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

{"title":"VERMONT μQFR: Diagnostic Accuracy of Murray Law-Based 2D-μQFR Compared to 3D-μQFR and vFFR.","authors":"Daniel Akrawi, Krishna Kadappu, James Xu, Tamer Yousef Naguib Badie, Oliver Gibbs, Hashim Kachwalla, Phong T D Nguyen, Rahul Kurup, Upul Premawardhana, Justyn Huang, Hao Tran, Kavie Soosapilla, Jim Basilakis, Aiden O'loughlin, Annemarie Hennessy, Giuseppe Femia, Sidney Lo","doi":"10.1002/ccd.70768","DOIUrl":"10.1002/ccd.70768","url":null,"abstract":"<p><strong>Background: </strong>Murray law-based quantitative flow ratio (μQFR) is an angiography-derived physiological index that utilizes a single angiographic projection with artificial intelligence-guided vessel segmentation.</p><p><strong>Aims: </strong>To evaluate the diagnostic accuracy and time efficacy of 2D-μQFR against wire-based fractional flow reserve (FFR ≤ 0.80), compare its performance with 3D-μQFR and vessel-FFR (vFFR), and assess feasibility in lesions excluded from vFFR analysis.</p><p><strong>Methods: </strong>This sub-study of the prospective VERMONT trial analyzed 2D- and 3D-μQFR retrospectively using prospectively acquired angiograms, with wire-based FFR as the reference standard.</p><p><strong>Results: </strong>Among 209 patients with 225 intermediate lesions, 205 lesions were analyzed. 2D-μQFR demonstrated excellent diagnostic accuracy for FFR ≤ 0.80 (AUC 0.95; 95% CI 0.93-0.98), with 93% sensitivity, 92% specificity, 88% positive predictive value (PPV), and 95% negative predictive value (NPV). Inter-observer agreement was excellent (r = 0.94, p < 0.001), and 2D-μQFR analysis was 15.1 min faster than wire-based FFR (1.8 ± 0.7 vs. 16.9 ± 5.4 min, p < 0.001). Diagnostic performance was comparable to that of 3D-μQFR, which achieved an AUC of 0.94 (95% CI 0.91-0.97), with 89% sensitivity, 90% specificity, 86% PPV, and 93% NPV. It was more specific than vFFR, which achieved an AUC of 0.92 (95% CI 0.89-0.96), with 90% sensitivity, 79% specificity, 74% PPV, and 93% NPV. Single-projection analysis was feasible in 85% of lesions excluded from vFFR due to image quality limitations.</p><p><strong>Conclusion: </strong>Single-projection 2D-μQFR provides accurate, rapid, and reproducible physiological assessment comparable to 3D-μQFR with superior specificity to vFFR. These findings support 2D-μQFR as a practical, wire-free alternative to invasive FFR in routine clinical practice.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1256-1267"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13667326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595442","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":"Procedural and Long-Term Outcomes of Percutaneous Coronary Intervention for In-Stent Chronic Total Occlusion.","authors":"Gal Sella, Chloe Kharsa, Yasser M Sammour, Rody G Bou Chaaya, Mangesh Kritya, Yueh-Yun Lin, Anshuj Deva, Jerrin Philip, Muhammad Haisum Maqsood, Neal S Kleiman, Alpesh R Shah","doi":"10.1002/ccd.70772","DOIUrl":"10.1002/ccd.70772","url":null,"abstract":"<p><strong>Background: </strong>This study examined procedural success and long-term outcomes of percutaneous coronary intervention (PCI) for in-stent chronic total occlusion (IS-CTO) compared with de novo CTO. While contemporary techniques have improved acute success rates for IS-CTO PCI, data on long-term outcomes remain limited.</p><p><strong>Aims: </strong>We aimed to examine procedural success rates for IS-CTO PCI using contemporary techniques, evaluate long-term clinical outcomes with extended follow-up, identify independent predictors of major adverse cardiac events, and compare our findings with recent multicenter registries.</p><p><strong>Methods: </strong>We analyzed 501 consecutive CTO PCI procedures in 456 patients at our institution between January 2018 and December 2023. Patients were stratified into IS (n = 82, 16.4%) and de novo CTO (n = 419, 83.6%) groups. The primary endpoint was a composite of in-stent restenosis requiring revascularization, heart failure hospitalization, myocardial infarction, and stroke at median follow-up of 713.5 days. Cox proportional hazards regression identified predictors of adverse events.</p><p><strong>Results: </strong>Patients with IS-CTO had a higher prevalence of diabetes (58.5% vs. 47.5%, p = 0.067) and prior myocardial infarction (46.3% vs. 27.5%, p = 0.001). Procedural success was similar (86.6% vs. 79.5%, p = 0.136) with comparable in-hospital complications. However, at median follow-up of 713.5 days, patients with IS-CTO experienced higher rates of the composite endpoint (26.4% vs. 12.8%, p = 0.003), driven by in-stent restenosis (20.8% vs. 5.2%, p < 0.001). After adjustment, IS-CTO showed a trend toward increased risk for composite outcome (HR 2.03, 95% CI 1.00-4.11). Independent predictors of composite outcome included heart failure (HR 2.15, 95% CI 1.17-3.94) and male sex (protective: HR 0.49, 95% CI 0.26-0.90).</p><p><strong>Conclusions: </strong>Despite achieving procedural success comparable to de novo CTO, IS-CTO PCI is associated with significantly worse long-term outcomes over extended follow-up, particularly recurrent restenosis. These findings underscore the need for improved therapeutic strategies in this challenging population.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1287-1300"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611600","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 \"Impact of Prolapse Width on Outcomes of Transcatheter Edge-to-Edge Repair in Degenerative Mitral Regurgitation\".","authors":"","doi":"10.1002/ccd.70838","DOIUrl":"10.1002/ccd.70838","url":null,"abstract":"","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1773-1774"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890166","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 Wire-Augmented Intravascular Lithotripsy in Refractory Calcified Coronary Lesions: A Five-Case Series.","authors":"Alfredo Marchese, Mattia Squillace, Pierluigi Demola, Giuseppe Speziale, Francesco Bedogni, Robert J Chilton","doi":"10.1002/ccd.70803","DOIUrl":"10.1002/ccd.70803","url":null,"abstract":"<p><p>Heavily calcified coronary lesions remain a major challenge in percutaneous coronary intervention (PCI), often limiting the effectiveness of intravascular lithotripsy (IVL). We report a five-case series in which IVL failed to achieve adequate lesion modification but was successfully augmented by the addition of one or more buddy wires. Lesion subsets included severe proximal right coronary artery calcification, IVL balloon rupture with preserved efficacy, nodular calcification refractory to atherectomy, stent underexpansion causing recurrent ST-segment elevation myocardial infarction, and a concentric lesion assessed with optical coherence tomography (OCT). In the OCT-guided case, buddy wire-augmented IVL produced multiple additional calcium fracture lines and significant luminal gain without further balloon dilation. These findings support a hypothesis-generating mechanism of mechanical-acoustic coupling, whereby guidewires may facilitate localized amplification of shockwave energy. Buddy wire-augmented IVL may represent a simple and effective adjunctive strategy in resistant calcified lesions.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1529-1535"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13667325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709328","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":"Use of Intracoronary Pressure Wire Assessment and Association With Outcomes: Insights From the British Cardiovascular Intervention Society National Database.","authors":"Hussein Bashar, Muhammad Rashid, Mamas A Mamas, Nick Curzen","doi":"10.1002/ccd.70835","DOIUrl":"10.1002/ccd.70835","url":null,"abstract":"<p><strong>Background: </strong>Despite recommendations in international guidelines, Intracoronary pressure wire assessment (PWA) utilization remains limited in clinical practice. This study aims to describe (i) trends of PWA during Percutaneous coronary interventional (PCI), (ii) factors that predict its application, and (iii) association with in-hospital outcomes.</p><p><strong>Methods: </strong>Adults with PCI for chronic coronary syndrome or Non-ST-elevation acute coronary syndrome in the British Cardiovascular Intervention Society (BCIS) database from January 2012 to March 2020 were included. Adjusted odds ratios (aOR) of PWA predictors and its association with in-hospital major adverse cardiovascular and cerebrovascular events (MACCE; a composite of total mortality, stroke/transient ischaemic attack, and new/reinfarction) were assessed using logistic regression models.</p><p><strong>Results: </strong>303,453 records identified of which 10.74% had PWA. There was a modest rise in the use of PWA from 9.1% in 2012 to peak just over 13% in 2018. Intracoronary imaging (aOR: 1.23, 95% CI: 1.18-1.27, p < 0.001), and previous PCI (aOR: 1.30, 95% CI: 1.26-1.34, p < 0.001) were positive predictors of PWA. MACCE was lower with PWA (aOR: 0.73, 95% CI: 0.62-0.87, p < 0.001) in the overall population. PWA was associated with lower procedural complications (aOR: 0.90, 95% CI: 0.84-0.96, P: 0.001).</p><p><strong>Conclusion: </strong>PWA remains underutilized in UK real world practice. Among patients undergoing PCI, PWA was associated with lower in-hospital procedural complications and MACCE. It's association with in-hospital MACCE should be viewed as a hypothesis-generating for future studies. Using pressure wire as a performance and a quality metric for PCI might help improve adoption in the future.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1743-1753"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13667319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868598","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":"Percutaneous Coronary Stentectomy: Redefining Stent Failure Management in the Modern Era.","authors":"Evandro Martins Filho, Raghav Gattani, Tim A Fischell, Ricardo Fonseca Oliveira Suruagy Motta, Marielle Rodrigues Martins, Tarana Zaman, Briana Kulisch, Lindsey A Cilia, Emmanouil S Brilakis, Alexander G Truesdell","doi":"10.1002/ccd.70815","DOIUrl":"10.1002/ccd.70815","url":null,"abstract":"<p><p>Percutaneous coronary stentectomy, intentional retrieval of a fully deployed coronary stent, has evolved from anecdotal salvage to a structured interventional strategy. It addresses scenarios where a deployed stent causes ongoing complications: malapposition, longitudinal deformation, or excessive aorto-ostial protrusion leading to restenosis, thrombosis, or interference with structural heart interventions. We performed a narrative review of the published literature on intentional percutaneous coronary stent retrieval, supplemented by five illustrative cases from three academic centers representing acute, subacute, and late retrieval scenarios. Stentectomy was feasible across acute and late settings. Snare-based retrieval through guide extension catheters was the predominant approach; stents with three or fewer inter-ring connectors allowed more predictable extraction. Intravascular ultrasound was essential for procedural planning, confirmation of complete removal, and post-extraction management. Drug-coated balloons enabled metal-free revascularization after stent removal. A novel reverse hairpin-assisted snare extraction technique facilitated pre-TAVR stent retrieval in one case. The Side Flap technique and stentectomy emerged as complementary strategies for managing excessive aorto-ostial protrusion. Percutaneous coronary stentectomy is a feasible strategy for selected clinical scenarios, with intravascular imaging central to procedural planning and assessment. When performed with appropriate technique and Heart Team evaluation, it can address stent complications, restore coronary access, and enable metal-free revascularization.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1572-1588"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763711","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":"Clinical Outcomes of Drug-Eluting Stents and Drug-Coated Balloons in Tortuous Small Coronary Lesions.","authors":"Shunichiro Ishio, Takashi Nagasaka, Ryota Taniuchi, Shiro Amanai, Yohei Ishibashi, Noriaki Takama, Hideki Ishii","doi":"10.1002/ccd.70814","DOIUrl":"10.1002/ccd.70814","url":null,"abstract":"<p><strong>Background: </strong>In small, tortuous coronary lesions, the long-term comparative performance of drug-coated balloon (DCB) angioplasty versus drug-eluting stent (DES) treatment remains uncertain, despite both strategies being widely used in contemporary percutaneous coronary intervention (PCI) practice.</p><p><strong>Aims: </strong>This study aimed to compare 3-year clinical outcomes between DES and DCB in patients undergoing PCI for small, tortuous coronary lesions.</p><p><strong>Methods: </strong>This retrospective, single-center study included 366 patients treated with either DES (n = 226) or DCB (n = 140) for lesions with at least one angulation ≥ 45°. The primary endpoint was major adverse cardiac events (MACE). Time-to-event outcomes were assessed using Kaplan-Meier analysis and Cox proportional hazards models.</p><p><strong>Results: </strong>Procedural success rates were high and comparable between groups. At 3 years, MACE occurred more frequently in the DCB group than in the DES group (log-rank p = 0.013). In multivariable analysis, DCB use remained associated with higher risks of MACE (hazard ratio [HR] 1.88; 95% confidence interval [CI] 1.12-3.16; p = 0.017) and target vessel revascularization (TVR) (HR 1.84; 95% CI 1.01-3.21; p = 0.045). Subgroup analysis showed that DES had significantly better outcomes than DCB in lesions with mild-to-moderate tortuosity, whereas event rates were similar between groups in severely tortuous segments.</p><p><strong>Conclusion: </strong>In small, tortuous coronary lesions, DES use was associated with lower rates of MACE and TVR at 3 years than DCB use. The advantage of DES was most apparent in mild-to-moderate tortuosity, whereas it was not statistically significant in severely tortuous vessels. These findings highlight the importance of anatomic complexity when selecting a treatment strategy for tortuous coronary lesions.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1680-1689"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13667340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805226","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 After Scoring-Balloon and Sirolimus-Eluting Balloon Strategy in Diffuse Small-Vessel Coronary Artery Disease (SCA-DEB Study): A Single-Center Prospective Study.","authors":"Dobrin Vassilev, Niya Mileva, Panayot Panayotov, Vladimir Shurupov, Ilter Pazardzhakli, Gavril Stoev, Slawomir Golebiewski, Gianluca Rigatelli, Robert J Gil","doi":"10.1002/ccd.70784","DOIUrl":"10.1002/ccd.70784","url":null,"abstract":"<p><strong>Background: </strong>The treatment of diffuse coronary artery disease is challenging, with high rates of repeat revascularization without satisfactory treatment.</p><p><strong>Aims: </strong>We designed a prospective, single-center, single-arm study to evaluate the feasibility and safety of a new strategy for the treatment of diffuse, small-vessel coronary artery disease using a systematic combination of Scoring-balloon Angioplasty and Sirolimus-eluting balloon Angioplasty.</p><p><strong>Methods: </strong>We included patients with diffuse (lesion length ≥ 20 mm) and small vessel (diameter 1.5-2.75 mm) coronary disease. Patients with STEMI, left main stenosis, and a life expectancy of less than 24 months were excluded. The procedure strategy was scoring-balloon angioplasty (SBA), 1:1 diameter ratio with distal reference plus sirolimus-eluting balloon angioplasty (SEB) using Mozec balloon (Meril, India).</p><p><strong>Results: </strong>From December 2022 until June 2025, 167 patients with 194 vessels were included. The mean age was 67 ± 9 years, 71% males, 92% with dyslipidemia, and 44% diabetics. The left anterior descending artery was the most frequently treated vessel (66%). The mean reference vessel diameter was 2.1 ± 0.74 mm, MLD 0.71 ± 0.31 mm, and %DS 67 ± 14%. The mean lesion length was 35 ± 15 mm. For a median clinical follow-up of 15 [8-29] months, the overall rate of MACE was 5.4%, 4.8% patients had TLR, and the total percentage of POCE was 10.2%.</p><p><strong>Conclusions: </strong>A novel strategy using a combination of scoring balloon angioplasty followed by sirolimus-eluting balloon inflation for the treatment of diffuse coronary artery disease yields promising angiographic and clinical outcomes.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1417-1424"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148665483","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":"Novel Bailout for Pulsta Valve Embolization: Microporous Endograft Fixation at the SVC-RA Junction in Repaired Tetralogy of Fallot With Severe Pulmonary Regurgitation.","authors":"Chia-Yu Ou, Jieh-Neng Wang, Chung-Dann Kan","doi":"10.1002/ccd.70810","DOIUrl":"10.1002/ccd.70810","url":null,"abstract":"<p><p>This report describes a 47‑year‑old woman with a history of repaired tetralogy of Fallot presenting with a massively dilated native right ventricular outflow tract (RVOT) and enlarged pulmonary arteries. She underwent bilateral branch pulmonary artery valve implantation using self-expanding Pulsta valves. Early embolization of the left pulmonary artery valve necessitated a complex percutaneous rescue, including balloon anchoring, through-and-through wiring, and stepwise relocation. Following a subsequent embolization into the right ventricle resulting in tricuspid entrapment, emergent surgical retrieval was recommended but declined by the patient's family. Consequently, the migrated prosthesis was ultimately managed via definitive fixation at the superior vena cava-right atrium (SVC-RA) junction using an off-label, fenestrated thoracic covered stent. This approach successfully avoided emergent redo sternotomy, illustrating a novel and effective transcatheter bailout strategy for embolized pulmonary valves in challenging RVOT anatomies when surgical intervention is refused.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1721-1725"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835843","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":"Crossing an Angulated SVG-RCA Anastomosis Using Distal Anchoring and Guide Extension: A Bailout Strategy in STEMI.","authors":"Ahad Firoz, Alirameen Akram, Swaiman Singh","doi":"10.1002/ccd.70834","DOIUrl":"10.1002/ccd.70834","url":null,"abstract":"<p><p>A 63-year-old male with a history of 2-vessel CABG (LIMA-LAD, SVG-RCA) presented with several hours of radiating chest pain. Electrocardiogram was significant for an inferior ST-elevation myocardial infarction. In the cardiac catheterization laboratory, the culprit lesion was identified as the right posterior descending artery. However, despite multiple attempts using an extra support guiding catheter, several drug-eluting stents and a drug-coated balloon were unable to advance beyond the anastomosis due to the acute takeoff of the RCA from the SVG. In response, a unique bailout approach utilizing a guide extension catheter (GEC) with distal balloon anchoring to facilitate deep GEC intubation across the acutely angulated graft anastomosis was employed; this technique facilitated the successful delivery and deployment of a drug-eluting stent. Potential complications associated with GEC and balloon anchoring include coronary artery dissection, challenges in stent advancement, air embolism, luminal obstruction, and vessel barotrauma. LEARNING OBJECTIVE: In STEMI with severely angulated SVG-native coronary anastomosis, distal balloon anchoring can enable deep guide extension catheter intubation across the anastomosis, facilitating device delivery when conventional strategies fail.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":"1717-1720"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820658","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}