Catheterization and Cardiovascular Interventions最新文献

{"title":"Atherectomy With Multimodal Embolic Protection for Severely Calcified Femoropopliteal Lesions","authors":"Daichi Yoshii,&nbsp;Osamu Iida,&nbsp;Taku Toyoshima,&nbsp;Yoshiteru Okina","doi":"10.1002/ccd.70479","DOIUrl":"10.1002/ccd.70479","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Severe calcification in femoropopliteal lesions remains a clinical challenge to achieve both the technical and long-term success in endovascular therapy. Although atherectomy is an effective treatment for calcified lesions, it is associated with the risk of distal embolization, even with the use of embolic protection devices (EPDs), and currently, no definitive strategy has been established to prevent this complication. We present a case successfully treated with atherectomy under EPDs and Parodi Anti-Embolism System (PAES). We report the case of a 77-year-old man with intermittent claudication in the left leg due to a severely calcified lesion in the superficial femoral artery. To mitigate the risk of distal embolization during atherectomy, proximal protection was achieved using Optimo catheter and distal protection was provided by Filtrap device. Additionally, arteriovenous circulation was established via a venous sheath and an external filter chamber, facilitating continuous flow reversal from the artery to the vein and effectively capturing debris within the external chamber. Atherectomy was performed under this double protection system, followed by drug-coated balloon angioplasty. Completion angiography confirmed the absence of distal embolization. Multiple calcified embolic debris were successfully captured by the aspiration system, filter, and filter chamber. This case demonstrates that combining double protection with arteriovenous circulation can establish a reliable flow reversal circuit during atherectomy, effectively preventing distal embolization. This strategy may offer an enhanced protection method for the atherectomy treatment of severely calcified femoropopliteal lesions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 5","pages":"1350-1354"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13043789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000465","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":"Extremity Function After Transfemoral Transcatheter Aortic Valve Implantation: A TAVI XS Sub-Study","authors":"Geert A. A. Versteeg,&nbsp;Maxim J. P. Rooijakkers,&nbsp;Kimberley I. Hemelrijk,&nbsp;Pieter J. Vlaar,&nbsp;Daniël C. Overduin,&nbsp;Marleen H. van Wely,&nbsp;Hugo M. Aarts,&nbsp;Dirk-Jan van Ginkel,&nbsp;Niels A. Stens,&nbsp;Lokien X. van Nunen,&nbsp;Robert Jan van Geuns,&nbsp;Leen A. F. M. van Garsse,&nbsp;Guillaume S. C. Geuzebroek,&nbsp;Michel W. A. Verkroost,&nbsp;Aysun Cetinyurek-Yavuz,&nbsp;Robin H. Heijmen,&nbsp;Dick H. J. Thijssen,&nbsp;Jurrien M. ten Berg,&nbsp;Pim A. L. Tonino,&nbsp;Ronak Delewi,&nbsp;Niels van Royen","doi":"10.1002/ccd.70470","DOIUrl":"10.1002/ccd.70470","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Physical decline after transcatheter aortic valve implantation (TAVI) is associated with worse outcomes. However, data on post-TAVI extremity function are limited. This sub-study of the TAVI XS trial aimed to assess extremity function after transfemoral TAVI, evaluate functional decline, compare outcomes between upper-and lower-extremity secondary access approaches and identify predictors of functional decline after TAVI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The TAVI XS was a randomized clinical trial comparing upper- and lower-extremity secondary access during TAVI. Patients were assessed for extremity function at baseline and at 30 days using the Lower Extremity Function Scale (higher score indicating better function) and the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (higher score indicating worse function).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Lower-extremity (45.0 [IQR 35.0–57.0] to 52.0 [39.0–63.0]; <i>p</i> &lt; 0.001), and upper-extremity function (11.4 [2.3–25.0] to 6.8 [0–22.7]; <i>p</i> = 0.003) improved after TAVI. Relevant decline in lower-extremity function occurred in 20 (8.4%) patients, and in upper-extremity function in 19 (8.0%) patients. No differences in post-TAVI function were observed between upper- or lower-extremity secondary access (lower-extremity: 10.1% vs. 6.7%; <i>p</i> = 0.35, upper-extremity: 7.6% vs. 8.4%; <i>p</i> = 0.81). Predictors (OR [95% CI]) of clinically relevant decline were baseline use of dual antiplatelet therapy/oral anticoagulants (4.17 [1.39–12.49]; <i>p</i> = 0.01) for lower-extremity function and multiple punctures (4.05 [1.46–11.24]; <i>p</i> = 0.007) for upper-extremity function. Age inversely affected lower- (0.92 [0.85–0.99/year]; <i>p</i> = 0.02) and upper-extremity function (0.93 [0.86–0.99/year]; <i>p</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The incidence of clinically relevant decline in extremity function after TAVI is low. No differences in reported extremity function were observed between the upper- and lower-extremity secondary access approach. Predictors of decline were antithrombotic therapy and multiple punctures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT05672823.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 5","pages":"1293-1302"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13043799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961111","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":"The Interventional “Backstop”: The Stent-Mid-Perforation Coiling Technique for Large Distal Coronary Perforations","authors":"Syed H. Haq,&nbsp;Sidra R. Shah,&nbsp;Amanda Laird,&nbsp;Will Hinegardner,&nbsp;Sandeep M. Patel","doi":"10.1002/ccd.70480","DOIUrl":"10.1002/ccd.70480","url":null,"abstract":"<div>\u0000 \u0000 <p>Coronary artery perforations (CAP) presentations following percutaneous intervention (PCI) may vary depending on the size and location of the injured vessel. Distal coronary perforations (DCP) can rapidly progress, making treatment notoriously challenging. Endovascular coils have frequently been utilized for DCP. Unfortunately, anatomical restrictions, the size of perforation, or equipment deficiencies can complicate deployment. We present a case of large DCP complicated by acute cardiac tamponade that was unamenable to conventional methods. This was successfully treated with a drug-eluting stent (DES) through the perforation into the pericardium and the placement of endovascular coils within the stent, that is, the stent-mid-perforation (and coiling) technique.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 5","pages":"1355-1360"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000470","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":"The “Skipping Rope” Technique: A Novel Strategy for Distal Burr Entrapment During Rotational Atherectomy","authors":"Thomas J. Ford,&nbsp;Michael Parkinson,&nbsp;Colm Hanratty,&nbsp;Simon Walsh","doi":"10.1002/ccd.70476","DOIUrl":"10.1002/ccd.70476","url":null,"abstract":"<p>We describe the “skipping rope technique” for managing burr entrapment during rotational atherectomy. Sequential counterclockwise rotational force is applied to the drive shaft, generating alternative torque dynamics. This maneuver provides a safe method to disengage a stuck rotaburr, offering operators an additional strategy for this challenging complication.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 5","pages":"1389-1392"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13043795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069574","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":"Evaluation of the Efficacy of Transcatheter Aortic Valve Replacement in Asymptomatic Patients With Severe Aortic Stenosis Using Cardiopulmonary Exercise Testing","authors":"Ya Chang,&nbsp;Liu Li,&nbsp;Yinshan Ma,&nbsp;Jie Zhou,&nbsp;Le Wang,&nbsp;Yinge Zhan","doi":"10.1002/ccd.70473","DOIUrl":"10.1002/ccd.70473","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The management of asymptomatic patients with severe aortic stenosis (AS) remains challenging. While transcatheter aortic valve replacement (TAVR) is established for symptomatic AS, its objective functional benefits in asymptomatic individuals are not well-defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate the safety and hemodynamic efficacy of TAVR in asymptomatic patients with severe aortic stenosis and to objectively quantify their functional recovery using cardiopulmonary exercise testing (CPET).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this single-center retrospective study, 156 asymptomatic patients with severe AS undergoing TAVR with the VitaFlow valve were enrolled. Safety endpoints were adjudicated per Valve Academic Research Consortium (VARC-3) criteria. Efficacy was assessed via serial echocardiography and brain natriuretic peptide (BNP) levels at baseline, 1 day, 7 days, 3 months, and 12 months. Functional capacity was objectively quantified using CPET at baseline, 1 month, and 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Procedural success was 100% with no mortality, stroke, or major complications. Hemodynamics improved immediately (mean gradient: 51.6 ± 11.7 to 13.7 ± 7.2 mmHg, <i>p</i> &lt; 0.001) and remained stable at 12 months. BNP levels decreased significantly from 7 days onward (<i>p</i> &lt; 0.05). CPET revealed substantial improvements in functional capacity: peak oxygen uptake (VO₂) increased from 15.6 ± 3.6 to 19.8 ± 4.0 mL/kg/min (<i>p</i> &lt; 0.001), anaerobic threshold (AT) increased, and ventilatory efficiency (VE/VCO₂ slope) decreased (all <i>p</i> &lt; 0.001). The incidence of exercise-induced adverse events also significantly declined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TAVR is a safe and highly effective intervention for asymptomatic severe AS, resulting in immediate hemodynamic improvement and sustained, objective enhancement of functional capacity, as rigorously quantified by CPET.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 5","pages":"1369-1375"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000493","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":"Recanalization of Thrombosed Atrial Flow Regulator in Failing Fontan: A Bridge to Transplant","authors":"Raymond N. Haddad,&nbsp;Estibaliz Valdeolmillos,&nbsp;Emre Belli,&nbsp;Sébastien Hascoët","doi":"10.1002/ccd.70481","DOIUrl":"10.1002/ccd.70481","url":null,"abstract":"<p>We report the case of a 10-year-old boy (41 kg, 133 cm) with hypoplastic left heart syndrome (mitral and aortic atresia), who underwent staged palliation: Norwood-Sano at 6 days, Glenn at 7 months, and Fontan completion at 3 years using a 16 mm non-fenestrated extracardiac Gore-Tex conduit. By age 8, he developed Fontan failure with elevated pressures and protein-losing enteropathy, refractory to medical management, supportive therapy, and hepatic lymphatic embolization. At age 9, the Fontan conduit was needle-perforated, dilated with a 7 mm balloon, and a 6 × 5 mm Occlutech atrial flow regulator (AFR) was implanted. Complete AFR thrombosis occurred 4 months later. Recanalization was achieved using an Astato® 30 0.018” wire under carotid protection with 6 mm SpiderFX filters, followed by high-pressure ballooning and a 9 × 18 mm BeSmooth stent implantation. Despite a patent AFR and optimized therapy, the patient showed no clinical improvement and ultimately underwent successful heart transplantation 1 month later under more favorable conditions.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 5","pages":"1380-1383"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13043797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032651","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":"Vessel-Oriented Analysis on the Relationship Between Quantitative-Flow Ratio and Mortality in Patients With Severe Aortic Stenosis and Intermediate Coronary Lesions","authors":"Iginio Colaiori,&nbsp;Luca Paolucci,&nbsp;Fabio Mangiacapra,&nbsp;Emanuele Barbato,&nbsp;Giulia Nardi,&nbsp;Javier Escaned,&nbsp;Gianluca Campo,&nbsp;Simone Biscaglia,&nbsp;Francesco Versaci,&nbsp;Giuseppe Biondi-Zoccai,&nbsp;Achille Gaspardone,&nbsp;Marco Vitolo,&nbsp;Giorgio Benatti,&nbsp;Luigi Vignali,&nbsp;Giuseppe Boriani,&nbsp;Vincenzo Guiducci","doi":"10.1002/ccd.70491","DOIUrl":"10.1002/ccd.70491","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Quantitative flow ratio (QFR) is effective in predicting mortality in patients undergoing transcatheter aortic valve replacement (TAVR). How QFR reclassifies coronary artery disease (CAD) at vessel-level compared to angiography and how this influences the risk of death, remains undetermined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We calculated QFR from consecutive 280 TAVR patients with bystander coronary stenoses. All lesions were managed conservatively. Angiographic CAD was defined by a diameter stenosis ≥ 50%, functional CAD by a QFR ≤ 0.80. The outcome was mortality at 3 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 635 lesions were included. Angiographic CAD was evident in 165 (26.0%), functional CAD in 17 (11.2%) (reclassification: <i>p</i> &lt; 0.001). Angiography/QFR mismatch occurred in 22.5%, mostly in large vessels and lesions located in the proximal left anterior descending (LAD). QFR ≤ 0.80 was an independent predictor of death (HR 2.91, 95% CI 1.94−4.36; <i>p</i> &lt; 0.001). The risk was progressively increased for lower QFR values and positive QFR at LAD site (vs. QFR &gt; 0.80 HR: 3.92, 95% CI 2.78−5.53; <i>p</i> &lt; 0.001; vs. QFR ≤ 0.80 at non-LAD site: HR 2.65, 95% CI 1.07−6.59; <i>p</i> = 0.034).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>QFR leads to a significant reclassification of CAD rates at vessel-level and shows a significant prognostic value in patients undergoing TAVR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 5","pages":"1407-1417"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088786","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":"Determinants of Left Ventricular Ejection Fraction Improvement After Successful Percutaneous Coronary Intervention for Chronic Total Occlusion: A Study Using Myocardial Perfusion Imaging","authors":"Keisuke Hirai,&nbsp;Tomohiro Kawasaki,&nbsp;Sora Serikawa,&nbsp;Takashi Yamamoto,&nbsp;Kensho Abe,&nbsp;Masao Hidaka,&nbsp;Toshiya Soejima,&nbsp;Yurie Fukami,&nbsp;Satoshi Asada,&nbsp;Kazuki Haraguchi,&nbsp;Ryota Fukuoka,&nbsp;Yoshiya Orita,&nbsp;Kyoko Umeji,&nbsp;Hisashi Koga,&nbsp;Hiroshige Yamabe","doi":"10.1002/ccd.70484","DOIUrl":"10.1002/ccd.70484","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Few studies have investigated the factors associated with left ventricular ejection fraction (LVEF) improvement after successful chronic total occlusion percutaneous coronary intervention (CTO-PCI), as assessed by myocardial perfusion imaging (MPI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to identify patient and lesion characteristics, and MPI findings that associated with LVEF improvement following CTO-PCI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Among 100 consecutive patients who underwent CTO-PCI at our hospital between April 2013 and March 2023, 87 with a patent vessel at 1-year follow-up were included. LVEF improvement (ΔEF) was calculated for each patient. Patients in the highest quartile of ΔEF were defined as the “high ΔEF group,” and the remaining quartiles as the “low ΔEF group.” Factors associated with LVEF improvement were evaluated using group comparisons and multivariate logistic regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Pre-PCI transient ischemic dilatation (TID) was most strongly associated with inclusion in the high ΔEF group (Odds ratio [OR] 6.37, <i>p</i> = 0.017). In addition, female sex, lower baseline LVEF, and lower post-PCI summed stress score (SSS) were significantly associated with greater LVEF improvement (male sex: OR 0.025, <i>p</i> = 0.002; baseline EF: OR 0.871, <i>p</i> = 0.001; post-PCI SSS; OR 0.824, <i>p</i> = 0.005).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Positive pre-PCI TID was the strongest predictor of LVEF improvement. Female sex, lower baseline LVEF, and lower post-PCI SSS also contributed significantly to greater improvement in LVEF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 5","pages":"1333-1339"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004957","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":"Mechanistic Insights Into How Rewiring and Bifurcation Angle Affect DK-Crush Stent Deployment","authors":"Andrea Colombo,&nbsp;Dario Carbonaro,&nbsp;Mingzi Zhang,&nbsp;Claudio Chiastra,&nbsp;Mark Webster,&nbsp;Nigel Jepson,&nbsp;Susann Beier","doi":"10.1002/ccd.70475","DOIUrl":"10.1002/ccd.70475","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Double kissing crush (DKC) is a preferred two-stent technique for complex coronary bifurcation lesions. Proximal cell rewiring is routinely recommended to reduce technical failure, and DKC is considered effective across various bifurcation angles. However, it remains unclear whether this standard approach is optimal for all patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study investigates the interaction between bifurcation angle and rewiring configuration to identify anatomy-specific strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Computational modeling of the DKC procedure was used to simulate 12 DKC procedures across three left main bifurcation angles (45°, 70°, and 100°) and four rewiring configurations: proximal−proximal (P−P), proximal−distal (P−D), distal−proximal (D−P), and distal−distal (D−D). Evaluation metrics included stent malapposition, side branch ostium clearance, arterial wall stress, low time-averaged endothelial shear stress, and high shear rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>DKC performed in wide bifurcations (100°) resulted in worse outcomes, with malapposition reaching 18%, side branch clearance down to 23%, and up to twice the exposure to adverse high shear rates compared to narrower angles. In contrast, intermediate (70°) and narrow (45°) angles generally resulted in more favorable outcomes, though optimal rewiring varied by angle. Proximal strategies, that is, P−P and P−D, were most effective at 70°, while D−D performed best at 45°. No single strategy was consistently superior across all bifurcation angles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DKC outcomes depend on bifurcation angle and can be optimized by tailoring rewiring strategies, challenging the current clinical understanding. These findings support anatomy-specific procedural planning and intravascular imaging to guide rewiring. This study provides a mechanistic rationale to improve clinical decision-making and tailor bifurcation interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 5","pages":"1314-1323"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13043802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000454","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":"Bench Testing Analysis of Perforation Management in the Setting of Bifurcation Coronary Intervention","authors":"Rayyan Hemetsberger,&nbsp;Anass Maaroufi,&nbsp;Kevin Hamzaraj,&nbsp;Judit Andreka,&nbsp;Mohammad Abdelghani,&nbsp;Serdar Farhan,&nbsp;Daniel Lootz,&nbsp;Johannes Gollmer,&nbsp;Nader Mankerious,&nbsp;Christian Hengstenberg,&nbsp;Tom W. Johnson,&nbsp;Gabor G. Toth","doi":"10.1002/ccd.70406","DOIUrl":"10.1002/ccd.70406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Management of coronary perforation in bifurcation lesions with covered stents remains challenging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We aimed to describe a proper practice and toolbox for “jailed-branch” management after covered stent deployment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a bench model, we tested various wires with a 120° angulated microcatheter for their ability to penetrate covered stents to access jailed side branches (SB). Next, four PCI techniques were assessed: Test #1 (main branch [MB] rupture simulation): MB covered stent, graft penetration, and kissing balloon inflation (KBI) (<i>n</i> = 7). Test #2: Test #1 completed with Culotte using a drug-eluting stent (DES) (<i>n</i> = 3). Test #3: Culotte with two covered stents simulating MB and SB rupture (<i>n</i> = 3). Test #4: Test #3 plus final DES in MB (<i>n</i> = 3).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>High tip-load wires ( &gt; 12 g) successfully penetrated covered stents within 14 s. All procedures were completed successfully. Test #1 showed lumen area reductions of –8% (MB) and –25% (SB), with graft overhang at the SB. Conversion to Culotte with DES (Test #2) improved SB lumen reduction to –8%. Test #3 showed reductions of –7% (MB) and –15% (SB), with graft overhang at MB, corrected in Test #4 by DES implantation, resulting in +9% lumen gain (MB) and improved SB lumen reduction (–11%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this bifurcation perforation in-bench model, high tip-load wires effectively penetrated covered stents toward excluded branches after crossover covered stent implantation. Conversion to Culotte, using either a DES or a second covered stent, was feasible. Overhanging graft material following SB fenestration could be addressed by overstenting with a DES.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 4","pages":"888-897"},"PeriodicalIF":1.9,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12953214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746417","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}