Eurointervention最新文献

{"title":"Aortic regurgitation: can transcatheter therapies deliver what we need?","authors":"Torsten P Vahl, Lauren S Ranard","doi":"10.4244/EIJ-D-25-01191","DOIUrl":"10.4244/EIJ-D-25-01191","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 8","pages":"e419-e421"},"PeriodicalIF":9.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of device implantation depth on blood flow dynamics after left atrial appendage closure.","authors":"Pedro Cepas-Guillén, Carlos Albors, Jordi Mill, Adel Aminian, Philippe Garot, Ole De Backer, Jens Erik Nielsen-Kudsk, Xavier Iriart, Manuel Barreiro-Perez, Eduardo Flores-Umanzor, Ignacio Cruz-González, Dabit Arzamendi, Marisa Avvedimento, Luis Nombela-Franco, Nina Leduc, Jérôme Horvilleur, Klaus Fuglsang Kofoed, Kasper Korsholm, Hubert Cochet, Rodrigo Estevez-Loureiro, Manal Barrouhou, Ana Lafond, Xavi Millán, Laura Sanchis, Josep Rodés-Cabau, Oscar Camara, Xavier Freixa","doi":"10.4244/EIJ-D-25-01328","DOIUrl":"10.4244/EIJ-D-25-01328","url":null,"abstract":"<p><strong>Background: </strong>Device-related thrombus (DRT) remains a concern after left atrial appendage closure (LAAC), particularly when the device is deeply implanted. However, the mechanistic links between implantation depth, flow dynamics, and DRT risk are not well understood.</p><p><strong>Aims: </strong>We therefore aimed to evaluate the impact of LAAC device implantation depth on local flow characteristics and its association with DRT using patient-specific computational fluid dynamics (CFD).</p><p><strong>Methods: </strong>The study included 285 patients undergoing LAAC with either Amplatzer Amulet or WATCHMAN devices at 10 centres. Patient-specific CFD simulations were performed using postprocedural computed tomography and echocardiography-derived boundary conditions to assess blood flow dynamics. The primary endpoint was the comparison of CFD-derived flow indices - device surface velocity index (DSVI), endothelial cell activation potential (ECAP), and the presence of eddies/stagnated flow - between proximal and distal device implantation groups. Secondary analyses explored the relationship between these flow features and DRT.</p><p><strong>Results: </strong>Proximal implants (57.2%) showed more favourable flow patterns: higher DSVI (0.11 m/s vs 0.09 m/s; p=0.002), lower ECAP (0.75 vs 0.90; p=0.003), and fewer recirculating zones (40.5% vs 74.6%; p<0.001). DRT incidence increased with greater implantation depth, paralleled by worsening flow indices. A composite CFD-based DRT risk score, incorporating ECAP, implantation depth, and flow complexity, demonstrated good discrimination (area under the receiver operating characteristic curve [AUC] 0.81), outperforming anatomical depth alone (AUC 0.71).</p><p><strong>Conclusions: </strong>Deeper LAAC device implantation is associated with adverse flow profiles and a higher risk of DRT. CFD-based flow characterisation may enhance risk stratification beyond anatomical criteria alone. Further studies incorporating clinical variables are warranted to validate these methods.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 8","pages":"e444-e454"},"PeriodicalIF":9.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrosurgical laceration and stabilisation of tricuspid edge-to-edge repair: the ELASTA-T technique.","authors":"Hector A Alvarez-Covarrubias, Fiorenzo Simonetti, N Patrick Mayr, Tobias Rheude, Fabian Starnecker, Erion Xhepa, Christian Thilo, Matti Adam, Michael Joner","doi":"10.4244/EIJ-D-25-01316","DOIUrl":"10.4244/EIJ-D-25-01316","url":null,"abstract":"<p><p>Recurrent tricuspid valve regurgitation (TVR) after tricuspid transcatheter edge-to-edge repair (T-TEER) poses a significant challenge, particularly when centrally positioned clips impede subsequent transcatheter tricuspid valve replacement (TTVR). Electrosurgical laceration and stabilisation of T-TEER (ELASTA-T) has been developed to facilitate TTVR by enabling controlled single leaflet device attachment (SLDA). The aim of this manuscript is to provide a step-by-step standardised description of the ELASTA-T strategy, outlining essential procedural principles, the required equipment, and technical steps. ELASTA-T involves intentional detachment of the most centrally placed tricuspid clip using electrosurgical leaflet laceration. A modified coronary guidewire shaped into a \"flying V\" - based on Bioprosthetic Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA) and Laceration of the Anterior Mitral leaflet to Prevent Outflow ObstructioN (LAMPOON) principles - is positioned across the target leaflet using bilateral femoral vein access, deflectable guiding sheaths, microcatheters, and a snare-assisted venovenous rail. Laceration is performed under fluoroscopic and transoesophageal echocardiographic guidance, with preventive haemodynamic support on standby because of the risk of transient severe TVR. After laceration, the clip is mobilised towards the septal leaflet to avoid interference with valve deployment, followed by immediate implantation of a dedicated transcatheter tricuspid valve (TTV). ELASTA-T allows safe and reproducible SLDA, creating adequate central space for accurate positioning and full expansion of a TTV. Detachment can be reliably confirmed by fluoroscopy and transoesophageal echocardiography. By removing any mechanical obstruction from centrally placed clips, the technique facilitates secure TTVR anchoring and may reduce paravalvular regurgitation. This step-by-step framework may support procedural standardisation and broader adoption, ultimately improving outcomes in this high-risk population.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 8","pages":"e422-e431"},"PeriodicalIF":9.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter: Transcatheter paravalvular leak closure - insights on selection criteria, imaging, and comparative outcomes.","authors":"Ahmet Güner, Macit Kalçık, Mehmet Özkan","doi":"10.4244/EIJ-D-26-00101","DOIUrl":"10.4244/EIJ-D-26-00101","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 8","pages":"e463-e464"},"PeriodicalIF":9.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stable coronary patients with atrial fibrillation: when the kidneys tip the balance.","authors":"Martine Gilard, Romain Didier","doi":"10.4244/EIJ-D-26-00300","DOIUrl":"10.4244/EIJ-D-26-00300","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 8","pages":"e417-e418"},"PeriodicalIF":9.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischaemic and bleeding events after complex versus non-complex PCI: a systematic review and meta-analysis.","authors":"Raffaele Piccolo, Antonio Pio Vitale, Angelo Laino, Anna Franzone, Plinio Cirillo, Luigi Di Serafino, Luca Bardi, Carmen Anna Maria Spaccarotella, Giovanni Esposito","doi":"10.4244/EIJ-D-25-01204","DOIUrl":"10.4244/EIJ-D-25-01204","url":null,"abstract":"<p><strong>Background: </strong>Complex percutaneous coronary intervention (PCI) is increasingly performed among patients undergoing myocardial revascularisation.</p><p><strong>Aims: </strong>We conducted a systematic review and meta-analysis to evaluate the association between complex PCI and the risk of ischaemic and bleeding outcomes.</p><p><strong>Methods: </strong>Hazard ratios (HRs) were pooled using a random-effects model within a Bayesian framework. The primary analysis was restricted to studies providing adjusted risk estimates, whereas the secondary analysis included unadjusted risk estimates. The primary outcomes were myocardial infarction and major bleeding. The secondary outcomes were all-cause death, stent thrombosis, cardiovascular death, target lesion or vessel revascularisation, and stroke. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework for prognostic studies was used to determine the level of certainty in the association between complex PCI and the risk of events.</p><p><strong>Results: </strong>We included 290,039 patients, of whom 94,633 (33%) underwent complex PCI. Compared with non-complex PCI, patients undergoing complex PCI had a higher risk of myocardial infarction (adjusted HR 1.71, 95% credible interval [CrI]: 1.49-1.96), major bleeding (adjusted HR 1.24, 95% CrI: 1.14-1.35), all-cause death (adjusted HR 1.21, 95% CrI: 1.12-1.32), cardiovascular death (adjusted HR 1.29, 95% CrI: 1.15-1.46), stent thrombosis (adjusted HR 1.76, 95% CrI: 1.49-2.14), target lesion or vessel revascularisation (adjusted HR 1.99, 95% CrI: 1.58-2.50), and stroke (adjusted HR 1.21, 95% CrI: 1.03-1.42). The posterior probability of a higher risk associated with complex versus non-complex PCI was >99% for all study outcomes. Except for stroke (which was low certainty), the certainty of evidence was moderate to high for all other outcomes. Secondary analysis, including unadjusted risk estimates, provided consistent results.</p><p><strong>Conclusions: </strong>Patients undergoing complex PCI have an increased risk of both ischaemic and bleeding events compared with patients undergoing non-complex PCI (PROSPERO: CRD420250656254).</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 7","pages":"e402-e414"},"PeriodicalIF":9.5,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and prognostic impact of high ischaemic risk criteria in chronic coronary syndrome patients undergoing PCI.","authors":"Valeria Raona, Mauro Gitto, Angelo Oliva, Samantha Sartori, Yihan Feng, Birgit Vogel, Francesca Maria Di Muro, Mauro Chiarito, Prakash Krishnan, Joseph Sweeny, Pedro Moreno, Annapoorna Kini, George Dangas, Samin Sharma, Roxana Mehran","doi":"10.4244/EIJ-D-25-01174","DOIUrl":"10.4244/EIJ-D-25-01174","url":null,"abstract":"<p><strong>Background: </strong>A substantial proportion of patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI) experience recurrent ischaemic events. Guidelines recommend risk stratification at the time of PCI and consideration for prolonged dual antiplatelet therapy in high ischaemic risk (HIR) patients.</p><p><strong>Aims: </strong>This study aimed to evaluate the prevalence and prognostic impact of guideline-defined HIR criteria in a large, real-world cohort of CCS patients undergoing PCI.</p><p><strong>Methods: </strong>We retrospectively analysed CCS patients treated with drug-eluting stents at Mount Sinai Hospital between 2012 and 2022. Per the 2024 European Society of Cardiology guidelines on the management of CCS, HIR criteria included left main stenting, stent length >60 mm, diabetes mellitus, chronic kidney disease, bifurcation, and chronic total occlusion (CTO). Prognostic associations were assessed using multivariate Cox regression. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), including death, myocardial infarction (MI), or stroke.</p><p><strong>Results: </strong>Of 15,336 CCS patients, 10,952 (71.4%) met at least one HIR criterion. Overall, HIR status and most of its individual components, with the exception of bifurcation and CTO, predicted MACCE. Increasing numbers of HIR criteria were significantly associated with higher MACCE (p for trend<0.001), as well as the individual components of death (p for trend<0.001) and MI (p for trend<0.001).</p><p><strong>Conclusions: </strong>In a real-world CCS cohort, guideline-defined HIR status was associated with increased MACCE. However, as almost three-quarters of patients met at least one HIR criterion, risk stratification accuracy at the time of PCI may have been limited.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 7","pages":"e392-e401"},"PeriodicalIF":9.5,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precision over prevalence: moving beyond binary risk stratification after PCI.","authors":"Christiaan J M Vrints","doi":"10.4244/EIJ-D-26-00195","DOIUrl":"10.4244/EIJ-D-26-00195","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 7","pages":"e374-e375"},"PeriodicalIF":9.5,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stent retriever-assisted coronary thrombectomy with continuous aspiration.","authors":"Quentin Liabot, Marc Arcens, Quentin Chatelain, Marco Roffi, Juan F Iglesias","doi":"10.4244/EIJ-D-25-01014","DOIUrl":"10.4244/EIJ-D-25-01014","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 7","pages":"e415-e416"},"PeriodicalIF":9.5,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardising the complexity of contemporary PCI.","authors":"Gennaro Giustino","doi":"10.4244/EIJ-E-26-00002","DOIUrl":"10.4244/EIJ-E-26-00002","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 7","pages":"e376-e377"},"PeriodicalIF":9.5,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}