Cardiovascular Revascularization Medicine最新文献

{"title":"One-year outcomes after hybrid DES-DCB and two-stent strategies for true distal left main bifurcation lesions: A single-center registry.","authors":"Aninka Saboe, A Fauzi Yahya, Dendi P Wahyudi, Teddy A Sihite, Chaerul Achmad, Januar W Martha, Héctor M García-García","doi":"10.1016/j.carrev.2026.09.006","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.09.006","url":null,"abstract":"<p><strong>Background: </strong>True distal left main (LM) bifurcation percutaneous coronary intervention (PCI) is technically challenging. A hybrid strategy using a drug-eluting stent (DES) in the main branch and a drug-coated balloon (DCB) in the side branch may reduce permanent metal at the bifurcation, but LM-specific data remain limited.</p><p><strong>Objectives: </strong>To describe 1-year clinical outcomes after completed hybrid DES-DCB and two-stent strategies for true distal LM bifurcation lesions and to provide an exploratory unadjusted comparison between groups.</p><p><strong>Methods: </strong>This single-center retrospective cohort registry included consecutive adults undergoing PCI for true distal LM bifurcation disease between April 2020 and December 2024. Patients were classified according to the completed index strategy: hybrid DES-DCB or two-stent PCI. The primary clinical endpoint was the 1-year composite of cardiac death or clinically driven target lesion revascularization (CD-TLR). Between-strategy comparisons were exploratory and hypothesis-generating.</p><p><strong>Results: </strong>Among 83 patients, 52 underwent hybrid DES-DCB and 31 underwent two-stent PCI; intravascular imaging was used in 77 procedures (92.8%). The primary clinical endpoint occurred in 3 of 52 hybrid patients (5.8%; 95% CI, 1.2%-15.9%) and 2 of 31 two-stent patients (6.5%; 95% CI, 0.8%-21.4%; exploratory p = 1.000). Both deaths were sudden cardiac deaths.</p><p><strong>Conclusions: </strong>This selected single-center cohort provides descriptive 1-year outcomes after completed hybrid DES-DCB and two-stent procedures. Larger prospective LM-specific studies are needed.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical circulatory support in hypertrophic cardiomyopathy with cardiogenic shock: A National Inpatient Sample analysis.","authors":"Nithila Sivakumar, Chanokporn Puchongmart, Camila Padovese, Tulaton Sodsri, Ben Thiravetyan, Dina Soliman, Thitiphan Srikulmontri, Valmiki Maharaj","doi":"10.1016/j.carrev.2026.09.010","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.09.010","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock in patients with obstructive hypertrophic cardiomyopathy (HCM) is highly lethal. Temporary mechanical circulatory support (MCS), including percutaneous ventricular assist devices such as Impella and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), is increasingly used in refractory cardiogenic shock. However, data regarding outcomes in this population remain limited.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using the National Inpatient Sample from 2016 to 2022. All adult patients with obstructive HCM complicated by cardiogenic shock were included and stratified by temporary MCS use. Survey-weighted multivariable regression evaluated the association between MCS use and in-hospital mortality, length of stay, and total hospital charges.</p><p><strong>Results: </strong>A total of 4610 obstructive HCM hospitalizations with cardiogenic shock were identified; 280 (6.1%) underwent temporary MCS, most commonly VA-ECMO. MCS recipients were younger (58.2 vs 64.6 years, p < 0.01) and less frequently female (46.4% vs 61.0%, p = 0.03). In-hospital mortality was higher with MCS (42.9% vs 22.0%, p < 0.01). After multivariable adjustment, MCS remained independently associated with in-hospital death (aOR 2.88, 95% CI 1.46-5.69) and with higher total hospital charges (adjusted β $391,783, 95% CI $173,936-$609,631), but not with length of stay (β 5.5 days, 95% CI -1.3 to 12.2).</p><p><strong>Conclusions: </strong>In obstructive HCM complicated by cardiogenic shock, temporary MCS was associated with higher in-hospital mortality and substantially higher resource utilization. These findings likely reflect the greater severity of illness among patients selected for MCS rather than treatment-related harm.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of photon-counting detector CT for detection of coronary in-stent restenosis.","authors":"Karl Aramouni, Chloe Kharsa, Patrick Sarkis, Alpesh R Shah, Waleed Ahmed","doi":"10.1016/j.carrev.2026.09.009","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.09.009","url":null,"abstract":"<p><strong>Background: </strong>Photon-counting detector computed tomography (PCD-CT) offers improved spatial resolution and reduced blooming artifacts compared with conventional CT, potentially improving visualization of coronary stents. We evaluated the diagnostic performance of PCD-CT for detecting significant coronary in-stent restenosis (ISR) using invasive coronary angiography (ICA) as the reference standard.</p><p><strong>Methods: </strong>This retrospective, single-center diagnostic-accuracy study included consecutive adults with prior coronary stenting who underwent clinically indicated PCD-CT followed by ICA between February 2025 and January 2026. The primary outcome was the diagnostic performance of PCD-CT for detecting significant ISR, defined as >50% luminal diameter stenosis, on a per-stent basis. Secondary analyses evaluated patient-level performance and exploratory differences according to stent diameter, length, and location.</p><p><strong>Results: </strong>The study included 52 patients (mean age, 70.5 ± 9.7 years; 83% male) with 69 evaluated stents. Significant ISR was present on ICA in 16 stents. PCD-CT correctly identified 12 of 16 stents with ISR and excluded ISR in 44 of 53 stents without ISR, corresponding to a sensitivity of 75.0%, specificity of 83.0%, positive predictive value of 57.1%, negative predictive value of 91.7%, and area under the curve (AUC) of 0.79 (95% CI, 0.67-0.91). Patient-level sensitivity was 86.7%, specificity was 85.7%, and AUC was 0.86 (95% CI, 0.76-0.97). Diagnostic performance was numerically higher in stents ≥3 mm than in stents <3 mm (AUC, 0.82 versus 0.71), although the difference was not statistically significant (P = 0.42).</p><p><strong>Conclusion: </strong>PCD-CT demonstrated promising diagnostic performance and a high negative predictive value for detecting significant coronary ISR. Its potential utility for excluding ISR, including in smaller stents, warrants validation in larger prospective multicenter studies using standardized acquisition protocols.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"More hypoattenuated thickening but better sealing after WATCHMAN FLX Pro: Healing or Thrombosis?","authors":"Teruhiko Imamura","doi":"10.1016/j.carrev.2026.09.008","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.09.008","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Laser disappointments.","authors":"On Topaz","doi":"10.1016/j.carrev.2026.09.005","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.09.005","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PCI in patients who had been referred for coronary bypass surgery.","authors":"Spencer B King","doi":"10.1016/j.carrev.2026.09.004","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.09.004","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness and safety of carotid endarterectomy, carotid stenting, and optimal medical therapy across symptomatic and asymptomatic carotid stenosis: An updated network meta-analysis of randomized controlled trials.","authors":"Carolina Hoyos, Stefan Milutinovic, Naveed A Delrooz, Abigail Morse, Allen Gee, Cristina Sanina, Arthur Tarricone, Karlo A Wiley, Allison Anker, Aabha Divya, Zach Rozenbaum, Caroline Zahm, Pedro Cox, Krishna Allam, Pedro Villablanca, Jamil Borgi, Sasha Vukelic, Prakash Krishnan, Han Feng, Tiffany W Liu, Serdar Farhan, Jose Wiley","doi":"10.1016/j.carrev.2026.09.001","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.09.001","url":null,"abstract":"<p><strong>Background: </strong>Carotid stenosis is a major risk factor for ischemic stroke. While carotid endarterectomy (CEA) has historically been the standard of care, carotid artery stenting (CAS) has emerged as a less invasive alternative. However, management remains controversial, particularly in the context of contemporary optimal medical management (OMT).</p><p><strong>Methods: </strong>We conducted a systematic review and network meta-analysis of randomized controlled trials (RCT) comparing CAS, CEA, and/or OMT in patients with asymptomatic or symptomatic carotid stenosis. The primary composite outcome was early stroke or death (≤44 days) and ipsilateral stroke during follow-up. Random-effects models were used to estimate pooled relative risks with 95% confidence intervals. Treatment ranking was assessed using surface under the cumulative ranking curve (SUCRA) probabilities.</p><p><strong>Results: </strong>Nineteen RCTs were included. Most studies compared CEA vs. CAS or CEA vs. OMT, whereas only two RCTs directly compared CAS with OMT. For the primary outcome, CEA was associated with a lower risk compared with CAS in both asymptomatic (RR 0.72, 95% CI 0.54-0.96) and symptomatic patients (RR 0.59, 95% CI 0.43-0.82). In asymptomatic patients, comparisons between CEA and OMT did not reach statistical significance (RR 0.65, 95% CI 0.41-1.04). The CAS vs. OMT comparison was limited by sparse direct evidence (RR 0.91, 95% CI 0.57-1.44). Ranking analysis identified CEA as the highest-ranked treatment strategy across both populations (SUCRA 99.66-100%).</p><p><strong>Conclusions: </strong>CEA was associated with a lower risk of the composite outcome compared with CAS in both symptomatic and asymptomatic patients. Although comparisons between revascularization strategies and OMT in asymptomatic patients did not reach statistical significance, point estimates and ranking analyses consistently favored CEA. These findings should be interpreted in the context of limited direct randomized evidence, particularly for CAS versus OMT comparisons.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravascular ultrasound (IVUS)-guided angioplasty for femoropopliteal (FP) peripheral artery disease: A Meta-analysis of its mid-term efficacy.","authors":"Sania Zahrani, Rifqi Rizkani Eri, Muhammad Maulana Wildani, Suci Indriani, Ruth Grace Aurora, Taofan Taofan, Suko Adiarto, Iwan Dakota","doi":"10.1016/j.carrev.2026.09.003","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.09.003","url":null,"abstract":"<p><strong>Introduction: </strong>Intravascular ultrasound (IVUS)-guided femoropopliteal (FP) angioplasty has emerged as a promising imaging-guided strategy in clinical practice. However, current evidence remains heterogeneous, and recently, two randomized controlled trials (RCTs) have provided additional insights into its efficacy. This meta-analysis aims to reevaluate the efficacy of IVUS-guided angioplasty for FP lesions and to better clarify its clinical impact.</p><p><strong>Methods: </strong>Four databases were systematically searched for studies comparing IVUS-guided angioplasty to angiography-only in FP lesions. Study quality was assessed using the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. Meta-analysis was performed using an inverse-variance random-effects model using Rstudio version 2024.09.01.</p><p><strong>Results: </strong>Six high quality studies were included (n = 1544 patients). The risk for primary patency and freedom of clinically driven-target lesion revascularization(cd-TLR) at 1 year was significantly higher in the IVUS-guided group compared to the angiography group (RR 1.27 (95%CI 1.13-1.42, I² = 58.6%) and RR 1.10 (95%CI 1.01-1.20, I² = 56.8%), respectively), but no significant difference was observed in freedom of amputation and mortality (RR 1.00 (95%CI 0.98-1.01, I2 = 0%) and RR 1.06 (95%CI 0.67-1.70, I2 = 0%), respectively).</p><p><strong>Conclusion: </strong>IVUS-guided FP angioplasty improves primary patency and reduced cd-TLR rates. Further studies with longer follow-up duration should be the research focus in order to understand the long-term efficacy.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult congenital heart disease in the Adult Cath Lab: Proceedings from the 2026 CRT meeting.","authors":"Georges Ephrem, Abdul Moiz Hafiz, John T Saxon, Eric Horlick, Srinivasa Potluri, Allison Tsao, Harsimran Singh, Joanna Ghobrial, C Huie Lin, John D Serfas, Shamane Kimara March","doi":"10.1016/j.carrev.2026.09.002","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.09.002","url":null,"abstract":"<p><p>The U.S. adult congenital heart disease (ACHD) population now exceeds 2 million, outnumbering children with congenital heart disease (CHD). As these patients age, the complex sequalae of their childhood surgeries have led to an increase in need for novel and complex transcatheter procedures to be developed and performed in the adult cardiac catheterization lab. Building upon the success of the inaugural session at CRT 2025, the Adult Congenital Heart Disease in The Adult Cath Lab session at CRT 2026 set a new milestone in the ongoing effort to bridge the educational gap in caring for patients with ACHD. It covered a broad spectrum of topics, ranging from simple to complex pathologies, and included novel techniques and management options. The session set the stage for continued education in this fascinating and advancing field. It also outlined the challenges in management and need for expertise to care for this ever-increasing population of complex patients. Highlighted as well was the need to strengthen networks and improve legislation so providers can deliver the best quality long-term care.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of surgical aortic valve replacement with coronary artery bypass grafting versus transcatheter aortic valve replacement with percutaneous coronary intervention.","authors":"Dharmindra Dulal, Ahmed Maraey, Vahid Yazdi, Juan Carlo Avalon, Cezar Iliescu, Mehmet Cilingiroglu, Konstantinos Marmagkiolis, Konstantinos Dean Boudoulas","doi":"10.1016/j.carrev.2026.08.019","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.08.019","url":null,"abstract":"<p><strong>Background: </strong>Aortic stenosis (AS) often coexists with coronary artery disease (CAD). Although transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) is frequently performed, comparative data with surgical aortic valve replacement (SAVR) with coronary artery bypass grafting (CABG) remain limited. This study compared outcomes of TAVR plus PCI versus SAVR plus CABG in patients with severe AS and CAD.</p><p><strong>Methods: </strong>Data were obtained from the TriNetX Research Network, a large real-world retrospective database. Patients undergoing TAVR plus PCI or SAVR plus CABG between January 2015 to December 2022 were identified. After propensity score matching, 2483 patients were included in each group. Thirty-day outcomes included all-cause mortality, stroke, and permanent pacemaker (PPM) implantation. In addition, all-cause mortality at 1 and 3 years was determined.</p><p><strong>Results: </strong>At 30 days, SAVR plus CABG was associated with higher all-cause mortality (4.2% vs 2.7%; p = 0.005) and higher incidence of stroke (5.5% vs 3.8%, p = 0.003) compared to TAVR plus PCI; however, PPM was lower in SAVR plus CABG (5.2% vs. 8.4%; p < 0.001). At 1-year, all-cause mortality was similar between SAVR plus CABG and TAVR plus PCI (10.4% vs. 11.1% [p = 0.70], respectively). At 3 years, SAVR plus CABG demonstrated lower all-cause mortality compared with TAVR plus PCI (18.7% vs 26.2%; p < 0.001).</p><p><strong>Conclusion: </strong>In patients with severe AS and CAD, SAVR with CABG is associated with higher short term all-cause mortality and stroke with lower PPM implantation compared to TAVR with PCI. Despite worse early outcomes, SAVR with CABG demonstrated superior long-term survival at 3 years.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}