Journal of the Society for Cardiovascular Angiography & Interventions最新文献

{"title":"Performance of the STS Risk Score in Predicting Outcomes in Impella-Supported High-Risk Percutaneous Coronary Intervention: Insights From the PROTECT III Study","authors":"Batla Falah MD, MPH,&nbsp;Julia Thompson MS,&nbsp;Yousuf Shah MD,&nbsp;Tayyab Shah MD,&nbsp;David J. Cohen MD, MSc,&nbsp;Guido Ascione MD,&nbsp;Pedro Melo MD,&nbsp;Björn Redfors MD, PhD,&nbsp;Mir Babar Basir DO,&nbsp;Wayne B. Batchelor MD, MHS,&nbsp;Alejandro Lemor MD, MS,&nbsp;Alexander G. Truesdell MD,&nbsp;Cindy L. Grines MD,&nbsp;William W. O’Neill MD","doi":"10.1016/j.jscai.2026.105448","DOIUrl":"10.1016/j.jscai.2026.105448","url":null,"abstract":"<div><h3>Background</h3><div>Patients undergoing high-risk percutaneous coronary intervention (HRPCI) with Impella often present with similar or worse anatomical complexity than surgical revascularization candidates, yet the performance of surgical risk models in this setting is unknown. We evaluated Society of Thoracic Surgeons (STS) score performance in predicting outcomes in the PROTECT III study.</div></div><div><h3>Methods</h3><div>PROTECT III enrolled 1237 patients undergoing elective or urgent HRPCI with Impella support from March 2017 to March 2020. Patients were stratified into low (STS &lt;4), intermediate (≥4 to ≤8), and high (&gt;8) risk categories. Primary endpoints were 30-day major adverse cardiovascular and cerebrovascular events (MACCE) and mortality. Model discrimination was evaluated with receiver operating characteristic analysis; calibration was assessed with observed-to-expected (O/E) ratios and Hosmer–Lemeshow testing. Secondary endpoints included 90-day MACCE and 1-year mortality.</div></div><div><h3>Results</h3><div>Of 1237 patients, 728 patients were low-risk, 316 intermediate, and 193 high-risk based on STS score. Higher STS risk was associated with a higher number of comorbidities and more left main and multivessel disease. At 30 days, MACCE rose with risk (low 5.1%, intermediate 10.1%, high 17.6%; <em>P</em> &lt; .001), driven by mortality (3.5%, 8.6%, 16.8%; <em>P</em> &lt; .001). Patterns persisted at 90 days. The STS score showed good discrimination for 30-day percutaneous coronary intervention mortality (C-index 0.72; 95% CI:, 0.66-0.77) with acceptable global calibration (Hosmer–Lemeshow <em>P</em> = .13), comparable to the HRPCI-specific risk score. However, it underestimated mortality at 30 days (O/E 1.23), suggesting that existing scores do not capture the high-risk nature of this population.</div></div><div><h3>Conclusions</h3><div>The STS score provides reasonable discrimination in Impella-supported HRPCI but poorly predicts event rates, particularly underestimating mortality. These results underscore the need for modification of existing models and validation of HRPCI-specific tools.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 8","pages":"Article 105448"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148745977","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":"Catheter-Directed Recombinant Tissue Plasminogen Activator for Treatment of Aortic Root and Coronary Artery Thrombosis in Single Ventricle Patients: A Case Series","authors":"Jonathan Pacella MD,&nbsp;Amr Matoq MD,&nbsp;Sarosh Batlivala MD, MSCI,&nbsp;Shabana Shahanavaz MD","doi":"10.1016/j.jscai.2026.105510","DOIUrl":"10.1016/j.jscai.2026.105510","url":null,"abstract":"<div><div>We present a case series of 4 single ventricle patients with either native aortic root and/or coronary thrombosis who underwent catheter-directed thrombolysis with recombinant tissue plasminogen activator therapy. Two presented after cardiac arrest and extracorporeal membrane oxygenation cannulation, 1 patient with new ventricular dysfunction and ischemic electrocardiogram changes, and 1 presented with recalcitrant systemic vascular resistance crises. Thromboses resolved in 3 of 4 patients. The procedure was well tolerated without complications.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 8","pages":"Article 105510"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148746251","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":"Artificial Intelligence-Derived Fractional Flow Reserve in Routine Clinical Practice: An International Multicenter Retrospective Study","authors":"Eyal Ben-Assa MD,&nbsp;Bruce A. Samuels MD,&nbsp;Ehtisham Mahmud MD,&nbsp;Carlos Cafri MD,&nbsp;Ariel Roguin MD, PhD,&nbsp;Yair Feld MD,&nbsp;Eli Lev MD, MHA,&nbsp;Emanuel Harari MD,&nbsp;Tali Ben-Yehuda MD,&nbsp;Hector M. Garcia-Garcia MD, PhD,&nbsp;Gregg W. Stone MD","doi":"10.1016/j.jscai.2026.105451","DOIUrl":"10.1016/j.jscai.2026.105451","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence-based fractional flow reserve (AI-FFR) incorporates a machine learning-based algorithm to derive FFR directly from angiography. Its accuracy compared with invasive FFR has not been assessed.</div></div><div><h3>Methods</h3><div>AI-FFR was compared with wire-based FFR in patients with a single intermediate lesion (diameter stenosis ≥40% to &lt;70%) at 5 centers in the United States and Israel. AI-FFR assessments were performed by core laboratory analysts blinded to invasive FFR results. Diagnostic performance metrics were calculated using an FFR threshold of ≤0.80.</div></div><div><h3>Results</h3><div>A total of 504 vessels from 496 patients were analyzed. AI-FFR computation time was 36.1 ± 7.7 seconds. Lesion detection was fully automatic in 371 of 504 (73.6%) vessels, whereas semiautomated analysis with manual marking was performed in 133 of 504 (26.4%) vessels. Mean wire-based FFR was 0.85 ± 0.07 and mean AI-FFR was 0.85 ± 0.08 (mean difference, 0.00 ± 0.08; 95% CI, −0.15 to 0.15; <em>P</em> = .41). AI-FFR showed a sensitivity of 90.2%, specificity of 94.9%, positive predictive value of 83.5%, negative predictive value of 97.1%, and overall diagnostic accuracy of 93.8%. The area under the receiver operating characteristic curve (AUC) was 0.93 (95% CI, 0.89-0.96). Among 151 lesions with wire-based FFR values in the borderline “gray zone” (0.75-0.85), AI-FFR demonstrated a diagnostic accuracy of 91.4% and an AUC of 0.91 (95% CI, 0.86-0.96). AI-FFR demonstrated high diagnostic accuracy across vessel types and lesion locations in men and women and between the US and Israeli cohorts.</div></div><div><h3>Conclusions</h3><div>AI-FFR, an automated, machine learning-based tool, demonstrated high diagnostic accuracy compared with wire-based FFR. Its speed, simplicity, and independence from complex procedural steps may facilitate broader adoption during coronary angiography.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 8","pages":"Article 105451"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148746486","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 Aortic Valve Migration and Embolization During Transcatheter Aortic Valve Replacement: A Contemporary Management Review With a Practical Bailout Algorithm","authors":"Mohammad As Sayaideh MD, MBA,&nbsp;Eric Broadfoot MD,&nbsp;Taylor Goulding-Avedisian MD,&nbsp;Nagaraj Sanchitha Honganur MD,&nbsp;Mohammed Elzeneini MD,&nbsp;Bassam Omar MD, PhD,&nbsp;Nasser Lakkis MD,&nbsp;Kevin DeAndrade MD","doi":"10.1016/j.jscai.2026.105500","DOIUrl":"10.1016/j.jscai.2026.105500","url":null,"abstract":"<div><div>Transcatheter aortic valve replacement has become an established therapy for severe aortic stenosis across the surgical-risk spectrum. Although procedural safety has improved, transcatheter valve embolization or migration remains an uncommon but high-impact complication that may require immediate rescue under conditions of severe acute aortic regurgitation, hemodynamic instability, coronary compromise, or branch-vessel risk. Existing evidence is derived primarily from registries, observational cohorts, technical reviews, systematic reviews, and case-based reports rather than prospective comparative trials. Building on prior descriptions of device-embolization mechanisms and location-based management, this review synthesizes contemporary evidence into an operator-oriented phenotype-based framework. We classify transcatheter valve embolization or migration into left ventricular/left ventricular outflow tract migration, annular malposition with instability, ascending aortic embolization, distal aortic embolization, and delayed migration, while emphasizing that these phenotypes may overlap or evolve during the procedure. For each phenotype, we summarize reported mechanisms, platform-specific considerations, hemodynamic hazards, and commonly described bailout strategies. Because comparative data are lacking, the proposed framework should be interpreted as an evidence-informed practical decision aid rather than recommendation-level guidance. Standardized reporting and contemporary multicenter data are needed to refine risk prediction, define procedural success, and validate phenotype-specific rescue pathways.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 8","pages":"Article 105500"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148745975","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":"Sex-Stratified Outcomes of Drug-Eluting Resorbable Scaffolds Versus Balloon Angioplasty for Below-the-Knee Revascularization: Insights From the LIFE-BTK Trial","authors":"Danielle R. Bajakian MD,&nbsp;Serdar Farhan MD,&nbsp;David J. O’Connor MD,&nbsp;Zola N’Dandu MD,&nbsp;Katherine Kane MD,&nbsp;Sahil A. Parikh MD,&nbsp;Brian G. DeRubertis MD,&nbsp;Ramon L. Varcoe MBBS, MS, PhD, MMed (ClinEpi),&nbsp;Shawn Yu PhD,&nbsp;Karine Ruster PhD,&nbsp;Brad J. Martinsen PhD,&nbsp;Jennifer Meinen BS, MBA,&nbsp;Zsuzsanna Igyarto PhD,&nbsp;Prakash Krishnan MD","doi":"10.1016/j.jscai.2026.105388","DOIUrl":"10.1016/j.jscai.2026.105388","url":null,"abstract":"<div><h3>Background</h3><div>Women with chronic limb-threatening ischemia remain historically underrepresented in peripheral artery disease trials and often exhibit distinct anatomic and clinical profiles. The LIFE-BTK randomized trial demonstrated superiority of an everolimus-eluting resorbable scaffold (DRS) over percutaneous transluminal angioplasty (PTA) for below-the-knee revascularization. This analysis assessed whether sex influenced baseline characteristics, procedural details, or clinical outcomes after DRS compared with PTA.</div></div><div><h3>Methods</h3><div>LIFE-BTK randomly assigned 261 patients (2:1 DRS/PTA) with Rutherford-Becker class 4-5 ischemia across 50 global sites. Sex-stratified outcomes at 1 and 2 years were evaluated using descriptive statistics, multivariate models, and Kaplan–Meier estimates. The primary efficacy end point was freedom from above-ankle amputation, target vessel occlusion, clinically-driven target lesion revascularization (CD-TLR), and binary restenosis. The primary safety end point was freedom from major adverse limb events and perioperative death. Both end points are presented here as event rates.</div></div><div><h3>Results</h3><div>Female patients (32% of cohort) were older and had smaller reference vessel diameters and lower ankle-brachial index values; male patients had higher tobacco use and cardiovascular comorbidities. At 1 year, DRS significantly reduced event rates for the primary efficacy end point vs PTA in both sexes (female: 23.5% vs 57.1%; male: 26.5% vs 56.0%). Benefits persisted at 2 years (female: 34.1% vs 68.4%; male: 40.7% vs 66.7%). Binary restenosis and CD-TLR were lower with DRS. Multivariate analysis showed sex was not significantly associated with outcomes, and no sex-by-treatment interaction was observed. Female patients demonstrated higher restenosis but lower CD-TLR rates, suggesting discordance between anatomic and clinical failure.</div></div><div><h3>Conclusions</h3><div>DRS provided durable benefit over PTA irrespective of sex. Although sex did not modify treatment effect, differences in vessel size, ischemia severity, and restenosis–reintervention patterns highlight the need for sex-specific surveillance and personalized below-the-knee treatment strategies.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 8","pages":"Article 105388"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148745978","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":"Left Atrial Appendage Occlusion Device–Associated Infective Endocarditis: Analysis of the FDA-MAUDE Database","authors":"Anthony Mufarreh MD, MPH,&nbsp;Vivek Bhat MBBS,&nbsp;Adeeb Al-Quthami MD,&nbsp;Cynthia C. Taub MD, MBA,&nbsp;Jorge E. Romero MD,&nbsp;Ankur Kalra MD, MSc","doi":"10.1016/j.jscai.2026.105403","DOIUrl":"10.1016/j.jscai.2026.105403","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 7","pages":"Article 105403"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148532078","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":"Sex Disparities in Outcomes of Cardiogenic Shock Complicating Non–ST-Segment-Elevation Myocardial Infarction","authors":"Hritvik Jain MBBS,&nbsp;Nandan Patel MBBS,&nbsp;Jyoti Jain MD,&nbsp;Siddharth P. Agrawal MD,&nbsp;Allison Dupont MD,&nbsp;Alexander G. Truesdell MD,&nbsp;Srihari S. Naidu MD,&nbsp;J. Dawn Abbott MD,&nbsp;Saraschandra Vallabhajosyula MD, MSc","doi":"10.1016/j.jscai.2026.105383","DOIUrl":"10.1016/j.jscai.2026.105383","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 7","pages":"Article 105383"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148523604","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":"Pulmonary Artery Stent Molding Using a Rigid Bronchoscope: A Case Report","authors":"Ethan Frank MD,&nbsp;Howaida El-Said MD, PhD,&nbsp;Matthew Brigger MD, MPH","doi":"10.1016/j.jscai.2026.105397","DOIUrl":"10.1016/j.jscai.2026.105397","url":null,"abstract":"<div><div>Bronchial compression following pulmonary artery endovascular stenting is a well-reported phenomenon with significant impact on the course of care for patients with congenital heart disease. There is a paucity of techniques described to either prevent or address this postprocedural complication. We report our successful experience with a novel technical variation—using a rigid bronchoscope—to address postpulmonary artery stent airway compression in a patient with single ventricle pathology.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 7","pages":"Article 105397"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148546683","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":"Glucagon-Like Peptide–Based Therapy and Limb Outcomes in Patients With Peripheral Artery Disease and Diabetes: A Large-Scale Real-World Study","authors":"Helen Oletu MD, MPH,&nbsp;Osaremen Anthony Irivbogbe MD,&nbsp;Neil G. Barry IV DO, MBA,&nbsp;Yasir Akhtar MD","doi":"10.1016/j.jscai.2026.105399","DOIUrl":"10.1016/j.jscai.2026.105399","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 7","pages":"Article 105399"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148531987","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":"Combined Direct Current Cardioversion and Left Atrial Appendage Occlusion in Patients With Contraindication to Anticoagulation: A Single-Center Feasibility Study","authors":"Lawrence Chen MD,&nbsp;Tai Pham MD,&nbsp;Edris Aman MD,&nbsp;Anthony Khong MD,&nbsp;Irsa Munir MD,&nbsp;Tiffany Dong MD,&nbsp;Muhammad B. Munir MD,&nbsp;Thomas W.R. Smith MD,&nbsp;Jason H. Rogers MD,&nbsp;Gagan Singh MD","doi":"10.1016/j.jscai.2026.105393","DOIUrl":"10.1016/j.jscai.2026.105393","url":null,"abstract":"<div><h3>Background</h3><div>Direct current cardioversion (DCCV) for atrial fibrillation is typically followed by 3 to 4 weeks of oral anticoagulation (OAC) because of atrial stunning and thromboembolic risk, which some patients cannot tolerate. Left atrial appendage occlusion (LAAO) provides an OAC-sparing alternative, but the feasibility of performing DCCV immediately before LAAO has not been well defined.</div></div><div><h3>Methods</h3><div>We conducted a retrospective single-center study of consecutive patients with atrial fibrillation with relative or absolute contraindications to post-cardioversion OAC who underwent planned DCCV immediately followed by percutaneous LAAO using Watchman FLX or FLX Pro devices. Procedural characteristics, in-hospital outcomes, follow-up imaging findings, and clinical outcomes at 45 days, 3 months, and 1 year were assessed using cardiac computed tomography or transesophageal echocardiography.</div></div><div><h3>Results</h3><div>Twelve patients underwent concomitant DCCV + LAAO (mean age 75 ± 9 years; 33% women). Bleeding history was present in 67%, with mean CHA₂DS₂-VASc and HAS-BLED scores of 3.7 ± 1.1 and 2.1 ± 0.7, respectively. Acute DCCV success was achieved in 11 patients (92%), and LAAO technical success was 100%. Mean procedure time was 48 ± 15 minutes. Follow-up imaging was completed in 12 patients and identified 1 low-risk device-related thrombus (9%), peri-device leak &gt;3 mm in 18%, and no leaks &gt;5 mm. At 45 days and 3 months, there were no deaths, strokes, systemic embolic events, or major bleeding events. At 1 year (n = 7), 1 cardiovascular death occurred without thromboembolic or major bleeding complications.</div></div><div><h3>Conclusions</h3><div>In this pilot series, a combined DCCV + LAAO strategy was feasible and not associated with excess thromboembolic or bleeding events. Early and intermediate outcomes were comparable to contemporary standalone LAAO experience. Larger prospective studies are needed to further evaluate this OAC-sparing approach.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 7","pages":"Article 105393"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148532077","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}