Catheterization and Cardiovascular Interventions最新文献

{"title":"Comparison Between Gated Cardiac Magnetic Resonance Angiography and Computed Tomography Angiography for Harmony Valve Anatomic Fit Analysis.","authors":"Zsofia B Long, Doff B McElhinney, Ayush Jaggi, Ali B Syed, Frandics P Chan, Shiraz A Maskatia","doi":"10.1002/ccd.31594","DOIUrl":"https://doi.org/10.1002/ccd.31594","url":null,"abstract":"<p><strong>Aims: </strong>To determine if electrocardiogram (ECG)-gated magnetic resonance angiography (MRA) can be used to assess candidacy for transcatheter pulmonary valve replacement with the Harmony valve.</p><p><strong>Background: </strong>Anatomic fit assessment for the Harmony valve is conducted with retrospectively gated computed tomography angiography (CTA). The suitability of MRA for this purpose has not been assessed.</p><p><strong>Methods: </strong>We analyzed patients who were screened for Harmony valve candidacy at our institution through July 2024 and had both ECG-gated MRA and CTA. Measurements included RVOT centerline length and RVOT perimeters and diameters at 5 mm increments. The Medtronic fit algorithm was applied to CTA and MRA measurements. Correlation between CTA and MRA measurements was determined with intraclass correlation coefficient (ICC) and Bland-Altman analysis.</p><p><strong>Results: </strong>The study included 36 patients who met the inclusion criteria. The ICC between CTA and MRA was 0.99 for RVOT length, 0.92 for minimum perimeter-derived diameter, and 0.71 for proximal perimeter-derived diameter (all p < 0.001). MRA fit analysis was concordant with the Medtronic CTA-derived fit analysis in 72% of patients and was concordant with fit analysis based on internal CTA measurements in 75%.</p><p><strong>Conclusion: </strong>RVOT measurements on ECG-gated MRA images correlate well with those made from retrospectively gated CTA. Although perimeter plots generated from ECG-gated MRA and CTA measurements were discordant in some patients, the differences were minor and could still be interpreted to indicate implantable anatomy by the operator. These findings suggest that ECG-gated MRA may be an acceptable surrogate for CTA during the anatomic screening process.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109605","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":"Prognostic Significance of Bailout Stenting for Residual Stenosis or Dissection Following Drug-Coated Balloon Angioplasty: A Sub-Analysis of the EASTBOURNE Study.","authors":"Filippo Luca Gurgoglione, Bernardo Cortese","doi":"10.1002/ccd.31609","DOIUrl":"https://doi.org/10.1002/ccd.31609","url":null,"abstract":"","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109666","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":"Impact of Ischemic Preconditioning Preceding Transradial Access for Coronary Angiography on Preventing Postoperative Complications-A Randomized Controlled Trial.","authors":"Linhui He, Weiwei Zhang, Yingying Huang, Liao He, Chunlan Ma, Hao Luo, Yali Qu, Chunmei Xu, Yuting Zeng, Juan Zhang","doi":"10.1002/ccd.31592","DOIUrl":"https://doi.org/10.1002/ccd.31592","url":null,"abstract":"<p><strong>Background: </strong>Transradial access (TRA) has been endorsed as a Class 1a recommendation for coronary angiography (CAG) or percutaneous coronary intervention (PCI). However, some patients suffer from postoperative complications such as pain, swelling, bleeding and bruising.</p><p><strong>Aims: </strong>To investigate the effect of ischemic preconditioning with the compression tourniquet preceding TRA for CAG or PCI on preventing postoperative complications.</p><p><strong>Methods: </strong>A total of 1227 inpatients scheduled for selective transradial CAG or PCI from September 2021 to March 2022 at the Department of Cardiology, Daping Hospital, were enrolled. Patients were randomly divided into a control group (582 cases) and an ischemic preconditioning group (645 cases). The control group received routine preoperative education and postoperative care, while the ischemic preconditioning group underwent additional radial artery ischemic preconditioning training before operation. Patients were evaluated for swelling (palm/finger and arm), pain, and bleeding at 4 h, as well as bruising severity was assessed at 24 h postoperatively.</p><p><strong>Results: </strong>The swelling, pain, bleeding at 4 h and bruising severity at 24 h in the ischemic preconditioning group were significantly alleviated compared to those in the control group postoperatively (p < 0.05).</p><p><strong>Conclusion: </strong>Ischemic preconditioning with the compression tourniquet can reduce postoperative complications in the limb of patients undergoing transradial CAG or PCI.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109659","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":"Venous Access Alone Versus Arterial and Venous Access for Patent Arterial Duct Device Closure in Childhood.","authors":"Ahmed A Hassan, Marisa Signorile, Sophie McNamee, Rajiv Chaturvedi, Lee Benson","doi":"10.1002/ccd.31605","DOIUrl":"https://doi.org/10.1002/ccd.31605","url":null,"abstract":"<p><strong>Background: </strong>The persistently patent arterial duct accounts for ~12% of congenital heart lesions. Untreated, it may result in heart failure due to volume loading of the left heart, pulmonary hypertension, and infective endarteritis. Percutaneous device closure is the preferred occlusion technique, with the standard approach consisting of femoral artery access for angiography and venous access for device delivery (AA). A venous-only strategy (VA) for angiography and device delivery can also be employed.</p><p><strong>Hypothesis: </strong>We hypothesized that VA would eliminate the need of arterial entry, reduce procedure times and radiation exposure compared to standard AA.</p><p><strong>Methods: </strong>This is a retrospective cohort study of isolated arterial duct device closure at the Hospital for Sick Children from January 1, 2011, through December 31, 2022. Exclusions included premature neonates, children requiring arterial access for monitoring, and those who underwent other procedures. Children were categorized based upon initial access determined by operator preference into VA or AA groups.</p><p><strong>Results: </strong>The cohort consisted of 405 children, 252 (62.2%) females, with a median age of 3.1 years (IQR 1.30-5.84), median weight 13.2 kg (IQR 9.0-19.5), and duct diameter of 2.9 mm (IQR 2.0-3.5) with no significant differences between the groups. Type A ducts were more frequent in the AA group (90% vs. 72%). The VA group included 106 children, of which 14 (13.2%) required AA conversion for angiography due to complex ductal anatomy, to assess device position before release, but remained in the VA group for analysis. Children in the VA group had lower dose area product (DAP) (p < 0.001), fluoroscopy times (p = 0.025), contrast volumes (p < 0.001), procedure times (p < 0.001), and recovery room lengths of stay (LOS) (p < 0.001). Six (5.7%) VA children required admission compared to 44 (14.7%) in the AA group (p = 0.015) with no difference in reintervention rates. Weighted regression analysis showed VA was associated with reduced admission likelihood (OR: 0.354 [0.131, 0.822], p = 0.024), DAP (coef -126.4 [-213.3, -39.4], p = 0.004), and contrast volumes (coef 31.2 [-36.6, -25.9], p < 0.001) compared to AA.</p><p><strong>Conclusions: </strong>Venous-only access was associated with lower DAP and recovery room LOS. Additionally, VA was associated with a lower likelihood of admission with no difference in reintervention rates, suggesting procedural safety. These findings support the consideration of VA as a preferred approach for appropriate cases.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109737","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":"Rotational Atherectomy, Lithotripsy, or Laser for Calcified Coronary Stenosis: One-Year Outcomes From the ROLLER COASTER-EPIC22 Trial.","authors":"Mattia Basile, Antonio Gómez-Menchero, Borja Rivero-Santana, Ignacio J Amat-Santos, Santiago Jiménez-Valero, Juan Caballero-Borrego, Soledad Ojeda, Gema Miñana, Ariana Gonzálvez-García, Daniel Tébar-Márquez, Maria Jessica Roa-Garrido, Santiago Camacho-Freire, Raymundo Ocaranza-Sánchez, Antonio Domínguez, Guillermo Galeote, Raúl Moreno, Alfonso Jurado-Román","doi":"10.1002/ccd.31529","DOIUrl":"https://doi.org/10.1002/ccd.31529","url":null,"abstract":"<p><strong>Background: </strong>The ROLLER COASTR-EPIC22 was the first randomized trial to directly compare rotational atherectomy (RA), excimer laser coronary angioplasty (ELCA), and intravascular lithotripsy (IVL) for the treatment of patients with calcified coronary stenosis.</p><p><strong>Aims: </strong>The aim of this study is to report and compare its 1-year clinical outcomes.</p><p><strong>Methods: </strong>The ROLLER COASTR-EPIC22 trial randomized 171 patients with angiographic moderate to severe calcified coronary lesions to PCI with RA (n = 57), IVL (n = 57), or ELCA (n = 57). A pre-specified analysis of clinical events at one year from the index PCI was conducted. The clinical endpoints analyzed at one year were the rate of major adverse cardiovascular events (MACE), defined as the occurrence of cardiac death, target vessel myocardial infarction (TV-MI), target lesion revascularization (TLR), target vessel revascularization (TVR) and stent thrombosis. Furthermore, the rate of all-cause mortality, non-fatal TV-MI, TVR, TLR, and stent thrombosis were analyzed separately. Kaplan-Meier analysis was performed to assess time-to-event outcomes. The adjudication of clinical events was conducted in accordance with the intention-to-treat principle.</p><p><strong>Results: </strong>The mean age was 70.9 ± 8.2 years and 77.2% of the patients were men. Clinical presentation was acute coronary syndrome in 35.7% of patients and severe angiographic calcification was observed in 82.5% of lesions by the independent core laboratory unaware to the treatment arm. All patients showed criteria of severe calcification, either angiographic or at optical coherence tomography (OCT). At OCT evaluation, mean calcium arc was 300.8° ± 78.9°, maximum calcium thickness 1.17 ± 0.24 mm, calcification length 30.9 ± 12.9 mm and 30.5% of patients presented calcium nodules. Baseline characteristics were well balanced between groups. At one year, there were no significant differences in MACE incidence among the three arms (RA 5.3%, IVL 5.3%, ELCA 3.5%; p = 0.88). Furthermore, there were no significant differences in all-cause death between groups (p = 0.22), with no events in the IVL group (RA 5.3%, IVL 0%, ELCA 5.3%). No significant differences were observed among the 3 arms in the terms of TV-MI (RA 1.7, IVL 1.7, ELCA 0%; p = 0.61), TVR (RA 3.5%, IVL 5.3%, ELCA 1.7%; p = 0.59), TLR (RA 1.7%, IVL 1.7%, ELCA 1.7%; p = 1.00), or stent thrombosis (RA 1.7%, IVL 0%, ELCA 1.7; p = 0.61).</p><p><strong>Conclusions: </strong>This is the first randomized trial comparing RA, IVL, and ELCA for the treatment of patients with calcified coronary lesions and reporting long-term clinical outcomes. At one year, no significant differences were observed among the three arms in the composite endpoint of one-year all-cause mortality, AMI, TVR, TLR and stent thrombosis. Similarly, no significant differences were found when analyzing the individual components of the endpoint separately.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109672","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":"Paclitaxel-Coated Balloons for Femoropopliteal Artery Disease Treatment in French Patients: A Longitudinal Observational Study.","authors":"Yann Gouëffic, Maxime Dubosq-Lebaz, Jean-François Heautot, Aurore Tricotel, Antoine Sauguet","doi":"10.1002/ccd.31581","DOIUrl":"https://doi.org/10.1002/ccd.31581","url":null,"abstract":"<p><strong>Background: </strong>Clinical studies have demonstrated the safety and effectiveness of drug-coated balloon (DCB) angioplasty for femoropopliteal revascularization. Long-term studies in routine practice are limited.</p><p><strong>Aims: </strong>The aim of this study was to assess long-term outcomes after DCB angioplasty for femoropopliteal peripheral artery disease in a real-word-French population.</p><p><strong>Methods: </strong>Patients with lower-limb PAD treated with at least one IN.PACT Admiral DCB in the year 2018 were identified from the French National Health Data System, representing > 99% of the French population. Primary outcomes were all-cause mortality, major amputation (including target and nontarget limbs and vessels), and reintervention (any infrainguinal reintervention or new intervention of the target lesions, nontarget lesions, target limbs, or contralateral limbs) within 1 year from the date of angioplasty. Patients were followed for 3 years from the date of angioplasty.</p><p><strong>Results: </strong>A total of 3595 patients (average age 71.2 years) were enrolled, including 35.7% females, 35.3% with chronic limb-threatening ischemia (CLTI), 38.2% with diabetes, and 35.9% with a history of revascularization. All-cause mortality was 7.5% at 1 year and 19.7% at 3 years. The major amputation rate was 2.7% at 1 year and 4.6% at 3 years. The total reintervention rate was 25.9% at 1 year and 43.4% at 3 years. Three-year rates were significantly higher in patients with CLTI (vs. patients with intermittent claudication), diabetes (vs. no diabetes), and prior revascularization (vs. no prior revascularization).</p><p><strong>Conclusions: </strong>This real-world analysis with long-term follow-up showed satisfactory limb salvage and low mortality following angioplasty with DCBs for the treatment of femoropopliteal artery disease.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092361","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":"Pressure-Wire Guided Hybrid Branch Pulmonary Artery Band Placement for Palliation of Single Ventricle and Critical Congenital Cardiac Lesions.","authors":"Jonathan Pacella, Bryan H Goldstein, Eiméar McGovern, Shabana Shahanavaz, Russel Hirsch, David Lehenbauer, David Winlaw, David L S Morales, Sarosh P Batlivala","doi":"10.1002/ccd.31595","DOIUrl":"https://doi.org/10.1002/ccd.31595","url":null,"abstract":"<p><strong>Background: </strong>Historically, bilateral pulmonary artery band (PAB) placement was guided by pulmonary blood flow surrogates including systemic blood pressure (BP) and arterial saturation. These metrics alone may result in suboptimal bPAB placement. We perform a hybrid PAB (hPAB) procedure employing pressure-wire assessment to evaluate pulmonary hemodynamics and guide the procedure.</p><p><strong>Methods: </strong>Single-center retrospective study of consecutive patients that underwent hybrid bPAB procedure between August 2015 and May 2022. Procedures involved main pulmonary artery (PA) angiography and selective PA pressure-wire assessment. Aortic pressure and arterial saturation were recorded.</p><p><strong>Results: </strong>Twenty-three patients underwent hPAB procedure. Median procedure time was 190 min [range 122-480 min]. Ten patients underwent 15 total adjustments to a PA band, 6 (40%) based solely on pressure assessment with inappropriately low and non-pulsatile pressures. Five patients underwent 13 PA interventions after hPAB, 12 (92%) were transcatheter and 1 (8%) operative. Two patients underwent transcatheter angioplasty of a branch PA band in the interstage period while 4 underwent a total of 10 catheter-based PA interventions after the subsequent operation, at a median of 7 days [range 7-270 days] post-operatively. Two patients underwent PA stent implant. Branch PA Z-scores were normal at birth and remained normal at most recent follow-up for survivors (46 months), with final PA symmetry (smaller/larger PA area × 100) of 91% ± 9%.</p><p><strong>Conclusions: </strong>Pressure-wire data identified more patients with overly restrictive bands during hybrid bPAB procedures than traditional markers alone. Many survivors required future PA intervention, and all demonstrated appropriate bilateral PA growth and symmetry.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092279","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":"Use of ReCross to Increase Success Rate With Antegrade CTO PCI-A Multicenter Observational Study.","authors":"Mohamed Ayoub, Abdul Mozid, Legate Philip, Xavier Millan, Jaikirshan Khatri, Claudiu Ungureanu, Johan Bennett, Chadi Ghafari, Alexandre Avran","doi":"10.1002/ccd.31585","DOIUrl":"https://doi.org/10.1002/ccd.31585","url":null,"abstract":"<p><strong>Background: </strong>Antegrade approach remains one of the predominant techniques for CTO PCI. Success rates have increased significantly recently due to advancements in devices and strategies, along with the hybrid algorithm. ReCross is a uniquely modified microcatheter with two over-the-wire lumens and three exit ports, offering significant potential for application across all facets of antegrade CTO-PCI applications. However, there is limited published data investigating its efficacy.</p><p><strong>Objective: </strong>The objective of our study was to analyze the efficiency and outcome of the ReCross device, following an agreed step-by-step protocol in contemporary CTO PCI, based on our firsthand experience.</p><p><strong>Methods: </strong>During the period between June 2023 and April 2024, we evaluated patients undergoing CTO PCI at eight participating centers for scheduled clinically necessary CTO PCI with a planned primary antegrade approach using an upfront agreed ReCross strategy.</p><p><strong>Results: </strong>A total of 118 patients who underwent CTO PCI were included in the study. The mean JCTO score was 2.16 ± 0.95. The majority of cases (94%) were successfully resolved using an upfront ReCross strategy with a technical success of 96%, demonstrating a high level of effectiveness. The average procedure time (90 min) observed in our study was notably lower in comparison to other similar studies. There were no procedure-related mortalities until hospital discharge, although one distal wire perforation complication was reported.</p><p><strong>Conclusion: </strong>Our initial experience with the ReCross microcatheter suggests in select cases with the application of a dedicated algorithm, the antegrade approach can be highly successful.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092322","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":"Efficacy and Safety of Intravascular Lithotripsy in the Management of Underexpanded Stents: A Systematic Review and Meta-Analysis.","authors":"Marios Sagris, Stergios Soulaidopoulos, Angelos Papanikolaou, Nikolaos Ktenopoulos, Martijn J H van Oort, Jose M Montero-Cabezas, Nikolaos Patsourakos, Benjamin Honton, Dimitris Tousoulis, Konstantinos Tsioufis","doi":"10.1002/ccd.31588","DOIUrl":"https://doi.org/10.1002/ccd.31588","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Stent underexpansion significantly heightens the risk of major adverse cardiac events (MACE), and available treatment options for this condition remain limited. Intravascular Lithotripsy (IVL) technology disrupts superficial and deep calcium by using localized pulsative sonic pressure waves, emerges as a promising tool for underexpanded stents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;This study examines the overall efficacy and safety of IVL, an until-now off-label modality, in the management of underexpanded stents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Following PRISMA guidelines, we systematically explored PubMed, SCOPUS, and Cochrane databases up to April 30, 2024, for studies evaluating IVL's safety and efficacy in treating underexpanded stents. We gathered angiographic (QCA) and intracoronary imaging (OCT or IVUS) data, examining the stent's diameter stenosis (SDS), minimal lumen diameter (MLD), minimal stent area (MSA), and minimal lumen area (MLA) pre- and post-IVL application. Procedural success constituted the efficacy endpoint, while peri-procedural complications, in-hospital-30-days and long-term mortality, and MACE were safety endpoints.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This meta-analysis comprised 23 studies including 819 patients and 837 treated lesions in underexpanded stent. The mean age was 71.7 ± 8.8 years, with an overall IVL procedural success rate of 92% [(95% confidence interval (CI): 88%-95%, I&lt;sup&gt;2&lt;/sup&gt; = 35%), while the in-hospital-30-days and long-term mortality incidence were 1% (95% CI: 1%-3%, I&lt;sup&gt;2&lt;/sup&gt; = 0%) and 4% (95% CI: 2%-6%, I&lt;sup&gt;2&lt;/sup&gt; = 0), respectively. The 30-day rates acute myocardial infarction and stroke were 1% [(95% CI: 0%-1%, I² = 0%), (95% CI: 0%-2%, I&lt;sup&gt;2&lt;/sup&gt; = 0%)] each. No need for short term target lesion revascularization (TLR) was observed while the long-term rates were 6% (95% CI: 3%-10%, I&lt;sup&gt;2&lt;/sup&gt; = 48%). There was a significant decrease in the SDS [Standardized Mean Difference (SMD): -3.57 (95% CI: -4.64 to -2.44%, I&lt;sup&gt;2&lt;/sup&gt; = 94%)] and increase in MSA (SMD: +1.98, 95% CI: 0.86-3.09, I&lt;sup&gt;2&lt;/sup&gt; = 93%) after IVL application. It was observed a significant increase in MLD (SMD: +2.68, 95% CI: 1.94-3.41, I&lt;sup&gt;2&lt;/sup&gt; = 90%) and in the MLA (SMD: +1.92, 95% CI: 1.46-2.38, I&lt;sup&gt;2&lt;/sup&gt; = 69%). Major procedural and device related complications were 2% (95% CI: 1%-5%, I&lt;sup&gt;2&lt;/sup&gt; = 0%) and 1% (95% CI: 0%-2%, I&lt;sup&gt;2&lt;/sup&gt; = 80%) respectively. Notably low rates were observed for stent thrombosis (1%, 95% CI: 0%-2%, I&lt;sup&gt;2&lt;/sup&gt; = 0%), dissections (1%, 95% CI: 1%-4%, I&lt;sup&gt;2&lt;/sup&gt; = 0%), perforations (1%, 95% CI: 1%-3%, I&lt;sup&gt;2&lt;/sup&gt; = 0%) and no-reflow (0%, 95% CI: 0%-46%, I&lt;sup&gt;2&lt;/sup&gt; = 0%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;IVL demonstrates promise as a safe and effective strategy for underexpanded stent treatment, characterized by low rates of periprocedural complications. Future prospective studies are now warranted to compare IVL to other lesion prepar","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092350","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":"Continuation Versus Interruption of Oral Anticoagulation During TAVI: A Systematic Review and Meta-Analysis Oral Anticoagulation Management in TAVI.","authors":"Jefferson Manoel Borges Martins, Rafael Dos Santos Borges, Giovanni Gosch Berton, Paula Larissa Ferreira Vieira, Pedro Antônio Machado Gomes de Sousa, Ana Livia Chaves Vieira, Christian Ken Fukunaga, Vanessa Karlinski Vizentin, Esthefani Monique Rodrigues Macedo, Camila Mota Guida","doi":"10.1002/ccd.31599","DOIUrl":"https://doi.org/10.1002/ccd.31599","url":null,"abstract":"<p><p>Patients undergoing transcatheter aortic valve implantation (TAVI) often require long-term oral anticoagulation (OAC), but it is unclear whether to continue or interrupt OAC during the procedure. This meta-analysis compares clinical outcomes of continuing versus interrupting OAC during TAVI. PubMed, Embase, and Cochrane Central databases were searched from inception to September 2024 for studies comparing continuation versus interruption of OAC in patients undergoing TAVI with an indication for OAC, including vitamin K antagonists and direct oral anticoagulants. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model. Sensitivity analysis was performed using the Hartung-Knapp-Sidik-Jonkman method. Three studies were included, one randomized controlled trial and two cohort studies, with 2773 patients, of whom 1314 (47.4%) continued OAC during TAVI. At a 30-day follow-up after TAVI, there were no significant differences between groups in all-cause mortality (RR 0.74; 95% CI 0.45-1.20; p = 0.22), any bleeding (RR 1.08; 95% CI 0.81-1.43; p = 0.60), and major bleeding (RR 0.90; 95% CI 0.67-1.21; p = 0.48). However, the continued OAC group was associated with a lower stroke rate (RR 0.65; 95% CI 0.42-1.01; p = 0.053), also attested after a sensitivity analysis (RR 0.65; 95% CI 0.47-0.90; p < 0.03). In patients with an indication for OAC undergoing TAVI, uninterrupted anticoagulation is associated with similar thrombotic and hemorrhagic outcomes compared to interrupted OAC. Stroke risk was lower in the continued OAC group, with a significant reduction, as demonstrated in sensitivity analysis.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092054","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}