Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions最新文献

{"title":"Cangrelor Dosing, Administration, and Clinical Outcomes for Patients Undergoing Complex and High-Risk Percutaneous Coronary Interventions.","authors":"Siyu Ma, Wendy Y Cheng, Yinong Liang, Josephine Bryar, Gwyneth Wei, Joshua D Niznik, Christina Yin, Sue Liu-Yi, Jimmy L Kerrigan","doi":"10.1002/ccd.70942","DOIUrl":"https://doi.org/10.1002/ccd.70942","url":null,"abstract":"<p><strong>Background: </strong>Cangrelor reduces thrombotic events in patients undergoing percutaneous coronary intervention (PCI), with the advantage of rapid onset and offset. However, premature discontinuation may increase the risk of acute thrombosis for patients undergoing complex/high-risk PCI (CHIP).</p><p><strong>Aims: </strong>We evaluated the real-world administration of cangrelor and related health outcomes for CHIP patients.</p><p><strong>Methods: </strong>A US retrospective physician panel medical chart review (1/1/2020 to 6/26/2025) included patients 18+ years old who received cangrelor (1st dose = index date) during CHIP. We summarized patients' characteristics in the 6 months pre-index (baseline), cangrelor dosing and administration (IV bolus and/or infusion), and clinical outcomes within 48 h. We described MACE occurrence by dosing adherence.</p><p><strong>Results: </strong>Patients (n = 200) were mostly male (85.5%), had a mean age of 63 years, and had a BMI of 30.2 kg/m². Most (87.5%) received a cangrelor bolus (30.0 µg/kg) and maintenance infusion (4.0 µg/kg/mins), aligned with intended use recommendations. Of patients analyzed for infusion duration (n = 134), 64.9% deviated from the recommendation of at least 2 h or PCI length. Forty (29.9%) received cangrelor for less than the recommended duration. Overall, 30 (15%) patients experienced MACE, with a higher proportion of MACE seen in those who deviated from the recommended duration (16.1% [95% CI: 3.5%-23.1%] vs. 10.6% [95% CI: 9.1%-25.5%]).</p><p><strong>Conclusions: </strong>Our study provides real-world insight into cangrelor use and clinical outcomes in CHIP patients, highlighting notable variability in infusion duration and differences in MACE occurrence by dosing adherence. Further comparative effectiveness studies are warranted to examine the potential impact of deviation from intended dose/duration on clinical outcomes in CHIP.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187522","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":"Buddy, Can You Spare a Shockwave? The Marchese Technique.","authors":"Federico Boschi, Flavio L Ribichini","doi":"10.1002/ccd.70949","DOIUrl":"10.1002/ccd.70949","url":null,"abstract":"","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169361","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":"Predictive Value of Intraoperative Transcranial Doppler Hemodynamic Monitoring for Cerebral Hyperperfusion Syndrome After Carotid Artery Stenting.","authors":"Yi Zhang, Wenying Chu, Yu Wang, Qian Yang","doi":"10.1002/ccd.70865","DOIUrl":"https://doi.org/10.1002/ccd.70865","url":null,"abstract":"<p><strong>Background: </strong>Cerebral hyperperfusion syndrome (CHS) is a potentially serious complication following carotid artery stenting (CAS). Conventional risk assessment methods may not adequately capture rapid intraoperative hemodynamic changes. Real-time transcranial Doppler (TCD) monitoring may provide valuable information for the early identification of patients at risk of CHS.</p><p><strong>Aims: </strong>To investigate the predictive value of intraoperative real-time hemodynamic monitoring using TCD ultrasonography for CHS following CAS.</p><p><strong>Methods: </strong>A total of 600 patients who underwent CAS were included. Factors associated with CHS were analyzed, and the predictive performance and clinical utility of TCD parameters measured at the T1 time point were evaluated.</p><p><strong>Results: </strong>Factors associated with CHS following CAS were identified. The combined use of TCD parameters at the T1 time point demonstrated high predictive value and substantial net clinical benefit.</p><p><strong>Conclusion: </strong>TCD parameters measured at the T1 time point may be useful for predicting CHS following CAS and guiding clinical decision-making.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168749","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":"Correction to \"Effects of a 12-Week Calisthenics Exercise Program on Physical Fitness in Adults With Obesity\".","authors":"","doi":"10.1002/ccd.70939","DOIUrl":"https://doi.org/10.1002/ccd.70939","url":null,"abstract":"","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130178","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 Lithotripsy in Left Main Stem Percutaneous Coronary Intervention.","authors":"Claudia S Cosgrove, Retesh Bajaj, Ganeev Malhotra, Francis R Joshi, Akiko Maehara, Andrew McNeice, Margaret McEntegart, Gao Ong, Novalia Sidik, Julian W Strange, Simon Walsh, Ian Webb, Simon Wilson, Jiawei Wu, James C Spratt","doi":"10.1002/ccd.70927","DOIUrl":"https://doi.org/10.1002/ccd.70927","url":null,"abstract":"<p><strong>Background: </strong>IVL is increasingly used for coronary calcium modification; however, prospective data for its use in LMS lesions are lacking.</p><p><strong>Aims: </strong>To evaluate the feasibility, safety, and mechanical efficacy of intravascular lithotripsy (IVL) for calcium modification in calcified distal left main stem (LMS) percutaneous coronary intervention.</p><p><strong>Methods: </strong>In this prospective, multicentre, open-label study across five United Kingdom centers (NCT04319666), 50 patients with obstructive distal LMS disease and IVUS-confirmed circumferential calcification (maximum calcium arc ≥ 270° in at least one segment) underwent IVL-assisted PCI. IVUS was mandated at pre-treatment, post-IVL, and post-stent timepoints with independent core laboratory analysis. Co-primary endpoints were IVUS-assessed minimum stent area (MSA) and 30-day major adverse cardiac events (MACE).</p><p><strong>Results: </strong>Fifty patients underwent IVUS-guided LMS PCI with IVL for calcium modification. Device crossing was successful in all 50 cases. Mean LMS MSA was 13.36 ± 3.20 mm² (95% CI 12.44-14.28 mm²); 84% of patients (41/49) achieved an LMS MSA exceeding 11 mm². Significant luminal gain was observed across all territories (LMS 7.19 ± 3.52 mm², p < 0.001). IVUS-visible calcium fracture was not associated with stent expansion. There were no periprocedural deaths or myocardial infarctions and no MACE at 30 days. At 12 months, MACE occurred in 4 patients (8.0%) with no stent thrombosis.</p><p><strong>Conclusions: </strong>IVL is safe and mechanically efficacious for calcium modification in severely calcified distal LMS disease, achieving stent expansion exceeding prognostically validated thresholds with favorable clinical outcomes at 12 months.</p><p><strong>Clinical trial registration: </strong>clinicaltrials.gov NCT04319666.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130165","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":"Phenotype-Based Risk Stratification in Patients With New-Onset Atrial Fibrillation Following Myocardial Infarction Using a Data-Driven Approach.","authors":"Carl Ammoury, Shivabalan Kathavarayan Ramu, Judah Rajendran, Besir Besir, Alexander Egoavil, Sada Babazade, Tamari Lomaia, Taha Hatab, Vaidehi Mendpara, Krutarth Pandya, Akhilesh Khuttan, Khaled Ziada, Jacqueline Tamis-Holland, Grant Reed, Oussama Wazni, Venu Menon, Samir Kapadia","doi":"10.1002/ccd.70923","DOIUrl":"https://doi.org/10.1002/ccd.70923","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) after myocardial infarction (MI) is associated with significant morbidity and mortality, yet existing risk stratification tools perform poorly in this population. Conventional predictors fail to capture multidimensional risk, while data-driven approaches may identify latent phenotypes with improved prognostic value.</p><p><strong>Aims: </strong>We sought to identify phenotypes of new-onset AF after MI using principal component analysis (PCA), evaluate their association with adverse outcomes, and develop a simple decision-tree model for clinical risk stratification.</p><p><strong>Methods: </strong>We analyzed 451 patients with new-onset AF after MI. PCA identified low-, intermediate-, and high-risk phenogroups. The primary endpoint was 3-year mortality, stroke, or MACE. Kaplan-Meier and multivariable Cox models assessed outcomes. Decision trees predicted phenogroup membership, with angiographic features compared across risk tiers.</p><p><strong>Results: </strong>PCA identified three phenogroups (low, intermediate, high risk) driven mainly by LVESV, LVEDV, LVEF, sex, and CHA₂DS₂-VASc. Clusters showed clear separation on PCA mapping. Event-free survival differed significantly across groups (log-rank p < 0.0001), with the lowest survival in the high-risk cluster. After multivariable adjustment for clinical risk factors, phenogroups remained independently associated with adverse outcomes. A simplified decision tree using LVEF, CHA₂DS₂-VASc, LVEDV, age, and TR Vmax predicted risk with 72.3% accuracy, supporting bedside risk stratification in post-MI AF patient populations.</p><p><strong>Conclusion: </strong>Phenomapping identified three distinct AF risk groups with different clinical outcomes. LV size and function were the strongest contributors to phenotypic separation. The decision tree offered a clear, accurate, and interpretable framework that supports a new strategy for identifying appropriate patients with AF after MI.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130201","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 Delayed Mitral Annular Remodeling Following Transcatheter Edge-to-Edge Repair: An Echocardiographic Observational Study.","authors":"Edoardo Zancanaro, Kamil Stankowski, Michele Galasso, Francesco Ancona, Paolo Denti, Giacomo Ingallina, Eustachio Agricola, Tommaso Hinna Danesi, Francesco Maisano","doi":"10.1002/ccd.70928","DOIUrl":"https://doi.org/10.1002/ccd.70928","url":null,"abstract":"<p><strong>Background: </strong>Mitral transcatheter edge-to-edge repair (M-TEER) may modify mitral annular geometry beyond leaflet approximation, but the magnitude and temporal pattern of this effect remain incompletely characterized.</p><p><strong>Aims: </strong>To assess acute and delayed changes in anteroposterior (AP) and intercommissural (IC) mitral annular diameters after M-TEER with MitraClip and to explore their association with clinical outcomes.</p><p><strong>Methods: </strong>This retrospective single-center study included 151 patients undergoing M-TEER between February 2019 and June 2023. Annular diameters were measured by transoesophageal echocardiography before intervention and by transthoracic echocardiography before discharge and at the latest available echocardiographic follow-up. The primary analysis assessed continuous absolute changes in AP and IC diameters; an acute decrease of ≥ 1 mm in either diameter was retained only as an exploratory categorization. The exploratory clinical endpoint was the composite of all-cause death or heart-failure hospitalization.</p><p><strong>Results: </strong>Median age was 78 (72-83) years, and 61% were male. From pre-intervention to discharge, AP and IC diameters decreased by 2.2 ± 3.8 and 2.3 ± 3.7 mm, respectively (both p < 0.001). Using the exploratory acute threshold, 129 patients (85.4%) had a ≥ 1 mm reduction; when categorized by the greatest reduction observed in either diameter, 16 (10.6%) had a 1 mm reduction, 16 (10.6%) a 2 mm reduction, 16 (10.6%) a 3 mm reduction, and 81 (53.6%) a > 3 mm reduction. Echocardiographic follow-up was available in 75 patients at a median of 4.7 months; the AP diameter remained stable, whereas the IC diameter showed a further reduction. During clinical follow-up, 22 patients reached the composite endpoint; acute annular reduction was not associated with a significant difference in event-free survival in exploratory analysis.</p><p><strong>Conclusions: </strong>M-TEER is associated with measurable acute changes in mitral annular dimensions, with additional delayed IC remodeling observed in a subset with follow-up imaging. Because baseline and post-procedural measurements were obtained with different echocardiographic modalities, the magnitude of the acute change should be interpreted cautiously. The prognostic relevance of annular remodeling remains hypothesis-generating.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122453","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":"Long-Term Outcomes of iFR- Versus FFR-Guided Coronary Physiology in Real-World Clinical Practice.","authors":"Diogo Ferreira, Marta Vilela, Daniel Cazeiro, Cátia Silva, Miguel Raposo, Catarina Oliveira, Tiago Rodrigues, Ana Rita Francisco, Pedro Carrilho Ferreira, Cláudia Jorge, João Silva Marques, José Duarte, José Marques da Costa, Pedro Pinto Cardoso, Fausto Pinto, Miguel Nobre Menezes","doi":"10.1002/ccd.70930","DOIUrl":"https://doi.org/10.1002/ccd.70930","url":null,"abstract":"<p><strong>Background: </strong>Fractional flow reserve (FFR) is the reference standard for invasive physiological assessment of intermediate coronary stenoses. Instantaneous wave-free ratio (iFR) was introduced as a non-hyperemic alternative, and the DEFINE-FLAIR and iFR-SWEDEHEART trials demonstrated noninferiority of iFR- versus FFR-guided management at 1 year, leading to widespread adoption of iFR. However, long-term follow-up and pooled analyses subsequently suggested higher all-cause mortality with iFR-guided assessment. We therefore compared long-term outcomes of iFR- versus FFR-guided coronary physiology assessment in real-world clinical practice.</p><p><strong>Methods: </strong>This retrospective single-center study included consecutive patients undergoing invasive physiological assessment between 2012 and 2022. Patients were managed according to FFR- or iFR-guided strategies, with revascularization performed for physiologically significant lesions and deferred otherwise. The primary endpoint was all-cause mortality. Secondary endpoints included major adverse cardiovascular events (death from any cause, myocardial infarction or unplanned revascularization), and the individual componentes of the secondary composite endpoint. Time-to-event analyses were performed using Kaplan-Meier estimates and Cox proportional hazards models.</p><p><strong>Results: </strong>A total of 1104 patients were included, comprising 428 patients in the FFR group and 676 in the iFR group. Baseline clinical characteristics were well balanced between groups. Functionally significant stenoses were less frequently identified in the iFR group (42% vs. 49%, p = 0.001), resulting in higher rates of revascularization deferral. During long-term follow-up, iFR-guided management was associated with significantly higher all-cause mortality compared with FFR-guided management (HR 1.52, 95% CI 1.19-1.93; p < 0.001). The incidence of MACE was also significantly higher with iFR (HR 1.47, 95% CI 1.19-1.82; p < 0.001), driven by mortality, with no differences in myocardial infarction or unplanned revascularization.</p><p><strong>Conclusions: </strong>In this large real-world cohort, iFR-guided coronary physiological assessment was associated with higher long-term all-cause mortality and MACE compared with FFR-guided management, while rates of myocardial infarction and unplanned revascularization were similar. These findings parallel long-term observations from randomized clinical trials and support the need for further studies evaluating the prognostic implications of resting versus hyperemic physiological indices.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122441","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":"Baseline Invasive Hemodynamics Identify Patients at Risk for Suboptimal Clinical Response After Percutaneous Atrial Septal Defect Closure.","authors":"Go Hashimoto, Kenji Makino, Yutsuki Tsukagoshi, Atsuhiro Saito, Sari Waga, Shiho Ide, Hiromasa Hayama, Hiroki Niikura, Hidehiko Hara","doi":"10.1002/ccd.70790","DOIUrl":"10.1002/ccd.70790","url":null,"abstract":"<p><strong>Background: </strong>Clinical responses after transcatheter atrial septal defect (ASD) closure are heterogeneous, and predictors of suboptimal response remain poorly defined.</p><p><strong>Aims: </strong>We aimed to determine whether pre-closure invasive hemodynamic parameters might predict clinical response after ASD closure.</p><p><strong>Methods: </strong>We retrospectively screened 223 consecutive patients undergoing percutaneous secundum ASD closure. After exclusion of 19 patients aged < 18 years, 204 adult patients were included. Clinical response was categorized as improved (n = 66), unchanged (n = 109), or suboptimal (n = 29; defined as persistent or newly apparent dyspnea and/or new initiation of diuretic therapy). Invasive hemodynamic parameters, including pulmonary capillary wedge pressure (PCWP), mean pulmonary artery pressure (mPAP), and pulmonary vascular resistance (PVR), were assessed before closure.</p><p><strong>Results: </strong>Patients with suboptimal clinical response accounted for 14.2% of the adult cohort and had higher baseline mPAP and PCWP than those with improved or unchanged response. Although PVR differed across groups, it was not independently associated with suboptimal response in the multivariable analysis. In the multivariable model, age (OR, 1.05 per year; 95% CI, 1.00-1.09; p = 0.032) and mPAP (OR, 1.10 per mmHg; 95% CI, 1.01-1.20; p = 0.025) were independently associated with suboptimal clinical response, whereas PCWP showed a borderline association. ROC analysis demonstrated moderate discriminative ability of mPAP (AUC, 0.794; 95% CI, 0.698-0.889; p < 0.001).</p><p><strong>Conclusions: </strong>Baseline invasive hemodynamic burden, particularly mPAP, was associated with suboptimal clinical response and may help identify patients at elevated risk after percutaneous ASD closure.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1386-1396"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148665431","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":"Concordance Between Randomized Controlled and Real-World Evidence for Distal Radial Access: A Structured Comparison of the DISCO RADIAL Trial and KODRA Study.","authors":"Gregory A Sgueglia, Adel Aminian, Yongcheol Kim, Juan F Iglesias, Bong-Ki Lee, Ivo Bernat, Sang Yeub Lee, Jin Bae Lee, Maarten A H van Leeuwen, Jun-Won Lee","doi":"10.1002/ccd.70832","DOIUrl":"10.1002/ccd.70832","url":null,"abstract":"<p><strong>Background: </strong>Distal radial access (DRA) has emerged as an alternative to conventional transradial access (TRA) for percutaneous coronary procedures, with potential advantages for reducing radial artery occlusion (RAO).</p><p><strong>Aim: </strong>To assess whether favorable outcomes observed in randomized trials are consistently reproduced in routine clinical practice.</p><p><strong>Methods: </strong>A structured comparative analysis was performed between the largest randomized controlled trial of DRA (DISCO RADIAL; 650 patients, 16 centers, strict selection criteria, experienced operators) and the largest real-world DRA registry (KODRA; 4977 consecutive patients, 14 centers, broader inclusion criteria, heterogeneous operator experience). Access-related outcomes were summarized using inverse variance-weighted estimates and analyzed using random-effects models to assess agreement across clinical settings, with absolute differences as the primary measure. Heterogeneity (I²) was reported descriptively.</p><p><strong>Results: </strong>Despite marked differences in study design, patient populations (body surface area 2.0 vs. 1.7 m²), and operator experience (100% vs. 70% with ≥ 100 DRA cases), concordance was remarkable. RAO at discharge was 0.18% (95% CI 0.07%-0.29%, I² = 0%). Overall crossover occurred in 6.8% (95% CI 6.1%-7.4%, I² = 0%), with same-side conventional TRA as predominant bailout (4.3%). Femoral access was required in only 1.3% of cases. No serious bleeding events occurred in either study. Minor bleeding and hematoma showed considerable heterogeneity (I² = 80%-98%), likely reflecting differences in surveillance and practice patterns. Sensitivity analyses confirmed the stability of crossover and RAO estimates.</p><p><strong>Conclusions: </strong>DRA demonstrates very low RAO rates, high procedural success, and favorable safety, with consistent performance across controlled and real-world settings, supporting its feasibility in routine clinical practice.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1640-1651"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805316","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}