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

{"title":"Beyond the Valve: A Tailored Distal Snaring Strategy for Complex Arterial and Venous Nose Cone Entrapment During Transfemoral TAVI and TricValve Implantation.","authors":"Adrien Jossart, Ignacio Amat Santos, Sara Blasco Turrion, Marouane Boukhris, Jacques Auslender, Giuseppe Colletti, Raphael Soetens, Mihai Cocoi, Claudiu Ungureanu","doi":"10.1002/ccd.70934","DOIUrl":"https://doi.org/10.1002/ccd.70934","url":null,"abstract":"<p><p>Nose cone entrapment is a rare but potentially serious complication of structural heart interventions. Most cases have been reported during transcatheter aortic valve implantation (TAVI), typically related to heavy left ventricular outflow tract (LVOT) calcification, severe annular angulation, or under-expansion of the valve frame. Entrapment within vascular structures is much less common. We describe two unusual cases. The first involved femoral artery entrapment of the Evolut PRO+ nose cone due to a ProGlide suture knot, managed with a distal snaring technique but complicated by vascular injury requiring covered stent implantation. The second occurred during heterotopic caval valve implantation (TricValve system), in which interference from a prominent Eustachian valve was suspected to have contributed to venous entrapment and dislodgement of the delivery system nose cone. This was successfully retrieved en bloc with an EN Snare without vascular complications. These cases highlight that nose cone entrapment is not limited to valvular structures and may also occur in arterial or venous vasculature, with different mechanisms and bailout strategies.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122448","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":"Interaction of Operator-Patient Sex on Peri-Procedural Treatments and Major Coronary Outcomes After Percutaneous Coronary Intervention.","authors":"Sharon A Ayayo, Vicky P Taxiarchi, Angela Jerath, Evangelos Kontopantelis, Sonya N Burgess, Sarah Zaman, Mamas A Mamas","doi":"10.1002/ccd.70799","DOIUrl":"10.1002/ccd.70799","url":null,"abstract":"<p><strong>Background: </strong>There are limited data evaluating the association between operator-patient sex, and outcomes in patients undergoing percutaneous coronary intervention (PCI).</p><p><strong>Methods: </strong>We included 138,112 consecutive PCI procedures in patients presenting with acute coronary syndrome (ACS) in England and Wales, 2017-2020. Primary endpoints of in-hospital major adverse cardiovascular and cerebrovascular events (MACCE), and mortality were assessed. Risk ratios (RR) estimated independent associations of patient sex and patient-operator sex with peri-procedural treatment and outcomes.</p><p><strong>Results: </strong>Female patients had a 10% higher risk of MACCE [95% CI: 1.04, 1.16], and a 14% higher risk of in-hospital mortality than male patients [95% CI: 1.07, 1.21]. Male operators undertook the vast majority of PCI procedures; 130,604 (94.6%). Patient sex-based differences in outcomes were not present for female operators but were statistically significant amongst male operators. Risk-adjusted data found that, when treated by male operators, female patients experienced higher MACCE and mortality rates than male patients (4.1% vs. 3.7%; RR: 1.11 [95% CI: 1.05,1.18] and 3.1% vs. 2.7%; RR: 1.15 [95% CI: 1.08, 1.22] respectively). When treated by female operators, female patients experienced numerically lower MACCE rates than male patients (4.0% vs. 4.3%; RR:0.93 [95% CI: 0.72, 1.14] and similar mortality rates (2.9% vs. 2.9%; RR:1.01 [95% CI: 0.75, 1.26]). Operator-patient sex discordance was associated with lower transradial PCI (RR: 0.96 [95% CI: 0.95, 0.96]), lower prasugrel use (RR: 0.88 [95% CI: 0.82, 0.94]), higher MACCE (RR: 1.12 [95% CI: 1.06, 1.18]) and mortality (RR: 1.14 [95% CI: 1.07,1.21]) compared with operator-patient sex concordance.</p><p><strong>Conclusions: </strong>Female patients experienced higher risk-adjusted mortality than male patients; while outcomes appeared less favorable among those treated by male operators, this finding should be interpreted cautiously given the limited precision for female operators.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1520-1528"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13667334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Flow in Hypertrophic Obstructive Cardiomyopathy-Immediate Effects of Alcohol Septal Ablation.","authors":"Vojko V Misevic, Ana N Golocevac, Kosta S Krupnikovic, Stefan B Timcic, Natalija B Arnautovic, Dragana D Radoicic, Milan R Dobric, Aleksandar D Mandic, Stefan S Zivkovic, Aleksa D Obradovic, Vladimir D Mihajlovic, Natalija R Odanovic, Ivan S Ilic","doi":"10.1002/ccd.70791","DOIUrl":"10.1002/ccd.70791","url":null,"abstract":"<p><strong>Background: </strong>Hypertrophic cardiomyopathy is associated with alterations in coronary microvascular function which have variable pathophysiologic mechanisms, and variable reversibility acutely and chronically following alcohol septal ablation (ASA).</p><p><strong>Aims: </strong>The aim of this study was to examine immediate changes in absolute coronary blood flow before and after ASA using continuous thermodilution.</p><p><strong>Methods: </strong>Consecutive eligible patients without obstructive coronary artery disease undergoing ASA in a single center were enrolled in the study. Absolute coronary blood flow (Q) was measured using continuous thermodilution technique before and immediately after ASA and was used to calculate coronary flow reserve (CFR) and resistance (R).</p><p><strong>Results: </strong>Twenty-three patients, aged 57.9 ± 12.6 years, 47.8% female, underwent ASA. Left ventricular outflow tract gradient decreased from a median of 101 mmHg [IQR 77-133] to a median of 19 mmHg [16-36 mmHg] (p < 0.01). Comparing the state before and after ASA, no changes were observed in average resting (0.126 ± 0.064 vs. 0.129 ± 0.081 L/min) or hyperemic (0.264 ± 0.136 vs. 0.248 ± 0.116 L/min) coronary blood flow, or between resting (868 ± 564 vs. 929 ± 618 mmHg/[L/min]) or hyperemic (351 ± 172 vs. 345 ± 126 mmHg/[L/min]) resistance (p > 0.05 for all). The majority of patients n = 16 (69.6%) had an abnormal CFR (≤ 2.5) prior to ASA. Mean CFR was 2.31 ± 1.02 before and 2.35 ± 1.04 after ASA (p = 0.808 for difference). Thirteen patients experienced CFR improvement by 10%, and they had significantly lower hyperemic Q (0.219 ± 0.087 vs. 0.336 ± 0.171 L/min, p = 0.041) and CFR (1.86 ± 0.76 vs. 2.85 ± 1.19, p = 0.041) before ASA, compared to those who didn't.</p><p><strong>Conclusions: </strong>Patients with obstructive hypertrophic cardiomyopathy are a heterogeneous population with variable immediate microvascular response to ASA.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1344-1353"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13667329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aorto-Ostial Lesion Percutaneous Coronary Intervention: Clinical Characteristics, Predictors and Clinical Outcomes.","authors":"Simon M Thackray, Riley J Batchelor, Diem Dinh, Angela Brennan, Millie Watkins, Melanie Freeman, David Clark, Christopher M Reid, Dion Stub, Ernesto Oqueli, Chin Hiew, David Eccleston, William Chan, Anoop N Koshy, Andrew Ajani, Sinjini Biswas","doi":"10.1002/ccd.70817","DOIUrl":"10.1002/ccd.70817","url":null,"abstract":"<p><strong>Background: </strong>Aorto-ostial coronary lesions represent a high-risk subset of coronary disease because of fibrocalcific disease, elastic recoil, and difficulty achieving precise stent positioning. Percutaneous coronary intervention (PCI) of these lesions may therefore be associated with less favourable outcomes than of proximal non-ostial lesions. Furthermore, ostial left main coronary artery (LMCA) and right coronary artery (RCA) lesions differ in anatomy and myocardium at risk.</p><p><strong>Aims: </strong>To compare procedural practice and outcomes of aorto-ostial versus proximal non-ostial PCI.</p><p><strong>Methods: </strong>We analysed patients from the multicentre Melbourne Interventional Group Registry who underwent PCI between 2005 and 2020. Patients treated for ostial LMCA or ostial RCA lesions (aorto-ostial lesion [AOL] group) were compared with those undergoing PCI for proximal non-ostial LMCA or RCA lesions (non-AOL group). The primary outcome was long-term mortality. Secondary outcomes were in-hospital and 30-day major adverse cardiovascular events (MACE), with multivariable logistic regression used to identify independent predictors of 30-day MACE. Vessel-specific analysis compared ostial and non-ostial LMCA and RCA PCI separately.</p><p><strong>Results: </strong>Among 4683 PCI procedures, 538 (11.5%) underwent PCI for AOL and 4145 (88.5%) for proximal non-ostial LMCA or RCA lesions. Patients in the AOL group were older (70.1 vs. 65.0 years, p < 0.001), more often female (37.7% vs. 25.5%, p < 0.001), and had a greater burden of comorbidity and lesion complexity. Rotational atherectomy (4.5% vs. 1.2%, p < 0.001) and intravascular ultrasound (5.9% vs. 1.2%, p < 0.001) were used more frequently in the AOL group, although overall use was low. AOL location was not independently associated with 30-day MACE (adjusted OR 0.93, 95% CI 0.60-1.45; p = 0.76). Long-term survival was lower in the pooled AOL cohort (log-rank p < 0.001); vessel-specific analysis showed no difference for LMCA PCI (p = 0.69), whereas survival was lower after ostial RCA PCI (p < 0.001).</p><p><strong>Conclusions: </strong>Patients undergoing AOL PCI had a higher-risk clinical profile but similar adjusted early outcomes. In vessel-specific analyses, the pooled long-term survival difference appeared predominantly attributable to the RCA cohort, with no difference between ostial and non-ostial LMCA PCI. This may reflect differences in baseline patient risk rather than excess periprocedural risk alone.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1662-1668"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805294","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":"Evaluating the Impact of Enhanced Stent Visualization on PCI Outcomes in Older Patients With Multivessel Disease.","authors":"Marta Cocco, Alberto Sarti, Filippo Maria Verardi, Serena Caglioni, Jacopo Farina, Carlo Penzo, Carlo Tumscitz, Matteo Serenelli, Renè Tezze, Anna Cantone, Andrea Erriquez, Gianluca Campo, Simone Biscaglia","doi":"10.1002/ccd.70819","DOIUrl":"10.1002/ccd.70819","url":null,"abstract":"<p><strong>Background: </strong>Optimal stent expansion is a key determinant of long-term outcomes after PCI. Intravascular imaging provides the most accurate assessment of stent deployment but remains underused, especially in older patients with MI and multivessel disease. ESV is an angiographic enhancement technology that may help detect gross stent underexpansion when advanced imaging is not feasible.</p><p><strong>Aims: </strong>To evaluate the procedural and clinical impact of enhanced stent visualization (ESV)-guided percutaneous coronary intervention (PCI) in older patients with myocardial infarction (MI) and multivessel disease.</p><p><strong>Methods: </strong>In this prespecified sub-study of the FIRE trial, we evaluated the impact of ESV use during PCI in older MI patients. Among 1445 enrolled patients, 331 underwent ESV-guided PCI and 1114 standard angiography-guided PCI. Procedural optimization triggered by ESV was defined as additional postdilation, extra stent implantation, or use of intravascular imaging. Minimal lumen diameter (MLD) was assessed before and after ESV-guided optimization. Clinical outcomes were compared using multivariable and competing-risk adjusted Cox models.</p><p><strong>Results: </strong>Operator-driven optimization occurred in 85% of ESV cases, primarily through postdilation (96%). ESV guidance resulted in a significant MLD increase from 2.51 [2.22-2.87] to 2.93 [2.41-3.32] mm (p < 0.001), yielding an acute luminal gain of 0.42 mm (95% CI 0.37-0.47). At 3 years, the composite primary endpoint (death, MI, stroke, or ischemia-driven revascularization) was lower in the ESV group (adjusted HR 0.70, 95% CI 0.54-0.91; p = 0.008).</p><p><strong>Conclusions: </strong>In older MI patients with complex multivessel disease, ESV-guided PCI was associated with greater procedural optimization, improved acute stent expansion, and lower long-term adverse events. While not a substitute for intracoronary imaging, ESV represents a pragmatic and valuable adjunct to enhance PCI quality in settings where intravascular imaging is seldom performed.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier NCT03772743.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1698-1706"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13667337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of the Allegra Transcatheter System in Bioprosthetic Aortic Valve Failure: A Multicentre Valve-in-Valve Registry.","authors":"Hilal Khan, Mohamed Ali, Abdalazeem Ibrahem, Karim Ratib, Nur Ilia Mohd Zaki, Freidoon Keshavarzi, Alok Shah, Hesham Abdelaziz, Ayush Khurana, Alexander Chase, Diana A Gorog, Rajiv Das, Azfar Zaman, Mohammad AlKhalil, Mohamed Farag","doi":"10.1002/ccd.70811","DOIUrl":"10.1002/ccd.70811","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of bioprosthetic aortic valve failure is increasing due to the broader use of bioprosthetic valves, both surgical and transcatheter, and an ageing population. Registry data indicate a higher risk of coronary obstruction and elevated gradients following valve-in-valve transcatheter aortic valve implantation (TAVI). We report outcomes of the Allegra transcatheter heart valve system in valve-in-valve TAVI.</p><p><strong>Methods: </strong>In this retrospective multicentre cohort study, all patients undergoing valve-in-valve TAVI with the Allegra system between 2019 and 2025 at five UK centers were included. The combined primary outcomes were technical success, device success, and early safety at 30 days, as per the VARC-3 (Valve Academic Research Consortium-3) criteria. A key secondary outcome was all-cause mortality at the longest documented follow-up.</p><p><strong>Results: </strong>A total of 106 patients underwent valve-in-valve TAVI. The mean age was 79 ± 6 years, with 57.5% being female. Almost half of the patients had an index valve ≤ 21 mm, with an STS (Society of Thoracic Surgery) score of 7.1% (5.1-12.0). The post-implant aortic valve mean pressure gradient was 12 ± 6 mmHg, and the mean valve area was 1.7 ± 0.5 cm². The combined primary outcomes were technical success of 86.8% (CI 80.3%-93.2%), device success of 75.5% (CI 67.3%-83.7%), and early safety of 86.8% (CI 80.3%-93.2%). All-cause mortality at 30 days was 0%. All-cause mortality occurred in 6.6% at a median follow-up of 15 months.</p><p><strong>Conclusions: </strong>The Allegra TAVI system demonstrates promising technical and device success rates, with early safety and good post-implant haemodynamic performance in high-risk patients undergoing valve-in-valve TAVI. Larger randomized trials are needed to confirm these results.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1690-1697"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13667307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter Management of a Mitral Paravalvular Leak and an Adjacent Large Left Ventricular Pseudoaneurysm Using a Covered Stent-Nitinol Occluder Combination.","authors":"Pramod Sagar, Puthiyedath Thejaswi, Aashish Chopra, Kothandam Sivakumar","doi":"10.1002/ccd.70777","DOIUrl":"10.1002/ccd.70777","url":null,"abstract":"<p><p>Paravalvular leak (PVL) and left ventricular pseudoaneurysm can develop after surgical valve replacement, often as a result of suture dehiscence and annular disruption, potentially causing refractory heart failure. While re-operation poses a high risk, transcatheter PVL management remains equally difficult due to the possibilities of device instability and interference with mechanical prosthesis leaflets. We present an early postoperative mitral PVL that was connected to a large left ventricular pseudoaneurysm, in which standard PVL closure devices would have restricted leaflet movement. A novel transcatheter approach was developed with virtual reality simulation, and implemented through a combined transseptal and percutaneous transapical access to deploy a covered stent across the PVL for exclusion of the pseudoaneurysm, followed by device closure of the stent lumen.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1317-1321"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611918","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":"Balancing Circulatory Support and Ventricular Unloading in Post-Infarction Ventricular Septal Perforation: A Computational Analysis of ECPELLA Support Configurations.","authors":"Yuhi Nakamura, Hisato Takagi","doi":"10.1002/ccd.70793","DOIUrl":"10.1002/ccd.70793","url":null,"abstract":"<p><strong>Background: </strong>Ventricular septal perforation (VSP) is a catastrophic complication of acute myocardial infarction frequently associated with cardiogenic shock. Combined venoarterial extracorporeal membrane oxygenation (VA-ECMO) and Impella support (ECPELLA) has emerged as a promising strategy for circulatory stabilization; however, the hemodynamic effects of varying support configurations remain poorly understood.</p><p><strong>Aim: </strong>To evaluate the balance between systemic circulatory support and ventricular unloading across a spectrum of ECPELLA configurations using a computational cardiovascular model.</p><p><strong>Methods: </strong>A lumped-parameter cardiovascular model incorporating left and right ventricles, systemic and pulmonary circulations, post-infarction VSP, VA-ECMO, and Impella support was developed. Five ECPELLA configurations ranging from ECMO-dominant to Impella-dominant support were simulated. Left ventricular (LV) pressure-volume loops, LV stroke work (LVSW), systemic flow, mean arterial pressure, and shunt-related hemodynamics were analyzed.</p><p><strong>Results: </strong>Increasing Impella contribution progressively shifted LV pressure-volume loops leftward and reduced loop area, indicating enhanced ventricular unloading. LVSW decreased from 7082 to 6137 mmHg·mL, representing an approximately 13% reduction between ECMO-dominant and Impella-dominant configurations. Mean systemic perfusion increased by approximately 6% (87.6 to 93.0 mL/s) across the support spectrum. No discrete hemodynamic optimum was identified; instead, systemic flow increased while ventricular workload decreased progressively with increasing Impella contribution.</p><p><strong>Conclusions: </strong>In this computational model of post-infarction VSP, progressively greater Impella contribution was associated with improved systemic perfusion and reduced ventricular mechanical workload. These findings suggest that optimization of the balance between circulatory support and ventricular unloading may represent a fundamental principle of ECPELLA management in VSP.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1428-1434"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671736","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":"Chronic Total Occlusion PCI in Cancer Patients: National Trends and Periprocedural Risk Stratification.","authors":"Adrian Nubla, Hugo Lopez-Arevalo, Keerthana Manjunath, Bilal Bajwa, Marco Dispagna, Yousif Mohammed-Helo, Revati Varma","doi":"10.1002/ccd.70812","DOIUrl":"10.1002/ccd.70812","url":null,"abstract":"<p><strong>Background: </strong>Outcomes of chronic total occlusion (CTO) PCI in patients with active malignancy remain poorly characterized. We examined cancer prevalence trends and in-hospital outcomes among cancer patients undergoing CTO PCI nationally.</p><p><strong>Methods: </strong>We analyzed the National Inpatient Sample (2016-2022), identifying CTO PCI admissions using ICD-10-CM/PCS codes. Survey-weighted multivariable logistic regression and inverse probability of treatment weighting (IPTW) compared outcomes in cancer versus no-cancer patients. Myelosuppression was examined as a prespecified high-risk subgroup.</p><p><strong>Results: </strong>Among 214,365 weighted CTO PCI admissions, 4135 (1.9%) involved active cancer. Although absolute CTO PCI volume declined, the proportion of recipients with active cancer increased over the study period (survey-weighted odds ratio [OR]/year 1.065, 95% confidence interval [CI] 1.028-1.104, p = 0.0007). Despite higher unadjusted mortality (5.2% vs. 3.7%), cancer was not independently associated with higher in-hospital mortality after multivariable adjustment (adjusted OR [aOR] 0.91, 95% CI 0.63-1.32, p = 0.62) or IPTW (aOR 1.14, 95% CI 0.76-1.70, p = 0.54). In an exploratory subgroup, myelosuppression was associated with more than twofold higher mortality (aOR 2.59, 95% CI 1.07-6.29, p = 0.037); though this finding is hypothesis-generating given the small sample (n = 44).</p><p><strong>Conclusions: </strong>Active malignancy was not independently associated with in-hospital mortality among patients selected for CTO PCI, though findings cannot establish broad procedural safety given the pre-selected cohort. Myelosuppression and elevated transfusion risk represent periprocedural considerations warranting prospective validation.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1536-1541"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148715157","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":"The Combination of the Slipstream and the TD-ADR Techniques: An Effective and Safe Strategy for Precision Recanalization of Complex Chronic Total Occlusions.","authors":"Yuan Fu, Zhiyong Zhang, Chuang Li, Tao Zhang, Lin Zhao","doi":"10.1002/ccd.70744","DOIUrl":"10.1002/ccd.70744","url":null,"abstract":"<p><strong>Background: </strong>We aimed to evaluate the efficacy and safety of the combination of the Slipstream technique and the tip detection-antegrade dissection and re-entry (TD-ADR) technique in the treatment of complex CTO lesions.</p><p><strong>Methods: </strong>Forty-seven consecutive patients with long CTO lesion (>20 mm) between June 2024 and March 2025 were enrolled. The main steps of the procedure included: (1) for a CTO characterized by an ambiguous proximal cap and the presence of an applicable side branch originating proximal to the occlusion, the Slipstream technique was used to identify the precise entry point of the CTO lesion and guide the puncture into the CTO proximal cap. (2) Once the stiff guidewire went into the subintimal space during the advancement, IVUS was advanced along the guidewire to confirm the entry point of the subintimal space. (3) Advanced a dual-lumen microcatheter over the same guidewire and introduced another stiffer wire via the second wire port to puncture the entry point, and tried to re-enter the true lumen.</p><p><strong>Results: </strong>In this study, 17 (36.2%) cases were stumpless, and the left anterior descending artery (LAD) was the most frequent CTO target vessel (55.3%). The entry point into the subintimal space was identified by IVUS in all 47 cases, the combination of the Slipstream and TD-ADR techniques was succeeded in 42 cases. Fourty five CTO cases were finally successfully recanalized (95.7%) with no serious procedure-related complication.</p><p><strong>Conclusion: </strong>The combination of the Slipstream and the TD-ADR techniques is feasible and safe for the recanalization of complex CTO lesions.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1435-1444"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671812","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}