Catheterization and Cardiovascular Interventions最新文献

{"title":"Revisiting the Efficacy and Safety of Bivalirudin in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Insights From a Mixed Treatment Comparison Meta-Analysis of Randomized Trials.","authors":"M Haisum Maqsood, Jacqueline E Tamis-Holland, Frederick Feit, Sripal Bangalore","doi":"10.1002/ccd.31276","DOIUrl":"10.1002/ccd.31276","url":null,"abstract":"<p><strong>Background: </strong>Randomized trials of bivalirudin in patients with ST elevation myocardial infarction (STEMI) have yielded heterogeneous results.</p><p><strong>Aims: </strong>Our aim was to evaluate the efficacy and safety of four antithrombin regimens-unfractionated heparin (UFH), bivalirudin (stopped soon after percutaneous coronary intervention [PCI]), extended bivalirudin (continued for a few hours after PCI), and combined UFH and a Gp2b3a inhibitors (GPI) in patients who present with STEMI.</p><p><strong>Methods: </strong>A PubMed, EMBASE, and clinicaltrials.gov databases were searched for randomized clinical trials (RCTs) of the above antithrombin in patients with STEMI. The primary outcome was net adverse cardiovascular events (NACE). The primary ischemic endpoint was major adverse cardiovascular events (MACE), and the primary safety endpoint was major bleeding, and other endpoints included all-cause mortality and stent thrombosis. The primary analysis compared the effect of these antithrombin regimens in reference to UFH using a mixed treatment comparison meta-analysis.</p><p><strong>Results: </strong>In the 14 RCTs evaluating 25,415 patients with STEMI, when compared to UFH monotherapy, extended bivalirudin lowered NACE (OR = 0.71 with 95% CI: 0.53-0.96; moderate level of confidence) driven by a significant decrease in major bleeding (OR = 0.42 with 95% CI: 0.26-0.68; high level of confidence) without any significant difference in MACE or all-cause mortality. When compared with UFH monotherapy, UFH+GPI reduced risk of MACE (OR = 0.76 with 95% CI: 0.60-0.97; high level of confidence) but at the expense of an increase in major bleeding (OR = 1.48 with 95% CI: 1.11-1.98; high level of confidence) with no difference in NACE or all-cause mortality. For major bleeding, extended bivalirudin infusion ranked #1, bivalirudin ranked #2, UFH monotherapy ranked #3, and combined UFH and GPI ranked #4. For NACE, extended bivalirudin infusion ranked #1, bivalirudin ranked #2, combined UFH and GPI ranked #3, and UFH monotherapy ranked #4. Cluster plots for MACE and major bleeding demonstrated that extended bivalirudin had the best balance for efficacy and safety.</p><p><strong>Conclusions: </strong>In patients undergoing PCI for STEMI, extended bivalirudin offers the best balance for primary ischemic (MACE) and safety (major bleeding) outcomes.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":"54-67"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589683","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":"Clinical Outcomes of Transcatheter Mitral Valve-In-Valve and Valve-In-Ring Implantation: A Systematic Review and Meta-Analysis.","authors":"Khi Yung Fong, John Ming Yan Koh, Lip Wei Saw, Devy Anggreni, Ethel Zi Xie Ng, Yiong Huak Chan, Karl Poon, Dion Stub, Shih-Hsien Sung, Mann Chandavimol, Michael Kang-Yin Lee, Angus Shing Fung Chui, A B Gopalamurugan, Rajesh Nair, Yingqiang Guo, Mohammed Rizwan Amanullah, Victor Tar Toong Chao, See Hooi Ewe, Kay Woon Ho, Jonathan Yap","doi":"10.1002/ccd.31299","DOIUrl":"10.1002/ccd.31299","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter valve-in-valve (VIV) or valve-in-ring (VIR) therapies for degenerated mitral bioprosthetic valves and rings are still evolving. We aimed to characterize short- and long-term outcomes of these procedures.</p><p><strong>Methods: </strong>An electronic literature search was conducted to retrieve articles describing mitral VIV or VIR implantation with at least 10 patients. Meta-analysis of proportions was carried out for 30-day or in-hospital outcomes of mortality, stroke, major bleeding, transfusion, acute kidney injury, procedural success, valve embolization, paravalvular leak, pacemaker implantation, and hospital stay. Individual patient data meta-analysis using Kaplan-Meier curve reconstruction was used to estimate long-term mortality of VIV, VIR and redo surgical mitral valve replacement (SMVR).</p><p><strong>Results: </strong>We analyzed 34 studies (7047 patients). Pooled procedural success was 94.8% in VIV and 80.5% in VIR. Pooled short-term mortality and stroke risk was 6.4% and 1.9% respectively in VIV, 9.1% and 1.6% respectively in VIR, and 8.4% and 5.5% respectively in SMVR.</p><p><strong>Conclusions: </strong>This study provides prognostic information on clinical outcomes for redo SMVR and transcatheter mitral VIV and VIR implantation.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":"219-238"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681056","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 a Fully Angiography-Derived Versus a Hybrid of Angiography and Pressure-Wire-Derived Approach to Assess Coronary Microvascular Resistance: The Oxford Acute Myocardial Infarction Hybrid (OxAMI-HYBRID) Study.","authors":"Jason Chai, Federico Marin, Roberto Scarsini, Rafail Kotronias, Stefano Benenati, Miao Chu, Liam S Couch, Jeremy Langrish, Keith Channon, Adrian Banning, Giovanni Luigi De Maria","doi":"10.1002/ccd.31311","DOIUrl":"10.1002/ccd.31311","url":null,"abstract":"<p><strong>Background: </strong>Despite growing evidence of its clinical implications, assessment of coronary microvascular dysfunction (CMD) remains limited in routine clinical practice. Hence, there is an increasing interest in angiography-derived indices to encourage assessment of CMD in the cardiac catheterisation laboratory.</p><p><strong>Aims: </strong>We investigate here an alternative approach, using a combination of pressure-wire-based assessment of distal coronary pressure (P_d) and an angiography-derived surrogate of coronary flow, to derive a hybrid index of microcirculatory resistance (IMR_hybrid).</p><p><strong>Methods: </strong>Patients enroled prospectively under the Oxford Acute Myocardial Infarction (OxAMI) study were included in the OxAMI HYBRID substudy. The accuracy of IMR_hybrid was assessed in diagnosing CMD using bolus thermodilution-based Index of Microcirculatory Resistance (IMR) as a reference. The accuracy of IMR_hybrid was then compared against a fully angiography-derived index of microvascular resistance (IMR_angio).</p><p><strong>Results: </strong>One hundred and eighty six patients were enroled, of which 121 with acute coronary syndrome and 65 with stable coronary artery disease. A total of 240 vessel analyses were performed. Both IMR_hybrid and IMR_angio correlated with IMR (rho = 0.71, p < 0.001 and rho = 0.71, p < 0.001 respectively) and showed good and comparable overall diagnostic accuracy in predicting IMR ≥ 25 (80.8% and 83.1% respectively) with a receiver operator curve (ROC) analyses showing similar AUC of 0.86 (95% CI 0.82-0.91, p < 0.001) for IMR_hybrid and 0.86 (95% CI 0.809-0.906, p < 0.001) for IMR_angio, p for comparison = 0.641.</p><p><strong>Conclusion: </strong>Both approaches, IMR_hybrid and IMR_angio are viable and comparable indices correlating with bolus thermodilution-based IMR and retaining good diagnostic accuracy. IMR_hybrid specifically is a simple alternative to conventional bolus thermodilution-based IMR applicable to any pressure wire system.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":"81-90"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709345","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":"Pulmonary Flow Modulation With Diabolo Stent Technique Over the Subpulmonary Outflow Tract.","authors":"Piedad Sánchez-Gil Romero, Álvaro Lafuente-Romero, Enrique Balbacid Domingo, César Abelleira Pardeiro","doi":"10.1002/ccd.31330","DOIUrl":"10.1002/ccd.31330","url":null,"abstract":"<p><p>The diabolo stent technique enables the controlled dilation of stenosis, improving blood flow while avoiding hyperflow. In our case, it was successfully applied to a young girl with a single-ventricle heart. This approach offers a valuable alternative to surgical treatment.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":"184-186"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806185","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":"Pulsus Alternans: Caught in Action.","authors":"Emre Aslanger, Burcu Aggül, Duygu Genç Albayrak","doi":"10.1002/ccd.31295","DOIUrl":"10.1002/ccd.31295","url":null,"abstract":"<p><p>Pulsus alternans describes an arterial pulse waveform that shows alternating strong and weak beats despite a regular rhythm. Either discovered during physical examination or catheterization, pulsus alternans indicates severe left ventricular (LV) dysfunction and poor prognosis. There has been considerable debate about the underlying mechanism. We present a tracing which depicts a classic example of pulsus alternans and gives some clues about its initiation mechanism.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":"270-271"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667157","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":"Intravascular Ultrasound-Guided Versus Angiography-Guided Percutaneous Coronary Intervention: A Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Control Trials.","authors":"Mushood Ahmed, Zain Ali Nadeem, Areeba Ahsan, Hira Javaid, Hritvik Jain, Farhan Shahid, Raheel Ahmed, Mamas A Mamas","doi":"10.1002/ccd.31352","DOIUrl":"10.1002/ccd.31352","url":null,"abstract":"<p><strong>Background: </strong>Intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) allows better assessment of coronary artery lesion characteristics than angiography alone. This systematic review and meta-analysis aimed to comprehensively synthesize the available evidence regarding the efficacy of IVUS guidance compared to angiography-guided PCI.</p><p><strong>Methods: </strong>A comprehensive literature search of major bibliographic databases from inception until April 2024 was conducted to identify randomized control trials (RCTs) comparing IVUS-guided PCI versus angiography-guided PCI. Risk ratios (RR) with their corresponding 95% confidence intervals (CI) were pooled using the random-effects model, with a p < 0.05 considered statistically significant.</p><p><strong>Results: </strong>Fifteen RCTs were included with 9354 patients undergoing PCI. IVUS-guided PCI was associated with a lower risk of cardiac death [RR 0.49, 95% CI 0.33 to 0.72], major adverse cardiovascular events (MACE) [RR 0.64, 95% CI 0.51 to 0.80], myocardial infarction [RR 0.74, 95% CI 0.59 to 0.94], stent thrombosis [RR 0.48, 95% CI 0.29 to 0.81], target lesion revascularization [RR 0.60, 95% CI 0.48 to 0.75], and target vessel revascularization [RR 0.54, 95% CI 0.43 to 0.69] compared to angiography-guided PCI. IVUS-guided PCI was associated with a nonsignificant trend toward a reduced risk of all-cause mortality [RR 0.82, 95% CI 0.58 to 1.01]. Meta-regression showed a nonsignificant moderating effect of the duration of follow-up, age of patients, diabetes mellitus, and acute coronary syndrome presentation of patients on pooled outcomes.</p><p><strong>Conclusion: </strong>IVUS-guided PCI reduced cardiac death, MACE, myocardial infarction, stent thrombosis, target lesion revascularization, and target vessel revascularization compared to angiography-guided PCI.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":"68-80"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806170","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":"Outcomes of Left Main Chronic Total Occlusion Percutaneous Coronary Interventions.","authors":"Dimitrios Strepkos, Michaella Alexandrou, Deniz Mutlu, Pedro E P Carvalho, James W Choi, Sevket Gorgulu, Farouc A Jaffer, Raj Chandwaney, Khaldoon Alaswad, Mir B Basir, Lorenzo Azzalini, Olga C Mastrodemos, Bavana V Rangan, Konstantinos Voudris, Sandeep Jalli, M Nicholas Burke, Yader Sandoval, Emmanouil S Brilakis","doi":"10.1002/ccd.31289","DOIUrl":"10.1002/ccd.31289","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous coronary intervention (PCI) of left main (LM) chronic total occlusions (CTO) has received limited study.</p><p><strong>Methods: </strong>We compared the clinical and procedural characteristics and outcomes of patients who underwent LM versus non-LM CTO PCI at 41 US and non-US centers between 2012 and 2024.</p><p><strong>Results: </strong>During the study period 85 of 15,254 CTO PCIs (0.6%) performed in 14,969 patients were LM CTO PCIs. LM CTO PCI patients were older, had higher rates of dyslipidemia and heart failure and most (88.8%) had prior coronary artery bypass graft surgery (CABG). They were more likely to have moderately or severely calcified lesions (80.7% vs. 45.7%, p < 0.001) and had higher J-CTO (2.76 ± 1.17 vs. 2.37 ± 1.26, p = 0.008), PROGRESS-CTO MACE (3.56 vs. 2.57, p < 0.001), Mortality (2.45 vs. 1.68, p < 0.001), Pericardiocentesis (2.74 vs. 1.87, p < 0.001), Acute MI (1.72 vs. 0.89, p < 0.001) and Perforation (3.21 vs. 2.19, p < 0.001) scores. There was no difference in technical success (80.5% vs. 87.2%, p = 0.086) or major cardiovascular adverse events (MACE) (2.4% vs. 2.0%, p = 0.700). LM CTO PCI patients with and without prior CABG surgery had similar technical success and MACE. The retrograde approach in prior CABG patients was more likely to be performed through saphenous vein grafts.</p><p><strong>Conclusions: </strong>LM CTO PCI is infrequently performed, is associated with high comorbidity burden and angiographic complexity but can be performed with high success and acceptable complication rates.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":"23-31"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615657","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 Pulmonary Valve Implantation With Self-Expanding Valves for Carcinoid Heart Diseases.","authors":"Ka-Chun Un, Chun-Ka Wong, San-Fui Sophia Yong, Robbert de Winter, Bart Straver, Steven Chamuleau, Eric Rosenthal, Shakeel A Qureshi, Marcel Beijk, Matthew I Jones","doi":"10.1002/ccd.31302","DOIUrl":"10.1002/ccd.31302","url":null,"abstract":"<p><p>Carcinoid heart disease is an important complication of neuroendocrine tumors that may lead to significant morbidity and mortality. Right-sided heart valve involvement with consequent valve dysfunction is one of the common manifestations. Patients often have multiple, significant comorbidities with advanced metastatic disease and, as such, may not be suitable for surgical valve replacement due to excessive risk. Transcatheter valve replacement using balloon-expandable valves has been the mainstay of management for these patients, particularly with stenotic lesions but there is limited experience in patients with pulmonary regurgitation and dilated pulmonary arteries outside the dimensions that would be suitable for these valves. We report three successful cases of percutaneous pulmonary valve implantation with the VenusP-valve, a large self-expanding valve platform, and highlight the technical aspects and challenges specific to treatment of pulmonary regurgitation in patients with carcinoid heart disease. Percutaneous pulmonary valve implantation, using the VenusP-valve, may be considered an effective treatment in this patient group.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":"158-164"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646880","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":"New Frontiers for Orbital Atherectomy-Crossing an Uncrossable Chronic Total Occlusion.","authors":"Ayman Helal, Mohsin Farooq","doi":"10.1002/ccd.31318","DOIUrl":"10.1002/ccd.31318","url":null,"abstract":"<p><p>Managing chronic total occlusions (CTOs) in coronary artery disease remains a significant challenge, especially in cases where standard techniques fail to cross the lesion. Uncrossable lesions are rare but require innovative strategies for successful treatment. Orbital atherectomy, traditionally used for calcified plaques, may offer a solution in these cases. We present the case of a 62-year-old male with exertional chest pain and a CTO in the right coronary artery (RCA). The patient had a positive stress echocardiogram for inducible ischemia despite optimized medical therapy. Multiple conventional techniques, including ballooning, microcatheter use, and laser atherectomy, failed to cross the proximal cap of the CTO. After these methods proved ineffective, orbital atherectomy using the DiamondBack 360 system successfully crossed the lesion and enabled subsequent balloon angioplasty and stenting. This may be the first reported case where orbital atherectomy was used after the failure of laser and other techniques. The case highlights the role of orbital atherectomy in the treatment of uncrossable CTOs, expanding its application beyond calcified lesions. The versatility of this technology, particularly when other methods fail, underscores its importance as an adjunctive tool in complex PCI. In conclusion, orbital atherectomy should be considered a valuable option for crossing uncrossable coronary CTOs, especially when standard and advanced techniques, including laser atherectomy, fail. This case broadens the scope of its use in coronary intervention, providing a new perspective on tackling resistant lesions.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":"115-119"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766540","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":"Parallel Wire Approach for Recanalisation of Chronic Total Coronary Occlusions in a Large Contemporary Multi-Center Registry.","authors":"Gerald S Werner, Sudhir Rathore, Alexandre Avran, Roberto Garbo, Alfredo R Galassi, Bernward Lauer, Jörg Dalibor, Nicolas Boudou, Sevket Gorgulu, Joachim Weber-Albers, Juergen Arenz, Fabrice Leroy, Harald Lapp, Omer Goktekin, Mohamed Ayoub, Alessio La Manna, Gabriele Gasparini, Leszek Bryniarski, Jo Dens, Alexander Bufe, Jaroslaw Wojcik, Kambis Mashayekhi","doi":"10.1002/ccd.31315","DOIUrl":"10.1002/ccd.31315","url":null,"abstract":"<p><strong>Background: </strong>The parallel wire technique (PW) is a classic part of the antegrade strategy to open chronic total coronary occlusions (CTO).</p><p><strong>Aims: </strong>With modern wires and dual-lumen catheters (DLC) the approach has evolved, but this progress had not been evaluated in a contemporary registry of CTO interventions.</p><p><strong>Method: </strong>This analysis is based on 26,589 CTO procedures performed by 36 operators with > 50 procedures annually between 2015 and 2022. The different strategies and techniques were analyzed with respect to clinical and lesion characteristics, procedural resource use and periprocedural complications. Within the antegrade approach, PW was compared to antegrade wire escalation (AWE) and antegrade-dissection re-entry (ADR).</p><p><strong>Results: </strong>The primary antegrade approach was used in 65.9%, primary retrograde in 16.9% and a strategy change in 17.2% with a wide inter-operator variability. In primary antegrade approach, PW was applied in 10.8% and ADR in 5.3%. Lesion complexity was higher in AWE and PW than with single wire, and highest in ADR procedures, leading to more complex procedures with higher contrast and radiation usage. Complications increased with ADR, while they were similar with PW and AWE. Through the observation period PW adoption increased steadily from 6.7% to 10.7%, as the DLC use facilitating PW increased from 8.3% to 17.0% over the observation period.</p><p><strong>Conclusion: </strong>In this largest database of contemporary CTO PCI from Europe, PW adoption increased over time but remained low at about 10%. While there was a wide individual variety among the operators, it was a safe and successful technique.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":"32-42"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784140","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}