Catheterization and Cardiovascular Interventions最新文献

{"title":"Outcomes Stratified by Adapted Inclusion Criteria After Transcatheter Tricuspid Edge-to-Edge Repair","authors":"Giulio Russo,&nbsp;Daniela Pedicino,&nbsp;Marianna Adamo,&nbsp;Hannes Alessandrini,&nbsp;Martin Andreas,&nbsp;Daniel Braun,&nbsp;Kim A. Connelly,&nbsp;Gaetano Chiricolo,&nbsp;Paolo Denti,&nbsp;Rodrigo Estevez-Loureiro,&nbsp;Neil Fam,&nbsp;Rebecca T. Hahn,&nbsp;Claudia Harr,&nbsp;Joerg Hausleiter,&nbsp;Dominique Himbert,&nbsp;Daniel Kalbacher,&nbsp;Edwin Ho,&nbsp;Azeem Latib,&nbsp;Edith Lubos,&nbsp;Sebastian Ludwig,&nbsp;Gianluca Massaro,&nbsp;Philipp Lurz,&nbsp;Marco Metra,&nbsp;Vanessa Monivas,&nbsp;Georg Nickenig,&nbsp;Giovanni Pedrazzini,&nbsp;Alberto Pozzoli,&nbsp;Fabien Praz,&nbsp;Joseph Rodes-Cabau,&nbsp;Christian Besler,&nbsp;Karl-Philipp Rommel,&nbsp;Joachim Schofer,&nbsp;Andrea Scotti,&nbsp;Kerstin Piayda,&nbsp;Giuseppe Massimo Sangiorgi,&nbsp;Horst Sievert,&nbsp;Gilbert H. L. Tang,&nbsp;Isaac Pascual,&nbsp;Holger Thiele,&nbsp;Florian Schlotter,&nbsp;Andrea Natale,&nbsp;Ralph Stephan von Bardeleben,&nbsp;John Webb,&nbsp;Stephan Windecker,&nbsp;Martin Leon,&nbsp;Maurice Enriquez-Sarano,&nbsp;Francesco Maisano,&nbsp;Stefan Bloechlinger,&nbsp;Maurizio Taramasso","doi":"10.1002/ccd.70763","DOIUrl":"10.1002/ccd.70763","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent trials demonstrated that tricuspid transcatheter edge-to-edge repair (T-TEER) is particularly effective for symptoms and quality of life improvement. However, its effect on prognosis is still unclear. Moreover, the applicability of trials inclusion/exclusion criteria has not been investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aim of the present study is to investigate the applicability of TRILUMINATE and Tri.Fr trials inclusion and exclusion criteria on real-world patients from TRIVALVE registry, and to evaluate their effects on outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients undergoing T-TEER were selected from the TRIVALVE registry and, according to inclusion and exclusion criteria, divided in four groups: TRILUMINATE eligible versus ineligible and Tri.Fr eligible versus ineligible patients. TRILUMINATE and Tri.Fr analysis were conducted separately.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From a total of 664 patients of the TRIVALVE registry, 520 and 519 were included in the TRILUMINATE and Tri.Fr analysis, respectively. In particular, 240 patients (46%) met the TRILUMINATE criteria and 260 (50%) those of Tri.Fr. Baseline characteristics were significantly different between trials' eligible and ineligible patients. TRILUMINATE-eligible patients showed significant lower mortality/rehospitalization compared to ineligible ones (12% vs. 25%, <i>p</i> = 0.028), as well as Tri.Fr-eligible versus ineligible ones (15% vs. 22%, <i>p</i> = 0.007).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with TR undergoing T-TEER, inclusion and exclusion criteria of TRILUMINATE and Tri.Fr are applicable to around half of real-world patients. Patients matching trials criteria have lower mortality/rehospitalization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 4","pages":"1198-1205"},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552103","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":"Percutaneous Transaxillary Access for Large-Bore Cardiovascular Interventions: Evidence, Technique, and Complication Management","authors":"Gioel Gabrio Secco,&nbsp;Marco Lombardi,&nbsp;Edoardo Elia,&nbsp;Juan Guido Chiabrando,&nbsp;Andrea Demarchi,&nbsp;Rocco Vergallo,&nbsp;Andrea Audo,&nbsp;Giulia Maj,&nbsp;Giuseppe Patti,&nbsp;Nicolas M. Van Mieghem","doi":"10.1002/ccd.70759","DOIUrl":"10.1002/ccd.70759","url":null,"abstract":"<p>Percutaneous transaxillary access is an established alternative to transfemoral large-bore arterial access for transcatheter structural heart interventions and mechanical circulatory support (MCS). Although useful for overcoming hostile iliofemoral anatomy and providing prolonged support and patient mobilization in case of MCS, the axillary/subclavian territory poses distinct technical and anatomical challenges that demand meticulous pre-procedural imaging, patient selection, accurate puncture under ultrasound and angiographic guidance, preservation of bailout access, and familiarity with suture-based and balloon-assisted closure strategies. This review provides a contemporary practical framework for percutaneous transaxillary access, summarizing the available clinical evidence, technical aspects of puncture and closure, complication management, and procedural tips to improve safety and reproducibility.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 4","pages":"1186-1197"},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.70759","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537977","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":"Ticagrelor Induced 2:1 Atrio-Ventricular Block After Percutaneous Coronary Intervention to Right Coronary Artery","authors":"Siddhant Arora,&nbsp;Yash Paul Sharma,&nbsp;Prashant Panda,&nbsp;Samman Verma","doi":"10.1002/ccd.70748","DOIUrl":"10.1002/ccd.70748","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is standard following PCI. Ticagrelor is increasingly preferred due to its potent, reversible platelet inhibition. While generally safe, ticagrelor has been associated with conduction abnormalities, including sinus pauses and atrioventricular (AV) block, though clinically significant bradyarrhythmias remain rare. We report a rare case of symptomatic 2:1 Mobitz type II AV block following ticagrelor initiation post-PCI and emphasize the importance of timely recognition to avoid unnecessary pacemaker implantation. We describe a 68-year-old woman presenting with unstable angina. Coronary angiography revealed significant mid-RCA disease, and PCI with a sirolimus-eluting stent was performed successfully. She was discharged on aspirin and ticagrelor, without rate-limiting drugs, as her baseline heart rate was 60 bpm. Two weeks later, she developed dizziness and dyspnea (NYHA III). ECG showed 2:1 Mobitz type II AV block with a ventricular rate of 40 bpm. Repeat angiography confirmed a patent stent, and thyroid profile was normal. Holter monitoring corroborated persistent AV block. Ticagrelor was discontinued and replaced with clopidogrel, resulting in the restoration of sinus rhythm. On follow-up, the patient remained asymptomatic with normal ECG findings. Ticagrelor can rarely induce clinically significant AV block even in the absence of other rate-limiting drugs. Clinicians should maintain a high index of suspicion when post-PCI patients on ticagrelor present with bradyarrhythmias. Withdrawal of ticagrelor should be considered before resorting to pacemaker implantation, thereby preventing unnecessary interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 4","pages":"1176-1179"},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521777","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":"A Randomized Pilot Trial Comparing Combined Catheter-Interventional Treatment Versus Standard of Care in Intermediate High-Risk Pulmonary Embolism","authors":"Parham Shahidi,&nbsp;Luise Mentzel,&nbsp;Dmitry Sulimov,&nbsp;Paula Sagmeister,&nbsp;Charlotte Wolff,&nbsp;Tobias Kister,&nbsp;Holger Thiele,&nbsp;Maximilian von Roeder,&nbsp;Janine Pöss,&nbsp;Karl Fengler","doi":"10.1002/ccd.70758","DOIUrl":"10.1002/ccd.70758","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Catheter-directed treatment of pulmonary artery embolism (PE) is increasingly used worldwide. Numerous devices for mechanical thrombectomy (MT) and local fibrinolysis (LF) have become available over recent years. While various studies show safety and efficacy for either MT or LF, little is known about the combination of both treatment modalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This open-label, single-center, randomized controlled pilot trial aimed to investigate the treatment effect size and safety of a combined catheter-interventional treatment (CCIT) approach for PE, consisting of LF and MT in comparison to conventional guideline-directed therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty patients with intermediate-high risk PE were randomized 2:1 to CCIT or control. The two co-primary endpoints were the difference in (1) a combined clinical endpoint (consisting of systolic blood pressure over heart rate, and respiratory rate) and (2) right-to-left ventricular (RV/LV)-ratio from a transthoracic echocardiogram between the two groups 24 h after randomization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After 24 h, the combined clinical endpoint improved by 0.02 ± 0.01 in the CCIT group, whereas no improvement was observed in the control group (−0.01 ± 0.01, <i>p</i> &lt; 0.001 for between-group comparison). RV/LV-ratio was reduced by 0.3 ± 0.2 in the CCIT-group and remained unchanged in the control group (−0.1 ± 0.1, <i>p</i> = 0.02 for between-group comparison). Safety outcomes, including in-hospital mortality and bleeding, were similar between the two treatment groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this pilot study, CCIT of intermediate-high risk PE was found to be effective and safe in comparison to conventional PE treatment. These findings warrant confirmation in larger-scale trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 4","pages":"1169-1175"},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521690","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":"Patterns of Neoatherosclerotic Plaque Complications in Patients With Stent Failure: An Optical Coherence Tomography Study","authors":"Gunduz Incesu,&nbsp;Bilgehan Karadag,&nbsp;Mahmut Kaan Temiz,&nbsp;Isil Firdevs Saribay Incesu,&nbsp;Ahmet Atıl Aygun,&nbsp;Sedat Güney,&nbsp;Fatma Gungor,&nbsp;Asli Soysal,&nbsp;Alpin Mert Tekin,&nbsp;Damla Raimoglou,&nbsp;Murat Cimci,&nbsp;Utku Raimoglu,&nbsp;Eser Durmaz","doi":"10.1002/ccd.70760","DOIUrl":"10.1002/ccd.70760","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Neoatherosclerosis is a major mechanism of late and very late stent failure. While plaque rupture (PR) has traditionally been considered the dominant substrate, the prevalence and characteristics of other neoatherosclerotic plaque complications remain insufficiently defined. We aimed to investigate the morphological and clinical differences between neoatherosclerotic PR and plaque erosion (PE) using optical coherence tomography (OCT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective single-center study included patients with stent failure undergoing OCT-guided percutaneous coronary intervention between January 2020 and December 2025. Patients with neoatherosclerosis-related stent failure were classified according to OCT findings as PR or PE. Clinical presentation, angiographic characteristics, OCT-derived plaque morphology, and long-term outcomes were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 103 screened patients, 44 met the inclusion criteria; 28 had PR, 14 had PE and 2 had instent eruptive calcific nodule. PR patients more frequently presented with STEMI and demonstrated significantly higher levels of macrophage infiltration (57.1% vs. 23.1%, <i>p</i> = 0.043), cholesterol crystals (60.7% vs. 28.6%, <i>p</i> = 0.050), lipid arc ≥ 180° (80% vs. 42.9%, <i>p</i> = 0.031), and thin-cap fibroatheroma (35.7% vs. 7.1%, <i>p</i> = 0.048). In contrast, layered plaque was markedly more prevalent in PE (92.9% vs. 48.3%, <i>p</i> = 0.004), and minimal in-stent lumen area was smaller in PE lesions (<i>p</i> = 0.039). Postprocedural thrombus protrusion was significantly more common in PR (81% vs. 27.5%, <i>p</i> = 0.005). Although not statistically significant, all-cause and cardiac mortality were numerically higher in PR patients during follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Neoatherosclerotic PR and PE represent distinct mechanisms of stent failure with different inflammatory profiles, plaque morphology, and clinical presentations. PR is associated with higher lipid burden and inflammatory activity, whereas PE is characterized by layered neointima and lower inflammatory features. OCT-based plaque characterization may improve risk stratification and support personalized treatment strategies in late stent failure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 4","pages":"1157-1164"},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475663","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":"Current Outlook on Women in Interventional Cardiology Clinical Research: Closing the Gap, or Stuck in Place?","authors":"Georgiana Pintea Bentea,&nbsp;Pierre-Emmanuel Massart","doi":"10.1002/ccd.70773","DOIUrl":"10.1002/ccd.70773","url":null,"abstract":"","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 4","pages":"1226-1229"},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564233","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 Immediate Versus Staged Complete Revascularization in Patients With Index PCI Coronary Complications: A Study on Clinical Outcomes and Predictors of Complications","authors":"Alessandro Gabrielli,&nbsp;Jacob J. Elscot,&nbsp;William Camilleri,&nbsp;Hala Kakar,&nbsp;Eric Boersma,&nbsp;Nicolas M. Van Mieghem,&nbsp;Roberto Diletti,&nbsp;Wijnand K. Den Dekker","doi":"10.1002/ccd.70767","DOIUrl":"10.1002/ccd.70767","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In patients with acute coronary syndrome (ACS) and multivessel disease (MVD), complete revascularization (CR) improves clinical outcomes compared with culprit-only percutaneous coronary intervention (PCI). However, the optimal timing of CR, immediate (ICR) versus staged (SCR), remains debated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This post hoc analysis of the BIOVASC trial aimed to evaluate whether unresolved culprit-lesion-related complications influence outcomes of ICR compared with SCR and to identify predictors of procedural complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Among 1525 patients enrolled in BIOVASC, 1487 index coronary angiographies were analyzed. Coronary complications related to culprit lesion PCI were classified and assessed for resolution status. Clinical outcomes were evaluated at 2-year follow-up according to randomized treatment strategy (ICR vs. SCR). Logistic regression was used to identify independent predictors of complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Culprit-lesion-related complications occurred in 153 of 1487 procedures (10.3%), with 125 (81.7%) unresolved at the end of the index procedure. The most frequent complications were side branch occlusion or slow flow and distal slow reflow. Among patients with unresolved complications, the 2-year rate of major adverse cardiovascular events (MACE: death, myocardial infarction, unplanned revascularization, or stroke) was similar between ICR and SCR (10.6% vs. 17.2%; HR 0.58, 95% CI 0.22–1.52; <i>p</i> = 0.27). Independent predictors of procedural complications were complex culprit lesion morphology (class B2/C) (OR 1.68, 95% CI 1.07–2.63; <i>p</i> = 0.023) and STEMI presentation (OR 1.45, 95% CI 1.00–2.11; <i>p</i> = 0.049).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with unresolved culprit lesion complications during index PCI, ICR showed comparable 2-year outcomes to the staged approach. Complex lesion morphology and STEMI presentation independently predicted procedural complications. These findings suggest that ICR remains a safe and viable strategy in hemodynamically stable patients, even in the presence of procedural challenges.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 4","pages":"1241-1247"},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.70767","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581952","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":"FineCross M3 Microcatheter for Balloon Uncrossable Lesions","authors":"Harmanpreet Kaur,&nbsp;Noah N. Williford,&nbsp;Michaella Alexandrou,&nbsp;Emmanouil S. Brilakis","doi":"10.1002/ccd.70775","DOIUrl":"10.1002/ccd.70775","url":null,"abstract":"<div>\u0000 \u0000 <p>Balloon and microcatheter uncrossable lesions can be challenging to treat. Possible treatment options include small balloons, increasing guide catheter support, using specialized microcatheters, laser, atherectomy, or extraplaque crossing strategies. The FineCross M3 microcatheter (Terumo) has a low-profile and a hydrophilic coating. We describe three cases of successful use of the FineCross M3 to cross balloon/microcatheter uncrossable lesions after failure of other crossing modalities, highlighting its favorable combination of crossing ability and safety profile, including a securely attached distal marker with lower risk of tip separation than some alternative low-profile microcatheters.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 4","pages":"1180-1185"},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148538060","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":"Physiology-Guided Drug-Coated Balloon Angioplasty: What We Know and What is Yet to be Understood","authors":"Marco Frazzetto,&nbsp;Filippo Luca Gurgoglione,&nbsp;Bharat Khialani,&nbsp;Sandeep Basavarajaiah,&nbsp;Bernardo Cortese","doi":"10.1002/ccd.70720","DOIUrl":"10.1002/ccd.70720","url":null,"abstract":"&lt;p&gt;The advent of coronary physiology has significantly reshaped the approach to percutaneous coronary intervention (PCI), establishing its role as an essential tool for step-by-step guidance during revascularizations with drug-eluting stents (DES). Coronary physiology was introduced as a pre-PCI decision-making tool to guide revascularization of intermediate coronary artery stenoses, demonstrating better clinical outcomes compared to angiography-guided PCI. In recent years, postprocedural coronary physiology has proven to be a valuable tool for optimizing DES-PCI results and for reducing the risk of future cardiovascular events.&lt;/p&gt;&lt;p&gt;Recently, the latest European practical guidelines on chronic coronary syndromes have endorsed the use of coronary physiology tools (i.e., fractional flow reserve [FFR], instantaneous wave-free ratio [iFR], and quantitative flow ratio [QFR]) at the end of the procedure to identify patients at high risk of persistent angina and subsequent clinical events based on pioneering studies.&lt;/p&gt;&lt;p&gt;The rapid spread of drug-coated balloons (DCB) as a strategy for the treatment of coronary artery disease (CAD) is evolving either with technological advancements or procedural strategies [&lt;span&gt;1&lt;/span&gt;]. To date, quantitative coronary angiography (QCA) is commonly used to assess the quality of lesion preparation and to determine the success of DCB angioplasty, which is indicated by residual stenosis ≤ 40%, Thrombolysis in Myocardial Infarction (TIMI) flow grade 3, and the absence of flow-limiting dissections. However, QCA may be inaccurate in evaluating the hemodynamic significance of residual stenosis, particularly in the presence of vessel dissection, and in assessing the risk of abrupt vessel closure associated with the latter. Hence, the concept of a “physiology-guided DCB angioplasty” to overcome the limitation of QCA and improve the outcomes of DCB angioplasty seems attractive.&lt;/p&gt;&lt;p&gt;It is noteworthy to underscore that the implementation of coronary physiology after balloon angioplasty in the attempt to predict short- and long-term events is not a novel framework. Indeed, as early as 1987, Redd and colleagues [&lt;span&gt;2&lt;/span&gt;] suggested that a rising trend pattern identified by an increasing pressure gradient after deflation of the balloon was associated with an increased rate of acute vessel closure and myocardial infarction immediately after the procedure.&lt;/p&gt;&lt;p&gt;Several studies have investigated the potential application of different coronary physiology tools for guiding decision-making in PCI with DCB and the final optimization of DCB angioplasty. It is worth taking a closer look at how these results can be integrated into current recommendations and what implications they might have for future treatment decisions.&lt;/p&gt;&lt;p&gt;Back in 1999, Bech et al. [&lt;span&gt;3&lt;/span&gt;] suggested that an FFR &gt; 0.90 after simple angioplasty was a good indicator of immediate functional improvement and reduced restenosis at 2 years follow-up.&lt;/p&gt;","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 4","pages":"1149-1156"},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.70720","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475637","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":"Physiology-Guided Heart Rate Modulation in Cardiogenic Shock With Myocardial Bridging: Reversing the Inotrope Paradox","authors":"Giulia Puglisi,&nbsp;Simone Finocchiaro,&nbsp;Davide Capodanno","doi":"10.1002/ccd.70757","DOIUrl":"10.1002/ccd.70757","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Myocardial bridging is a dynamic coronary anomaly in which systolic compression may extend into early diastole, particularly under conditions of increased heart rate and contractility. In patients with cardiogenic shock, this creates a potential physiological conflict, as catecholaminergic support may worsen coronary flow impairment rather than improve haemodynamics. A 66-year-old man presented with inferolateral ST-segment elevation myocardial infarction due to thrombotic occlusion of the proximal left circumflex artery, successfully treated with primary percutaneous coronary intervention. Coronary angiography also showed a long myocardial bridge involving the mid left anterior descending artery. After revascularization, the patient devoped cardiogenic shock requiring norepinephrine and dobutamine, but remained haemodinamically unstable, with persistent tachycardia, low cardiac index, reduced stroke volume index, and progressive respiratory failure. Given the presence of myocardial bridging, a tachicardia-mediated limitation of dyastolic coronary perfusion was hypothesized. Low-dose landiolol, an ultra-short-acting and highly β1-selective blocker, was introduced under continuous haemodynamic monitoring. Heart rate decreased from 127 to 83 bpm and was accompained by a marked improvement in stroke volume index, cardiac index, and lactate levels, while vasopressor requirements remained stable. This case illustrates an “inotrope paradox” in which adrenergic stimulation may aggravate haemodynamic compromise in the presence of myocardial bridging by increasing heart rate and contractility, thereby intensifying systolic compression and shortening diastolic perfusion time. In this setting, physiology-guided heart rate reduction may restore coronary flow dynamics and improve systemic output. In selected patients with cardiogenic shock and myocardial bridging, ultra-short-acting β1-blockade may represent a targeted strategy to reverse tachycardia-mediated haemodynamic deterioration and support a diastole-centered approach to resuscitation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"108 4","pages":"1120-1123"},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148451382","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}