FP lesions at eight centers in Japan. Of these, 232 who underwent DCB angioplasty alone were analyzed. Patients were stratified according to blades-up use (with or without; n = 116 each). Propensity score matching was performed to minimize baseline differences. The primary endpoint was 1-year freedom from restenosis. Secondary endpoints included 1-year freedom from clinically driven target lesion revascularization (CD-TLR), acute limb ischemia (ALI), and major amputation. Procedure-related endpoints were the minimum lumen area (MLA) at the debulked segment after DCB and the incidence of persistently impaired flow on final angiography. RESULTS: Propensity score matching yielded 56 well-balanced pairs with no significant baseline differences. One-year freedom from restenosis was similar between the non-blades-up and blades-up groups. CD-TLR, ALI, and major amputation rates were also comparable. Among patients with available intravascular imaging data (non-blades-up group, n = 45; blades-up group, n = 42), post-DCB MLA did not differ significantly. Persistent impaired flow on final angiography was infrequent and comparable between groups. CONCLUSIONS: Blades-up atherectomy did not provide additional benefits in vessel patency, clinical outcomes, or procedural results after DCB angioplasty. Routine blade-up use may not be necessary when treating calcified FP lesions. TRIAL REGISTRATION: This study was not a prospective clinical trial; therefore, it was not registered.
Sheathless Femoral Impella Implantation: A Safer Hemodynamic Support in High-Risk PCI and Cardiogenic Shock.
Lio V, Barbero U, Drago S … +5 more , Persampieri S, Beqaraj F, Benedictis M, Giammaria M, Gagnor A
Catheter Cardiovasc Interv · 2026 May · PMID 41773429 · Publisher ↗
BACKGROUND: The Impella CP percutaneous ventricular assist device is designed to provide hemodynamic support during high-risk percutaneous coronary intervention (PCI). However, its femoral insertion through the dedicated...
BACKGROUND: The Impella CP percutaneous ventricular assist device is designed to provide hemodynamic support during high-risk percutaneous coronary intervention (PCI). However, its femoral insertion through the dedicated 14 F sheath is associated with a relevant incidence of vascular and bleeding complications, especially in patients with small or diseased femoral arteries. This study aimed to evaluate the feasibility and safety of a femoral sheathless technique for Impella implantation during different clinical scenarios, with the hypothesis that avoiding the 14 F sheath may reduce vascular complications. METHODS: We prospectively enrolled 18 consecutive patients in two Italian Cathlab to receive femoral sheathless Impella CP during high-risk PCI or cardiogenic shock. In this technique, the Impella CP catheter is advanced into the femoral artery over the 0.018" guidewire without sheath insertion, and the access is secured by the Repositioning Unit. Procedural success and periprocedural outcomes were assessed. RESULTS: Sheathless Impella implantation in the femoral artery was successful in the entire cohort. PCI was completed with adequate hemodynamic support and device stability. The Impella catheter was removed percutaneously in all cases without the need for surgical repair or endovascular bailout. No major vascular complications occurred. Hemostasis was achieved with standard closure devices. CONCLUSIONS: Femoral sheathless Impella implantation is feasible and safe in this initial series of patients undergoing high-risk PCI. This technique may be useful to reduce vascular complications and could be particularly valuable in patients with small-caliber femoral arteries or increased bleeding risk. Larger prospective studies are warranted to further validate these findings.
Drug-Coated Balloons in Coronary Artery Disease: Engineering, Pharmacology, and the Mechanisms Behind Angiographic Outcomes.
Marchetta M, Paragliola V, Benedetto D … +8 more , Sasso S, Crapanzano M, Levantesi F, Bella AD, Carrillo G, Granata LG, Massaro G, Sangiorgi GM
Catheter Cardiovasc Interv · 2026 May · PMID 41773415 · Publisher ↗
Drug-coated balloon (DCB) angioplasty represents a unique drug-delivery paradigm in which all therapeutic efficacy depends on the first seconds of device-tissue interaction. Unlike drug-eluting stents (DES), DCBs must ac...
Drug-coated balloon (DCB) angioplasty represents a unique drug-delivery paradigm in which all therapeutic efficacy depends on the first seconds of device-tissue interaction. Unlike drug-eluting stents (DES), DCBs must achieve meaningful drug transfer, penetration, and retention during a single, brief inflation. This review provides a mechanistic, bench-to-bedside framework linking drug physicochemistry, excipient chemistry, coating engineering, balloon mechanics, and tissue pharmacokinetics to angiographic and clinical outcomes. Paclitaxel-based DCBs consistently outperform sirolimus-coated platforms in early drug uptake, intracellular retention, transmural distribution, and late lumen loss. These advantages derive from paclitaxel's extreme lipophilicity, particulate deposition, and high-affinity microtubule binding, which enable durable antiproliferative activity despite modest absolute transfer. Sirolimus, by contrast, requires an engineered delivery system-crystalline matrices, PLGA micro-reservoirs, nanoparticle carriers, or pressure-driven infusion-to compensate for its lower membrane permeability and reversible intracellular binding. Integrating preclinical modeling, coating-stability studies, optical coherence tomography (OCT) remodeling signatures, randomized trials, and recent meta-analyses, this review demonstrates that DCB therapy is not a drug-class effect: technology, not drug load, determines biological behavior. Early transfer efficiency, tissue retention kinetics, depth of penetration, and platform-specific dissection response fully explain the divergent angiographic patterns observed across devices. Understanding these mechanistic principles is essential for rational device selection and for guiding the next generation of DCB technologies capable of achieving consistent and durable clinical performance.
Survival Beyond the Odds: Twelve-Week Follow-Up After Conservative Management of Post-Infarction Ventricular Free Wall Rupture.
Khalaf Y, Atta S, Helal A … +1 more , Bashir A
Catheter Cardiovasc Interv · 2026 May · PMID 41772389 · Publisher ↗
BACKGROUND: Left ventricular free wall rupture (LVFWR) is a rare but often fatal complication of acute myocardial infarction. While urgent surgical repair remains the gold standard, isolated reports suggest that selected...
BACKGROUND: Left ventricular free wall rupture (LVFWR) is a rare but often fatal complication of acute myocardial infarction. While urgent surgical repair remains the gold standard, isolated reports suggest that selected hemodynamically stable patients may survive with conservative management. CASE SUMMARY: We describe a 60-year-old man who presented with an inferior STEMI after three days of chest pain. Echocardiography and CT cardiac angiography confirmed a basal inferolateral LV free wall rupture with hemopericardium and clot formation. Despite elevated lactate and angiographic evidence of right? coronary artery significant stenosis and circumflex artery-occlusion, he remained hemodynamically stable following intra-aortic balloon pump support and dual antiplatelet therapy. Given his stability and anatomical findings, a multidisciplinary team elected for non-surgical management with intensive monitoring. Serial echocardiography and repeat CT demonstrated progressive stabilization of the rupture and resolution of pericardial effusion. At 12-week follow-up, CT confirmed healed myocardial rupture with localized thinning and preserved left ventricular systolic function. DISCUSSION: This case highlights the potential for spontaneous healing in subacute LVFWR when carefully selected patients are managed conservatively. Multimodal imaging was pivotal for diagnosis, monitoring, and confirmation of healing. While surgery remains standard, non-operative strategies may represent a safe alternative in high-risk or stable patients under close multidisciplinary supervision.
Five-Year Clinical and Hemodynamic Evaluation of the Hydra Self-Expanding Transcatheter Heart Valve in Patients With Severe Aortic Stenosis.
Bajoras V, Dabrowski M, Davidavicius G … +6 more , Cesna S, Peciuraite D, Witkowski A, Stoklosa P, Sudhir K, Aidietis A
Catheter Cardiovasc Interv · 2026 May · PMID 41772370 · Publisher ↗
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become the standard treatment for most patients with severe aortic stenosis. However, data on long-term mortality and durability of transcatheter heart valves...
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become the standard treatment for most patients with severe aortic stenosis. However, data on long-term mortality and durability of transcatheter heart valves (THVs) is limited. The Hydra CE study previously reported good early- and medium-term clinical performance and safety for TAVR with Hydra self-expanding THV (Vascular Innovations Co Ltd, Nonthaburi, Thailand, a subsidiary of Sahajanand Medical Technologies Limited, India). AIMS: We herein report 5-year follow-up results from the long-term follow-up cohort of the Hydra CE study. METHODS: The Hydra CE was a prospective, multicenter, single-arm study that enrolled 157 patients. Of these, 54 patients from two participating centers (Lithuania and Poland) provided consent for extended follow-up (up to 5 years), forming the long-term follow-up cohort. These patients were monitored for up to 5 years to assess the durability and sustained performance of the device. The primary endpoint of this cohort was all-cause mortality, with patients monitored for both clinical and echocardiographic outcomes throughout the follow-up period. RESULTS: Among the 54 patients, the mean age was 81.0 ± 4.1 years. At 5-year follow-up, all-cause mortality was 24.3%, with cardiovascular deaths accounting for 6.0% of the patients. Effective orifice area increased from 0.68 ± 0.15 cm to 2.09 ± 0.57 cm (p < 0.001) and mean aortic valve gradient decreased from 53.4 ± 14.24 mmHg to 8.0 ± 3.14 mmHg at 5 years (p < 0.001). Improvement of at least one NYHA functional class from baseline to 5 years was observed in 65% of patients. New permanent pacemaker implantation rate at 5-year follow-up was 16.7%. There were no cases of valve endocarditis, thrombosis, or structural valve deterioration over 5 years. CONCLUSION: The 5-year results from the long-term follow-up cohort of the Hydra CE study established excellent valve durability and sustained hemodynamic performance. The study demonstrated favorable long-term safety and clinical performance of the Hydra THV, with acceptable survival rates at 5-year follow-up.
Annular Ellipticity and Sizing Strategy in Transcatheter Aortic Valve Implantation: Independent or Combined Risk Patterns?
Polat E, Müller L, Schemet L … +4 more , Friedrich Welz S, Amer M, Girdauskas E, Owais T
Catheter Cardiovasc Interv · 2026 May · PMID 41766256 · Full text
BACKGROUND: Elliptical annular anatomy has been considered a risk factor for adverse outcomes after TAVI, particularly paravalvular leakage (PVL). Prosthesis oversizing is thought to improve sealing, but the interaction...
BACKGROUND: Elliptical annular anatomy has been considered a risk factor for adverse outcomes after TAVI, particularly paravalvular leakage (PVL). Prosthesis oversizing is thought to improve sealing, but the interaction between annular shape and sizing strategy remains unclear. AIM: To evaluate the combined impact of annular shape and sizing strategy on procedural success and short-term outcomes. METHODS: In this retrospective single-center study, 509 patients undergoing TAVI between January 2021 and December 2024 were analyzed. Ellipticity index (EI) was defined as the ratio of maximum to minimum annular diameter on preprocedural CT. The sizing index (SI) was calculated as prosthesis diameter relative to mean annular diameter. Primary and secondary endpoints were device success and PVL ≥ mild, PPI, new-onset LBBB, and early safety. RESULTS: Mean EI and SI were 1.27 ± 0.10; 15.3% ± 12.4%. Device success was achieved in 89% and was not significantly associated with EI (aOR 0.197, 95% CI 0.013-3.309, p = 0.25). Increasing SI was associated with higher device success, although this association did not reach statistical significance (aOR 1.017, p = 0.088). Success rates peaked with moderate oversizing (6%-15%; 93%). PVL ≥ mild occurred in 30% with undersizing and 14% with optimal oversizing but showed no association with EI or SI. Heatmaps showed lower device success when high EI (> 1.32) coincided with suboptimal SI (≤ 5% or ≥ 25%). CONCLUSION: Annular ellipticity alone did not predict adverse outcomes. While exploratory analysis suggested reduced device success in patients with both high ellipticity and suboptimal sizing, no significant interaction was identified. Moderate oversizing was associated with the most favorable results.
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