Cardiovascular Revascularization Medicine最新文献

{"title":"Percutaneous transaxillary arterial access for closure of post-infarction ventricular septal defect","authors":"Siu-Fung Wong,&nbsp;Mehdi Eskandari,&nbsp;James Cockburn,&nbsp;Christopher Broyd,&nbsp;Joao Ferreira-Martins,&nbsp;Huda Abu-Own,&nbsp;Andrew Hill,&nbsp;Arionilson Gomes,&nbsp;Jonathan Byrne,&nbsp;David Hildick-Smith","doi":"10.1016/j.carrev.2025.12.011","DOIUrl":"10.1016/j.carrev.2025.12.011","url":null,"abstract":"<div><h3>Background</h3><div>Post-infarction ventricular septal defect (PiVSD) is a rare but fatal complication of myocardial infarction (MI). Percutaneous closure via conventional venous access and venoarterial rail increases procedural complexity and time, exerts strain on surrounding septal tissue, and results in device angulation. Whilst such drawbacks can be mitigated with the transaxillary arterial approach, the acute safety and long-term efficacy are unreported.</div></div><div><h3>Methods</h3><div>We included all patients undergoing percutaneous transaxillary transarterial PiVSD closure in two large tertiary centres in England from April 2020 to May 2025. Procedural data, periprocedural, in-hospital and 1-year mortality were determined through review of local and national electronic records.</div></div><div><h3>Results</h3><div>Nine patients with comorbid cardiogenic shock were included. The median duration from MI to PiVSD closure was 4 (interquartile range 3–11) days. Right axillary access was used in all cases. The device implanted was either a 24 mm Amplatzer P.I. Muscular VSD Occluder or a larger Amplatzer Septal Occluder (Abbott, USA) necessitating an 80 cm 12F introduction sheath. Closure of the PiVSD was technically successful in all patients with reduction of the interventricular shunt to mild or less in eight of them. One patient died periprocedurally due to device erosion and cardiac tamponade. In-hospital death occurred in seven patients (77.8 %), in five of whom (55.6 %) death was attributed to cardiovascular causes. The two surviving patients had no further adverse events during 36 months of follow-up.</div></div><div><h3>Conclusion</h3><div>Transaxillary access is a technically reasonable approach for transarterial PiVSD closure. Periprocedural mortality is acceptable in a severely sick population. Survivors to discharge do well on longer-term follow-up.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"89 ","pages":"Pages 14-20"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846875","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":"Letter to the editor on “Examining the relationship between monocytes and monocyte-derived ratios in post-percutaneous coronary intervention patients and their impact on coronary artery disease progression”","authors":"Ankur Sharma,&nbsp;Varshini Vadhithala,&nbsp;Arun Kumar,&nbsp;Sushma Verma,&nbsp;Sushma Narsing Katkuri","doi":"10.1016/j.carrev.2025.12.010","DOIUrl":"10.1016/j.carrev.2025.12.010","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"89 ","pages":"Pages 97-98"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800780","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":"Expert perspectives on de-escalation of antiplatelet therapy – Beyond the Guidelines: Insights from the Cardiovascular Research Technologies 2026 meeting","authors":"Jason Galo,&nbsp;Matías Rodríguez Granillo,&nbsp;Pablo M. Rubio,&nbsp;Omar Mhaimeed,&nbsp;Adnan Kastrati,&nbsp;Sanjay Kaul,&nbsp;Usman Baber,&nbsp;C. Michael Gibson,&nbsp;Konstantinos Marmagkiolis,&nbsp;Manoj Kesarwani,&nbsp;Itsik Ben-Dor,&nbsp;Ron Waksman","doi":"10.1016/j.carrev.2026.06.009","DOIUrl":"10.1016/j.carrev.2026.06.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor remains foundational following percutaneous coronary intervention (PCI), yet prolonged exposure carries cumulative bleeding risk. Growing evidence supports shorter DAPT durations followed by P2Y12 inhibitor monotherapy, prompting re-evaluation of when, how, and with which agent to de-escalate. Despite evolving data, significant gaps and guideline divergence persist.</div></div><div><h3>Methods</h3><div>An expert panel convened at the 2026 Cardiovascular Research Technologies (CRT) conference synthesized contemporary evidence on antiplatelet de-escalation after PCI. This narrative state-of-the-art review prioritized randomized controlled trials, individual patient data meta-analyses, and current ACC/AHA and ESC guidelines. Evidence identification was informed by author expertise and structured review of landmark trials; a formal systematic search was not performed.</div></div><div><h3>Results</h3><div>Key areas of convergence and controversy were identified across six domains: choice of single antiplatelet therapy (SAPT) following DAPT, optimal timing of de-escalation, the preferred P2Y12 inhibitor for monotherapy, the evidentiary basis for guideline recommendations, long-term SAPT beyond one year, and antithrombotic management in patients with concomitant atrial fibrillation. The panel found strong evidence favoring P2Y12 inhibitor monotherapy, preferably clopidogrel, over aspirin as post-DAPT maintenance therapy, and supported a de-escalation window of 1–3 months after PCI. Methodological limitations of existing non-inferiority trials were identified as barriers to assigning the highest evidence classification to ticagrelor monotherapy. In patients with atrial fibrillation, early aspirin discontinuation with continuation of a direct oral anticoagulant plus clopidogrel was endorsed as the preferred strategy.</div></div><div><h3>Conclusions</h3><div>The evidence supports a fundamental shift from traditional “aspirin for life” paradigms toward individualized, P2Y12-based de-escalation strategies following PCI. Although ticagrelor monotherapy is reasonable after 1–3 months of DAPT in select patients, expert consensus was not achieved on the level of recommendation endorsed by the 2025 ACC/AHA guidelines. Future research should address high-risk subgroups, refine genotype-guided approaches, and evaluate the long-term comparative effectiveness of available de-escalation strategies.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"89 ","pages":"Pages 1-13"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438447","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":"Learning from uncertainty","authors":"Spencer B. King III","doi":"10.1016/j.carrev.2026.07.006","DOIUrl":"10.1016/j.carrev.2026.07.006","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"89 ","pages":"Pages 103-104"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438486","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: Transcatheter repair and mechanical circulatory support device for mitral regurgitation with shock","authors":"Subrata Kar","doi":"10.1016/j.carrev.2026.06.014","DOIUrl":"10.1016/j.carrev.2026.06.014","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"89 ","pages":"Pages 85-86"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354191","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":"Re: Impact of flow on outcomes in patients with left ventricular systolic dysfunction undergoing TAVR.","authors":"Çağrı Zorlu, Veli Akın","doi":"10.1016/j.carrev.2026.06.022","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.06.022","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649505","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-guided versus angiography-guided percutaneous coronary intervention for complex coronary lesions: A systematic review and meta-analysis.","authors":"Zixiang Ye, Ximena S Paredes, Roberto Diletti, Luca Testa, Joost Daemen, Jose M de la Torre Hernandez, Kefei Dou, Adrian P Banning, Ernest Spitzer","doi":"10.1016/j.carrev.2026.07.019","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.07.019","url":null,"abstract":"<p><strong>Background: </strong>Previous meta-analyses have suggested that intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) reduces the risk of adverse outcomes compared with angiography-guided PCI in patients with coronary artery disease. However, several large-scale randomized controlled trials published recently have provided new evidence, necessitating an updated evaluation.</p><p><strong>Objectives: </strong>This updated meta-analysis aimed to compare the clinical effects of IVUS-guided PCI versus angiography-guided PCI in patients with complex coronary artery lesions.</p><p><strong>Methods: </strong>Randomized controlled trials (RCTs) comparing IVUS-guided PCI with angiography-guided PCI in patients with complex coronary anatomy were systematically searched in PubMed/MEDLINE, EMBASE, and the Cochrane Library. A random-effects model was used to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Sensitivity analyses and publication bias assessments were performed. The primary outcome was cardiac death. Secondary outcomes included all-cause death, myocardial infarction, stent thrombosis, any repeat revascularization, target lesion revascularization, and target vessel revascularization.</p><p><strong>Results: </strong>A total of 12 RCTs comprising 7089 patients were included, with a weighted mean follow-up of 18.0 months (range 12-24 months). Compared with angiography-guided PCI, IVUS-guided PCI was not associated with significant reductions in cardiac death (RR 1.02, 95% CI 0.76-1.38, P = 0.870), all-cause death (RR 0.97, 95% CI 0.77-1.22, P = 0.800), or myocardial infarction (RR 0.90, 95% CI 0.71-1.15, P = 0.370). However, IVUS guidance significantly reduced definite stent thrombosis (RR 0.31, 95% CI 0.12-0.77, P = 0.010), any repeat revascularization (RR 0.67, 95% CI 0.51-0.88, P = 0.007), target lesion revascularization (RR 0.73, 95% CI 0.55-0.97, P = 0.031), and target vessel revascularization (RR 0.70, 95% CI 0.52-0.95, P = 0.039). These revascularization benefits were attenuated and no longer statistically significant after trim-and-fill adjustment for potential publication bias.</p><p><strong>Conclusions: </strong>In patients undergoing PCI for complex coronary artery lesions, IVUS-guided PCI did not reduce the incidence of cardiac death, all-cause death, or myocardial infarction compared with angiography-guided PCI. It was, however, associated with lower rates of definite stent thrombosis and repeat revascularization, although these benefits were sensitive to potential publication bias and largely driven by contemporary trials. These results support the selective use of IVUS-guidance for treatment of complex coronary lesions and call for further studies to optimize its use.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680565","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":"Supersaturated oxygen therapy after primary PCI in anterior STEMI: Current evidence and clinical uncertainties.","authors":"Jakub Juszczyk, Łukasz Kołtowski, Daria Valipur Kolti, Maria Juszczyk","doi":"10.1016/j.carrev.2026.07.017","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.07.017","url":null,"abstract":"<p><p>Even with timely reperfusion using primary percutaneous coronary intervention (PCI), patients with anterior ST-elevation myocardial infarction (STEMI) continue to remain at high risk of adverse outcomes, largely related to infarct size and microvascular injury. Supersaturated oxygen (SSO₂) therapy has been proposed as a catheter-based adjunctive strategy aimed at improving myocardial oxygen delivery following reperfusion in anterior STEMI. This narrative review evaluates current evidence on SSO₂, focusing mainly on its impact on infarct size, microvascular obstruction and on left ventricular ejection fraction (LVEF). Evidence regarding LVEF remains limited and somewhat inconsistent, with most findings coming from relatively small studies. In contrast, improvements in microvascular parameters such as microvascular obstruction (MVO), lower index of microcirculatory resistance (IMR) and myocardial salvage index (MSI), suggest that the benefit of SSO₂ therapy may be greatest in patients with impaired microvascular function. However, these improvements in surrogate markers have not translated into consistent reductions in major adverse cardiovascular events (MACE) or mortality. Overall, SSO₂ therapy represents a promising adjunct in anterior STEMI, but its clinical value remains uncertain. Further large-scale randomized trials are needed to define its role in routine practice.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707978","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":"Contemporary trends, predictors, and outcomes of pulmonary artery catheter use in heart failure-related cardiogenic shock.","authors":"Anas Alahmad, Majd Al-Ahmad, Laith Alhuneafat, Quang Le, Nisreen Hamawi, Mahmoud Shaaban Abdelgalil, Ishaq Khoury, Jimmy Saleh, Rhiannon Olivarez-Kidwell, Own Khraisat, Mohannad Al-Ahmad, Isabelle Beaudoin, John A Ambrose","doi":"10.1016/j.carrev.2026.07.016","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.07.016","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary artery catheterization (PAC) has re-emerged as a hemodynamic phenotyping tool in heart failure-related cardiogenic shock (HF-CS). Contemporary national data on PAC utilization, practice patterns, and outcomes remain limited. We evaluated temporal trends, predictors, and outcomes of PAC use in HF-CS without acute coronary syndrome.</p><p><strong>Methods: </strong>Using the National Inpatient Sample (2016-2022), we identified adult hospitalizations with cardiogenic shock excluding acute coronary syndrome. PAC was the primary exposure. The primary outcome was in-hospital mortality. Secondary outcomes included complications, length of stay, and hospital charges. Survey-weighted multivariable regression evaluated predictors and outcomes. Four sensitivity analyses were performed, excluding coded coronary artery disease, mechanical circulatory support, pulmonary hypertension, and durable left ventricular assist device (LVAD) implantation or heart transplantation during the index admission.</p><p><strong>Results: </strong>Among 17,480 weighted hospitalizations (unweighted n = 3496), 2655 (15.2%) underwent PAC. Utilization more than doubled from 9.9% in 2016 to 21.3% in 2022 (P for trend <0.001). After adjustment, PAC was associated with lower in-hospital mortality (aOR 0.67, 95% CI 0.54-0.83), but longer stay (+2.4 days), higher charges (+$65,075), higher rates of acute kidney injury (aOR 1.55) and mechanical circulatory support (aOR 1.69). Strongest predictors included urban teaching status (aOR 2.69), large hospital size (aOR 1.89), HFrEF (aOR 1.45), and pulmonary hypertension (aOR 1.86). The mortality association persisted across all four sensitivity analyses, including after excluding durable LVAD/transplant patients (SA4: aOR 0.74; 95% CI 0.59-0.92; P = 0.008), with aORs ranging from 0.58 to 0.74 (all P ≤ 0.010). In subgroup analysis, PAC was independently associated with lower mortality in the HFrEF phenotype (aOR 0.80; 95% CI 0.68-0.92; P = 0.006); the HFpEF subgroup was underpowered for formal inference.</p><p><strong>Conclusions: </strong>PAC use in HF-CS more than doubled from 2016 to 2022, remained concentrated at large urban teaching hospitals, and was independently associated with lower in-hospital mortality across four sensitivity analyses, including after excluding LVAD/transplant patients, supporting prospective evaluation of PAC-guided management in HF-CS.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702520","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":"Acute and late relocation of minimal lumen area after implantation of a magnesium-based bioresorbable scaffold.","authors":"Julie Grønbech, Kirstine Nørregaard Hansen, Jens Trøan, Christian Alexander Christensen, Mikkel Hougaard, Lisette Okkels Jensen","doi":"10.1016/j.carrev.2026.07.014","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.07.014","url":null,"abstract":"<p><strong>Background: </strong>Minimal lumen area (MLA) relocation occurs when the smallest cross-sectional area in a treated coronary artery segment shifts location after percutaneous coronary intervention (PCI).</p><p><strong>Aim: </strong>To investigate acute and late MLA relocation after Magnesium based bioresorbable scaffold (MgBRS) implantation, compare lumen, scaffold, plaque, and vessel dimensions in patients with and without MLA shift using optical coherence tomography (OCT) and intravascular ultrasound (IVUS), while also identifying predictors of MLA relocation.</p><p><strong>Methods: </strong>In a substudy of the Optimal Pre-dilatation Treatment before Implantation of a Magmaris bioresorbable scaffold in coronary artery Stenosis (OPTIMIS) trial, 74 patients with stable angina undergoing PCI with MgBRS were evaluated with serial OCT and IVUS imaging. MLA was assessed pre-procedure, post-procedure, and at 6-month follow-up. Relocation was defined as axial MLA shift and classified as acute (pre- to post-procedure) or late (post-procedure to follow-up).</p><p><strong>Results: </strong>Acute MLA relocation occurred in 46 (62.2%) patients, of whom 26 (56.5%) also experienced late relocation. Patients with acute relocation had larger post-procedural lumen volumes (183.9 mm³ ± 48.0 vs 137.1 mm³ ± 51.2, p < 0.001) and scaffold volumes (177.2 ± 46.4 vs 133.8 ± 41.6, p < 0.001) compared to patients without acute MLA relocation. Larger lumen and scaffold volumes persisted at follow-up. MLA was more often located at the scaffold edge in patients with acute relocation compared to patients without acute MLA relocation (23 (50.0%) vs 1 (3.6%), p < 0.001). At 6-month follow-up, the MLA was located at the scaffold edge in 30.4% of patients with late relocation versus 46.4% without late relocation (p = 0.15). No independent predictors of acute nor late MLA relocation were found.</p><p><strong>Conclusion: </strong>Acute and late MLA relocation were common after MgBRS implantation. In patients with acute relocation, MLA was more often located at the scaffold edge at post-procedure compared to patients without acute relocation.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670870","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}