Catheterization and Cardiovascular Interventions最新文献

{"title":"Modified Transseptal BATMAN for Anterior Leaflet Modification in High-Risk Transcatheter Mitral Valve-in-Valve Replacements: A Case Series","authors":"Hafez Golzarian,&nbsp;Rajendra P. Shah,&nbsp;Mukhtar Al-Saadi,&nbsp;Aswin Srinivasan,&nbsp;Melissa P. Howe,&nbsp;Boglarka Turos,&nbsp;Pranav Loyalka","doi":"10.1002/ccd.70824","DOIUrl":"10.1002/ccd.70824","url":null,"abstract":"<div>\u0000 \u0000 <p>The BATMAN (Balloon-Assisted Translocation of the Mitral Anterior leaflet) technique, a novel approach for modifying the anterior leaflet during transcatheter mitral valve replacement (TMVR), has recently demonstrated efficacy in preventing left ventricular outflow tract obstruction (LVOT) which constitutes a high-risk complication in valve-in-valve TMVR procedures. We describe three complex cases of severe bioprosthetic mitral stenosis who underwent successful valve-in-valve TMVR utilizing a modified transseptal BATMAN technique. We highlight the procedural methodology and explore the potential for this technique to be standard of care for valve-in-valve TMVR.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 5","pages":"1795-1800"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Two Percutaneous Femoral Closure Strategies During Transcatheter Aortic Valve Implantation","authors":"Thomas Roussel,&nbsp;Jérémy Boyer,&nbsp;Julien Polo,&nbsp;Hadrien Pichene,&nbsp;Sami Rahmani,&nbsp;Clémence Bassez,&nbsp;Marine Quillot,&nbsp;Thibaut Dabry,&nbsp;Antoine Vaillier,&nbsp;Pierre Morera,&nbsp;Nicolas Jaussaud,&nbsp;Pierre Deharo,&nbsp;Thomas Cuisset","doi":"10.1002/ccd.70840","DOIUrl":"10.1002/ccd.70840","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Percutaneous closure of femoral arterial access is a critical step in transcatheter aortic valve implantation (TAVI). A hybrid strategy combining a suture-based device (Perclose ProStyle) and a collagen-based device (Angio-Seal) has emerged as an alternative to the conventional double Perclose ProStyle technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The objective of the study is to compare femoral vascular complications between a hybrid strategy (1 Perclose ProStyle+ 1 Angio-Seal) and a non-hybrid strategy (2 Perclose ProStyle) in a large single-center experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective, single-center, non-randomized study included 633 consecutive patients who underwent transfemoral TAVI at Timone University Hospital (Marseille, France) between November 2024 and March 2026. The choice of closure strategy was left to the operator's discretion. The primary endpoint was the occurrence of any femoral vascular complication (classified according to VARC-3 criteria).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 273 patients underwent hybrid closure, and 360 underwent non-hybrid closure. The overall rate of vascular complications was 4.9% (31/633), with no significant difference between groups (hybrid 4.8% vs. non-hybrid 5.0%; <i>p</i> = 1.000). There were no differences in major VARC-3 complications (2.2% vs. 1.9%, <i>p</i> = 1.000) or minor complications (2.6% vs. 3.1%, <i>p</i> = 0.899). In univariate analysis, preprocedural dual antiplatelet therapy was the main predictor of overall complications, hematoma, pseudoaneurysm, and minor VARC-3 complications. Dialysis was associated with major VARC-3 complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The hybrid closure strategy (1 Perclose ProStyle + 1 Angio-Seal) demonstrates a vascular safety profile comparable to the conventional strategy (2 Perclose ProStyle) in transfemoral TAVI. Preprocedural antithrombotic therapy, rather than the closure device strategy, appears to be the main determinant of vascular complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 5","pages":"1777-1783"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of the HATCH Score for New-Onset Atrial Fibrillation Following TAVI","authors":"Çağatay Tunca,&nbsp;Reha Yasin Şengül,&nbsp;Ahsen Özge Akpınar,&nbsp;Fatih Cihat Büyükbaş,&nbsp;Mehmet Taha Özkan,&nbsp;Özgür Ulaş Özcan,&nbsp;Veysel Ozan Tanık,&nbsp;Bülent Özlek","doi":"10.1002/ccd.70845","DOIUrl":"10.1002/ccd.70845","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>New-onset atrial fibrillation (NOAF) is a frequent complication after transcatheter aortic valve implantation (TAVI) and is associated with adverse outcomes, yet simple pre-procedural tools to identify at-risk patients are limited. The HATCH score predicts incident atrial fibrillation in other settings but has not been evaluated in TAVI. We assessed whether the HATCH score predicts NOAF after transfemoral TAVI and compared it with the CHA₂DS₂-VASc score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective single-center study, 268 patients in sinus rhythm who underwent transfemoral TAVI for severe aortic stenosis between October 2022 and January 2026 were included. NOAF was defined as atrial fibrillation or flutter lasting ≥ 30 s during the index hospitalization. Independent predictors were identified by multivariable logistic regression; discrimination was assessed by the area under the receiver operating characteristic curve (AUC), compared using the DeLong test, and internally validated by bootstrapping.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>NOAF occurred in 44 patients (16.4%). The HATCH score was higher in the NOAF group (2.75 ± 0.81 vs. 2.03 ± 0.85; <i>p</i> &lt; 0.001). On multivariable analysis, the HATCH score (adjusted odds ratio [OR] 2.69, 95% CI 1.75–4.13; <i>p</i> &lt; 0.001) and aortic root angulation (adjusted OR 1.05 per degree, 95% CI 1.02–1.09; <i>p</i> = 0.002) were independent predictors of NOAF. The HATCH score yielded an AUC of 0.730 (95% CI 0.672–0.782), numerically higher than that of the CHA₂DS₂-VASc score (0.668, 95% CI 0.608–0.724), although the difference was not significant (<i>p</i> = 0.216); a HATCH score ≥ 3 provided 63.6% sensitivity and 77.7% specificity. The optimism-corrected C-statistic was 0.761 with a calibration slope of 0.918. NOAF was associated with a higher rate of in-hospital stroke (15.9% vs. 3.6%; <i>p</i> = 0.005).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The HATCH score independently predicted NOAF after transfemoral TAVI and performed at least as well as the CHA₂DS₂-VASc score; aortic root angulation was an additional independent correlate. As a simple, bedside tool, the HATCH score may aid pre-procedural risk stratification, pending external validation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 5","pages":"1848-1857"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balancing Thrombosis and Bleeding: A Case Report of Acute Myocardial Infarction in an Elderly Patient With Hemophilia A","authors":"Dehua Huang,&nbsp;Xi Yang,&nbsp;Xianglan Zhang,&nbsp;Xiaoyu Huang","doi":"10.1002/ccd.70858","DOIUrl":"10.1002/ccd.70858","url":null,"abstract":"<div>\u0000 \u0000 <p>Hemophilia A combined with acute myocardial infarction (AMI) is rare and challenging to treat. This article reports a 65-year-old patient with hemophilia A admitted for acute inferior ST-segment elevation myocardial infarction, who successfully underwent emergency drug-coated balloon (DCB) angioplasty with factor VIII replacement support. Dual antiplatelet therapy (DAPT) was discontinued 3 weeks after the operation, after which the patient received neither antithrombotic therapy nor replacement therapy, while comprehensive risk factor control was intensified. No recurrent thrombotic or hemorrhagic events were observed during the 1-year follow-up. This case suggests that the DCB strategy can shorten the required duration of antithrombotic treatment, and discontinuing antithrombotic and replacement therapies may be safe for selected patients, with comprehensive risk factor control serving as the core antithrombotic intervention at this stage.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 5","pages":"1879-1882"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-Guided Transcatheter Aortic Valve Replacement in Bicuspid Aortic Stenosis With a Large Membranous Ventricular Septal Aneurysm: Challenges in Annular Sizing and Valve Selection","authors":"Louay Dandach,&nbsp;Asma Bergaoui,&nbsp;Alaa Masri","doi":"10.1002/ccd.70844","DOIUrl":"10.1002/ccd.70844","url":null,"abstract":"<div>\u0000 \u0000 <p>Membranous ventricular septal aneurysm (MSA) is an uncommon anatomical finding that may significantly alter the geometry of the aortic annulus and left ventricular outflow tract, creating challenges for transcatheter aortic valve replacement (TAVR). We report the case of a 78-year-old woman with symptomatic severe bicuspid aortic stenosis and a large MSA who underwent successful TAVR following CT-guided procedural planning. Cardiac computed tomography demonstrated interruption of annular continuity by the aneurysmal cavity, making conventional annular sizing unreliable. A virtual annular plane excluding the aneurysm was reconstructed to estimate the effective landing zone, yielding an annular area of 387 mm² and a perimeter of 71.4 mm. Given the large aneurysmal neck and bicuspid valve with a calcified raphe, a 29-mm Evolut FX+ self-expanding valve was selected. Following balloon valvuloplasty, valve implantation was successfully performed with excellent positioning and minimal residual aortic regurgitation. At 2-month follow-up, the patient reported marked symptomatic improvement. Cardiac CT demonstrated stable prosthesis positioning, absence of leaflet thrombosis, and reduction of MSA systolic volume from 2.81 cm³ to 1.55 cm³. This case highlights the importance of multimodality imaging, CT-based virtual annular reconstruction, and individualized valve selection in patients with complex structural anatomy undergoing TAVR.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 5","pages":"1818-1823"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter Edge-to-Edge Repair With the PASCAL Precision System: Advanced Catheter Steering Maneuvers for Mitral and Tricuspid Interventions","authors":"Giulio Russo,&nbsp;Marcello Marchetta,&nbsp;Maurizio Taramasso,&nbsp;Giuseppe Massimo Sangiorgi","doi":"10.1002/ccd.70862","DOIUrl":"10.1002/ccd.70862","url":null,"abstract":"<div>\u0000 \u0000 <p>Transcatheter edge-to-edge repair (TEER) has become the most common percutaneous technique for patients affected by severe regurgitation, either mitral or tricuspid, as recommended by the latest European and American guidelines on valvular heart disease. Among the available devices, the PASCAL Precision system (Edwards Lifesciences, Irvine, California) is the latest technology introduced on the market, with a CE Mark obtained in 2019 for MR and in 2020 for TR treatment. Several studies have demonstrated its safety and effectiveness in both the treatment of MR and TR, but optimal TEER results are closely connected to the operator's experience. In this perspective, the aim of the present manuscript is to provide a full guide on basic and advanced movements of the PASCAL system for the treatment of MR and TR.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 5","pages":"1858-1868"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maximum Allowable Contrast Dose and Risk of Acute Kidney Injury After Coronary Procedures","authors":"Harshita Gaba,&nbsp;Elise Mesenbring,&nbsp;Christine Chow,&nbsp;Jennifer A. Rymer,&nbsp;Celina M. Yong,&nbsp;Stephen W. Waldo,&nbsp;Jacob A. Doll","doi":"10.1002/ccd.70854","DOIUrl":"10.1002/ccd.70854","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent studies have questioned whether iodinated contrast is causally related to acute kidney injury (AKI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> AIM</h3>\u0000 \u0000 <p>We pursed a contemporary analysis to determine the impact of contrast dose on AKI following coronary procedures in an era of lower contrast doses and less nephrotoxic agents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This national cohort study examined patients who had percutaneous coronary intervention (PCI) or diagnostic angiography from October 2010 to May 2023. We used logistic regression to test associations between (1) baseline (pre-procedural) AKI risk and contrast dose, and (2) contrast dose and post-procedure AKI. Contrast exposure was quantified as a proportion of the maximal allowable contrast dose (MACD; 2.5 mL × body weight (kg)/serum creatinine).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median contrast volume decreased during our study period for PCI (200 to 150 mL, <i>p</i> &lt; 0.01) and angiography (95 to 60 mL, <i>p</i> &lt; 0.01). In the combined cohort of 175,963 procedures, the mean patient age was 68.5 years; 97.5% were male. Decile plots revealed that patients at higher baseline risk of AKI received lower contrast volumes. When the contrast dose exceeded MACD, there was a stepwise association between contrast dose and adjusted odds of AKI. The highest odds of AKI were observed for patients with eGFR &lt; 30 who received &gt; 200% of the MACD (OR, 2.89; 95% CI, 2.21 to 3.79).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this large national cohort of patients undergoing coronary procedures, there was a reduction in contrast dose over time and evidence that physicians are reducing contrast volume for high-risk patients. The MACD remains a reasonable target to reduce AKI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 5","pages":"1869-1878"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.70854","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Determinants of Ventricular Arrhythmias After Self-Expandable Pulsta Valve Implantation in the Native Right Ventricular Outflow Tract","authors":"Woo Young Park,&nbsp;Gi Beom Kim,&nbsp;Sang Yun Lee,&nbsp;Mi Kyoung Song,&nbsp;Seung Min Baek,&nbsp;Susan Taejung Kim,&nbsp;Duck Woo Lee,&nbsp;Eun Jung Bae","doi":"10.1002/ccd.70859","DOIUrl":"10.1002/ccd.70859","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ventricular arrhythmias (VA) after percutaneous pulmonary valve implantation (PPVI) have been mainly reported with balloon-expandable valves. Data on VA following self-expandable valves, particularly the Pulsta valve, remain limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate the incidence, clinical characteristics, and predictors of clinically significant VA after Pulsta valve implantation in patients with native right ventricular outflow tract (RVOT) disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed 129 consecutive patients who underwent PPVI with the Pulsta valve. All patients received continuous telemetry monitoring until discharge. Clinically significant VA was defined as VA requiring antiarrhythmic therapy. Clinical, electrocardiographic, RVOT morphological, and valve-related variables were analyzed using univariable logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median age at PPVI was 27 years (interquartile range, 22.0–36.0). Over a median follow-up of 3.3 years, any VA occurred in 42 patients (32.6%), predominantly transient premature ventricular complexes (PVCs; 16.3%) or non-sustained ventricular tachycardia (VT; 16.3%). Among patients with non-sustained VT, antiarrhythmic therapy was required in 5 patients (3.9%), with only 2 patients (1.6%) remaining on medication at discharge. No sustained VT, hemodynamic instability, or persistent arrhythmia requiring long-term therapy was observed. Proximal RVOT implantation was the strongest predictor of VA (odds ratio 5.74, 95% confidence interval 1.08–30.57 vs. mid/distal RVOT, <i>p</i> = 0.039). Other clinical, electrocardiographic, anatomical, and valve-related factors were not associated with VA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with native RVOT disease treated with self-expandable Pulsta valve, clinically significant VA was rare, and most VAs were benign and self-limited. Pulsta valve implantation at proximal RVOT was the key determinant of VA risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 5","pages":"1898-1905"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optical Coherence Tomography-Guided Directional Coronary Atherectomy Using Tip-Detection Method","authors":"Tomoaki Haga,&nbsp;Akihito Tanaka,&nbsp;Yosuke Tatami,&nbsp;Masanori Shinoda","doi":"10.1002/ccd.70848","DOIUrl":"10.1002/ccd.70848","url":null,"abstract":"<div>\u0000 \u0000 <p>Directional coronary atherectomy (DCA) requires precise spatial orientation. Although the tip detection method is established for intravascular ultrasound, its application in optical coherence tomography (OCT)-guided DCA remains unestablished. We present a case of functionally significant stenosis at the left anterior descending (LAD) artery ostium treated with OCT-guided DCA. We adapted the tip detection method using a second guidewire with a tip curve. Aligning the fluoroscopically directed guidewire with the 3 o'clock position on the OCT cross-section achieved precise three-dimensional spatial co-registration, enabling accurate plaque localization. This first report demonstrates that OCT-guided tip detection offers a safe and sophisticated debulking strategy for complex coronary lesions.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 5","pages":"1824-1827"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-Time IVUS-Guided Wiring With a Dual-Lumen Microcatheter for Blunt Proximal Cap CTO: Procedural Technique and Comparative Outcomes","authors":"Dong-Eon Kim,&nbsp;Inki Moon,&nbsp;Min Gyu Kong,&nbsp;Hyun Woo Park,&nbsp;Hyung-Oh Choi,&nbsp;Yoon Haeng Cho,&nbsp;Nae-Hee Lee,&nbsp;Jon Suh","doi":"10.1002/ccd.70847","DOIUrl":"10.1002/ccd.70847","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) with blunt proximal caps is technically challenging due to unclear vessel morphology. Real-time intravascular ultrasound (IVUS) guidance can improve wire entry accuracy; however, its application with conventional pull-back IVUS systems remains underinvestigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate the feasibility and outcomes of real-time IVUS-guided wiring for blunt proximal cap CTO PCI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed patients who underwent PCI for blunt-cap CTOs between January 2020 and December 2024. Patients were categorized into IVUS-guided and angiography-guided wiring groups based on the initial strategy. The IVUS-guided approach employed a conventional pull-back IVUS system with a shaft-mounted transducer, advanced into a side branch, alongside a dual-lumen microcatheter positioned on the same wire to facilitate real-time imaging. In-hospital events and follow-up clinical outcomes were assessed. Overlap weighting based on propensity scores was applied to balance baseline and angiographic characteristics between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 152 patients, 17 underwent IVUS-guided wiring and 135 underwent angiography-guided wiring. The IVUS-guided group demonstrated reduced use of parallel wiring and retrograde techniques. Procedural success rates were high in both groups. Complete revascularization was numerically more frequent in the IVUS-guided group. Over 15.4 ± 6.9 months, the IVUS-guided group showed numerically lower rates of adverse clinical events, though the study was underpowered to detect definitive differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Real-time IVUS-guided wiring using a conventional pull-back IVUS system with a dual-lumen microcatheter was feasible in selected blunt proximal cap CTO lesions. When a suitable side branch is available, this technique may offer a practical option for resolving proximal cap ambiguity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 5","pages":"1837-1847"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}