Cardiovasc Revasc Med
· 2026 Mar · PMID 41951441
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BACKGROUND: Drug-coated balloon with paclitaxel was established as a standard of care for the treatment of in-stent restenosis (ISR). The efficacy and safety of sirolimus-eluting balloons compared to paclitaxel-coated is...BACKGROUND: Drug-coated balloon with paclitaxel was established as a standard of care for the treatment of in-stent restenosis (ISR). The efficacy and safety of sirolimus-eluting balloons compared to paclitaxel-coated is unknown. OBJECTIVES: The authors performed an interstudy comparison of long-term clinical outcomes of the AGENT IDE and SELUTION4ISR randomized pivotal control trials comparing the efficacy of paclitaxel-coated vs. sirolimus-eluting balloons for the treatment of in-stent restenosis. METHODS: Data from the pivotal studies of these devices was compared between the paclitaxel-coated vs. sirolimus-eluting arms for their primary endpoint the 1-year target-vessel failure (defined as a composite of cardiac death, target-vessel myocardial infarction, or ischemia-driven target vessel revascularization). RESULTS: This analysis included 615 patients, 406 in AGENT and 210 in SELUTION. There were no differences in the one-year TVF rate between the paclitaxel DCB vs. sirolimus DEB arms, 17.9% vs. 16.2%, respectively (log-rank p = 0.3). There was also no difference in the secondary endpoint of the individual components of TVF: CV death (2.9% vs. 2.0%, p = 0.45), TV-MI (7.5% vs. 7.0%, p = 0.38), or TLR (13% vs. 13%, p = 0.64). CONCLUSIONS: Both devices paclitaxel-coated balloon and sirolimus-eluting balloons have similar performance for the treatment of ISR at one year. Longer follow-up to determine if the results are sustained and similar at longer follow-up are warranted.
Suruagy-Motta RFO, Nogueira CFSC, Dexheimer da Silva L
… +11 more, Bertoli ED, Barbosa GLV, Pinto ELO, Brígido ARD, de Moraes SRR, Rosa Filho AAM, de Carvalho GD, Pileggi B, Filho EM, Stone GW, Cavalcante JL
Cardiovasc Revasc Med
· 2026 Mar · PMID 41934056
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INTRODUCTION: Transcatheter aortic valve replacement (TAVR) is frequently associated with conduction disturbances and arrhythmias, often requiring permanent pacemaker (PPM) implantation in an elderly, high-bleeding-risk...INTRODUCTION: Transcatheter aortic valve replacement (TAVR) is frequently associated with conduction disturbances and arrhythmias, often requiring permanent pacemaker (PPM) implantation in an elderly, high-bleeding-risk population. Leadless pacemakers (LPMs) reduce pocket and lead-related complications and have demonstrated noninferior safety compared with transvenous pacemakers (TVP) in non-TAVR populations. However, comparative data in the post-TAVR setting are lacking. METHODS: We systematically searched Pubmed, Cochrane, Embase, Web of Sciences and Scopus for studies comparing LPM vs. TVP following TAVR. Random effects models were used to calculate risk ratios (RRs) with 95% confidence intervals (CIs) for all-cause mortality, device-related complications, re-hospitalization and vascular access site complications. Statistical analysis was performed with R software, version 4.2.3. RESULTS: Six retrospective studies comprising 10,681 patients were included, of whom 874 (7.56%) underwent LPM implantation. Compared with TVP, LPM was associated with a significant reduction in device related complications (RR 0.46; 95% 0.25-0.83; p < 0.011) and vascular access site complications (RR 0.15; 95% CI 0.03-0.68; p = 0.011). There was no significant difference in re-hospitalization (RR 0.82; 95% CI 0.23-3.12; p = 0.76). LPM was associated with a higher risk of all-cause mortality (RR 1.61; 95% CI 1.01-2.57; p = 0.047). CONCLUSIONS: Among these six retrospective studies, LPM use following TAVR was associated with fewer device-related and vascular access complications compared with TVP, albeit with a higher risk of all-cause mortality at 2 years. However, this finding likely reflects a selection bias in non-adjusted baseline characteristics rather than device inferiority. No significant differences were observed in re-hospitalization between the two strategies. Prospective studies are required to confirm or refute these findings.
Abusnina W, Al Qaraghuli AK, Chitturi KR
… +8 more, Chaturvedi A, Verma BR, Galo J, Case BC, Ben-Dor I, Hashim HD, Mintz GS, Waksman R
Cardiovasc Revasc Med
· 2026 Mar · PMID 41916800
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The saphenous vein remains the most commonly used conduit for coronary artery bypass grafting despite its low long-term patency rate. This has prompted extensive research focused on understanding the pathophysiology of g...The saphenous vein remains the most commonly used conduit for coronary artery bypass grafting despite its low long-term patency rate. This has prompted extensive research focused on understanding the pathophysiology of graft failure and improving both short- and long-term patency. Several mechanisms of venous graft failure have been discussed in the literature, and different methods have been proposed to prevent and slow this pathological process, with the goal of improving the longevity of grafts. This review aims to provide a comprehensive overview of the novel therapies, techniques, and strategies to improve saphenous vein graft longevity after coronary artery bypass grafting.
Nakawatase S, Ichibori Y, Sotomi Y
… +3 more, Mori N, Sawa Y, Iida O
Cardiovasc Revasc Med
· 2026 Mar · PMID 41916799
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BACKGROUND: Post-percutaneous coronary intervention (PCI) abnormalities in the index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) reflect microvascular dysfunction and are associated with adverse...BACKGROUND: Post-percutaneous coronary intervention (PCI) abnormalities in the index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) reflect microvascular dysfunction and are associated with adverse clinical outcomes. Atherectomy devices (ADs) are commonly employed to optimize stent delivery and expansion in heavily calcified lesions; however, their impact on post-PCI microcirculatory indices remains uncertain. This study aimed to evaluate post-procedural IMR and CFR values in patients undergoing PCI with and without the use of ADs using the bolus thermodilution method. METHODS: Seventy-five consecutive patients with left anterior descending artery lesions underwent PCI with (AD [+], n = 42) or without (AD [-], n = 33) rotational or orbital atherectomy. IMR and CFR were assessed immediately post-procedure, and high-sensitivity cardiac troponin T levels were measured the following day. Propensity score matching was used to adjust for baseline differences. RESULTS: There were no significant differences in IMR or CFR between the AD (+) and AD (-) groups (IMR: 16.79 ± 8.02 vs. 17.90 ± 7.63, P = 0.54; CFR: 2.64 ± 2.22 vs. 3.26 ± 1.33, P = 0.14). These findings persisted after matching. However, the AD (+) group demonstrated significantly higher post-PCI troponin T levels (0.32 ± 0.40 vs. 0.12 ± 0.13 ng/ml, P = 0.003). CONCLUSIONS: Contemporary use of ADs does not appear to adversely affect post-procedural coronary microcirculatory function. Nonetheless, the observed elevation in high-sensitivity cardiac troponin T suggests that microembolization during atherectomy may contribute to subclinical localized myocardial injury.
Abdul-Kafi O, Chedid M, Ansani T
… +4 more, Nguyen J, Bergstedt S, Willet A, Gössl M
Cardiovasc Revasc Med
· 2026 Mar · PMID 41916798
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BACKGROUND: Patients with severe aortic valve stenosis and concomitant mild to moderate mitral stenosis (MS) or mitral regurgitation (MR) from mitral annular calcification (MAC) often undergo aortic valve replacement (AV...BACKGROUND: Patients with severe aortic valve stenosis and concomitant mild to moderate mitral stenosis (MS) or mitral regurgitation (MR) from mitral annular calcification (MAC) often undergo aortic valve replacement (AVR) while sparing the mitral valve. This study aimed to analyze the rate of progression of mitral valve disease in patients with MAC undergoing AVR. METHODS: A retrospective cohort study was conducted on 147 patients with MS and/or MR and MAC undergoing AVR at Allina Health in 2012-2022. The rate of progression for MR, MS, left ventricular ejection fraction (LVEF), and survival probability were assessed at a median follow-up of 2.0 (1.24-3.70) years. RESULTS: The mean age was 78 ± 10 years. Most patients were female (66%) with NYHA class III symptoms (70%) prior to AVR, and the majority underwent TAVR (93%). Most patients had MS ranging from trace to moderate range (90%) and MR ranging from trace to moderate range (91%) prior to the procedure. There was no significant change in MS or MR severity, or mortality (p = 0.47) based on MAC severity within the follow up duration. CONCLUSION: Overall, patients with MAC with moderate or less MS and/or MR and aortic stenosis had no significant change in MS or MR severity and no need for mitral valve intervention during 6 years of follow-up after AVR.
Carvalho PEP, Johnson NP, Kern M
… +15 more, Fearon WF, Seto A, Raphael CE, Smilowitz NR, Widmer RJ, Toleva O, Jeremias A, Alexandrou M, Strepkos D, Mastrodemos O, Rangan BV, Collet C, De Bruyne B, Brilakis ES, Sandoval Y
Cardiovasc Revasc Med
· 2026 Mar · PMID 41912370
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BACKGROUND: Modern coronary physiology in the cardiac catheterization laboratory has evolved from a solely wire-based approach to a broader portfolio that now includes coronary computed tomography angiography, angiograph...BACKGROUND: Modern coronary physiology in the cardiac catheterization laboratory has evolved from a solely wire-based approach to a broader portfolio that now includes coronary computed tomography angiography, angiography-derived physiology, and microcatheter-derived physiology. Limited data exists on real-world practice patterns and perspectives among interventional cardiologists. METHODS: A web-based 76-item international survey was distributed to attending interventional cardiologists via email and social media from April to July 2024. RESULTS: In total, 206 interventional cardiologists completed the survey. Respondents represented diverse global regions, with 55% based in the United States. Most operators performed both percutaneous coronary intervention (PCI) and structural interventions (34%) or only PCI (25%). Nearly all respondents (98%) had access to invasive coronary physiology tools, with non-hyperemic pressure ratios (NHPR) usage being favored over fractional flow reserve (FFR) by operators (60% vs. 40%), particularly in US centers. Pressure-wire pullback was routinely performed by 44% of operators. Angiography-derived FFR was used by 33%, with lack of access being the primary barrier to adoption. Coronary microvascular dysfunction (CMD) evaluation was performed or referred by 39%, primarily using bolus thermodilution (78%) followed by continuous thermodilution in 22%. CONCLUSIONS: This multinational survey demonstrates substantial heterogeneity and marked geographic variation in the use of modern coronary physiology tools. Although important advances have broadened the coronary physiology toolkit, their routine use remains limited and inconsistent. These findings provide valuable insights into how novel modalities are being integrated into practice, including notable geographic differences.
Galli S, Genta EO, Ventura E
… +4 more, De Martini S, Pontone G, Bonomi A, Montorsi P
Cardiovasc Revasc Med
· 2026 Mar · PMID 41876322
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BACKGROUND: Coronary vulnerable plaque (VP) identification is crucial for preventing acute events. Intravascular ultrasound with near-infrared spectroscopy (IVUS-NIRS) is a reference technique to assess plaque vulnerabil...BACKGROUND: Coronary vulnerable plaque (VP) identification is crucial for preventing acute events. Intravascular ultrasound with near-infrared spectroscopy (IVUS-NIRS) is a reference technique to assess plaque vulnerability by quantifying lipid core burden index (LCBI) and plaque burden (PB). Murray's flow ratio (μFR) and maximal radial wall strain (RWS) are new angiography-derived parameters that may stratify plaque risk profile. We aim to evaluate their ability to identify VP as defined by IVUS-NIRS. METHODS: This retrospective study included 89 lesions who underwent IVUS-NIRS. VP was defined as maxLCBI ≥325 and PB ≥70%. μFR and RWS were calculated offline. Pearson/Spearman correlations assessed relationships with IVUS-NIRS parameters. Receiver operating characteristic (ROC) curve evaluated diagnostic performance for VP. Potential confounders were included in a multivariable model. RESULTS: μFR was inversely correlated with maxLCBI (r = -0.452, p < 0.001) and PB (r = -0.276, p = 0.009). RWS was positively correlated with maxLCBI (r = 0.597, p < 0.001) and PB (r = 0.294, p < 0.001). ROC analysis revealed good accuracy for identifying VP for both μFR (AUC = 0.71) and RWS (AUC = 0.80). In multivariable analysis, RWS remained independently associated with VP, whereas μFR lost statistical significance. CONCLUSIONS: μFR and RWS were correlated with PB and maxLCBI. RWS demonstrated independent predictive ability to identify VP.
Landi A, Biscaglia S, Cuculi F
… +17 more, Erriquez A, Bossard M, Colombo A, Mangieri A, Meuwissen M, Iglesias JF, Sangiorgi G, Lipšic E, Oreglia JA, Häner JD, Paradies V, Crimi G, Milzi A, Pavon AG, Leo LA, Frigoli E, Valgimigli M
Cardiovasc Revasc Med
· 2026 Mar · PMID 41820070
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The optimal management of patients with ST-segment elevation myocardial infarction (STEMI) with large thrombus burden (LTB) undergoing primary percutaneous coronary intervention (PCI) remains unsettled. The NATURE (clini...The optimal management of patients with ST-segment elevation myocardial infarction (STEMI) with large thrombus burden (LTB) undergoing primary percutaneous coronary intervention (PCI) remains unsettled. The NATURE (clinicaltrials.gov, NCT04969471) study is a prospective, multicenter, two-arm randomized clinical trial designed to assess the safety and effectiveness of the enVast stent retriever as an adjunctive reperfusion strategy in STEMI patients with LTB undergoing primary PCI. Eligible patients consenting for trial participation are randomly allocated (1:1) to enVast-assisted mechanical thrombectomy followed by conventional PCI (experimental arm) versus standard of care (control arm). Randomization is stratified by site, time from symptom onset (≤ 3 versus >3 h) and intended use of parenteral antiplatelet agents (i.e. glycoprotein IIb/IIIa inhibitors or cangrelor). Scheduled follow-up visits take place at 30 (±7) days, 150 (±60) days, and 365 (±30) days post-randomization. The primary endpoint is the infarct size assessed by the area under the curve for creatin kinase myocardial band (CK-MB) activity. Clinical events will be adjudicated by an independent Clinical Events Committee. A central core-lab will analyse 12‑lead ECG, coronary angiography examinations, cardiac magnetic resonance imaging and echocardiography examinations. A sample size of 148 (74 per arm) STEMI patients with complete primary endpoint assessment will provide a 90% power with a two-sided 5% significance level to detect a decrease in the AUC for CK-MB by 30%. The NATURE trial is the first randomized clinical trial aimed at investigating if enVast-assisted mechanical thrombectomy as adjunctive reperfusion strategy is safe and may reduce infarct size in STEMI patients with LTB undergoing primary PCI. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT04969471.