Catheterization and Cardiovascular Interventions最新文献

{"title":"Validation of a Novel Computational Fluid Dynamics Based Method for Assessing Intracoronary Flow: Combining Coronary Angiography and Fractional Flow Reserve.","authors":"Xinzhou Xie, Na Li, Tiantong Yu, Wenjun Pu, Heqiang Lin, Xiang Li, Guoquan Li, Chengxiang Li, Yan Chen, Kun Lian","doi":"10.1002/ccd.31498","DOIUrl":"https://doi.org/10.1002/ccd.31498","url":null,"abstract":"<p><strong>Background: </strong>With a 3D model reconstructed from coronary angiography, intracoronary blood flow can be calculated using a computational fluid dynamics (CFD) model with fractional flow reserve (FFR) measured pressure as boundary conditions.</p><p><strong>Aims: </strong>The aim of this study is to investigate the clinical feasibility of this method by evaluating its ability to identify myocardial ischemia diagnosed by SPECT myocardial perfusion imaging (MPI).</p><p><strong>Methods: </strong>Patients who underwent both SPECT-MPI and coronary angiography with FFR within 1 week were enrolled. Based on the summed stress score (SSS) and summed difference score (SDS) of SPECT MPI, myocardial ischemia in individual coronary territories was identified. Mean flow rate (Q), total flow resistance (TFR), absolute microvascular resistance (AMR) and their corresponding resting state indices were computed using the novel CFD model.</p><p><strong>Results: </strong>A total of 52 patients with 53 vessels were investigated. Based on SPECT MPI, 23 patients (43.4%) were associated with abnormal MPI. Q was significant higher in normal MPI group compared with abnormal MPI group (59.68 ± 40.33 mL/min vs. 25.67 ± 21.55 mL/min, p < 0.001). The TFR were significantly lower in normal MPI group (TFR: 1898.25 ± 951.55 mmHg min/L vs. 4786.31 ± 3056.18 mmHg min/L, p < 0.001). The ROC-AUC of Q and TFR for discriminating normal and abnormal MPI were 0.876 (95% CI: 0.783-0.970, p < 0.001) and 0.854 (95% CI: 0.745-0.963, p < 0.001).</p><p><strong>Conclusions: </strong>Intracoronary flow assessed by the novel CFD based method has shown promise in accurately identifying patients with abnormal SPECT MPI, offering a convenient and quantitative approach for assessing coronary physiology.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708755","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":"Three-Dimensional-Printed Models Reduce Adverse Events of Left Atrial Appendage Occlusion: A Systematic Review and Meta-Analysis.","authors":"Jaeny Delos Santos, Francis Joshua Beloy, Ralf Martz Sulague, Henry Okudzeto, Jillian Reeze Medina, Thea Danielle Cartojano, Nikki Cruz, Edward Daniel Mortalla, Jacques Kpodonu","doi":"10.1002/ccd.31503","DOIUrl":"https://doi.org/10.1002/ccd.31503","url":null,"abstract":"<p><strong>Background and aims: </strong>Left atrial appendage occlusion (LAAO) has an excellent safety profile but there is growing evidence of adverse long-term sequelae of peri-device leak and device-related thrombus. This study seeks to determine if guidance from 3D-printed models of left atrial appendages reduces the incidence of side effects.</p><p><strong>Methods: </strong>A systematic literature search was conducted in the following databases: Pubmed, Google Scholar, and Europe PMC. Cohort studies that directly compared outcomes using 3D-printed model simulations before undergoing LAAO versus using conventional imaging only among patients with nonvalvular atrial fibrillation, CHA₂DS₂-VASc scores ≥ 1, and relative or absolute contraindications to long-term anticoagulation were included. Clinical outcomes included incidence of peri-device leak, mismatch, and device-related thrombus. Meta-analysis was done using the random-effects model.</p><p><strong>Results: </strong>Only three cohort studies were eligible for meta-analysis with a mean follow-up period of 25 months. This included a total of 204 patients (mean age, 75 years). Using 3D printed models of left atrial appendage based on transesophageal echocardiogram and cardiac computed tomography had statistically significantly less incidence of peri-device leak (log OR -2.47; 95% CI: -3.70 to 1.24; p = 0.00), incidence of mismatch (log OR -1.61; 95% CI: -2.50 to 0.73; p = 0.00) and shorter procedural time (mean difference -24.86; 95% CI: -31.75 and -27.11; p = 0.00). Although the incidence of device-related thromboembolism was 49% less in the 3D printing-guided group, the difference was not statistically significant (p = 0.58).</p><p><strong>Conclusion: </strong>Less incidence of peri-device leak and mismatch were observed with 3D printing-guided left atrial appendage occlusion. A highly powered randomized controlled trial may have to be done to confirm the findings.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718076","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 Prognostic Implications of Change in LVEDP during TAVI.","authors":"Paul Bamford, Amr Abdelrahman, Nadir Elamin, Rowan Hall, Amanda Sherwen, Kate V Gatenby, Amir Aziz, Suleman Aktaa, Christopher J Malkin, Michael S Cunnington, Daniel J Blackman, Noman Ali","doi":"10.1002/ccd.31508","DOIUrl":"https://doi.org/10.1002/ccd.31508","url":null,"abstract":"<p><strong>Background: </strong>Elevated left ventricular end diastolic pressure (LVEDP) following transcatheter aortic valve implantation (TAVI) has been identified as a predictor of heart failure and mortality.</p><p><strong>Aims: </strong>To determine whether change in LVEDP is a more powerful predictor of adverse clinical outcomes than elevated LVEDP post-TAVI.</p><p><strong>Methods: </strong>Patients who underwent TAVI at two high volume centers between January 2013 and December 2023 were screened for inclusion. LVEDP measurements were taken before and immediately after TAVI. Hospital records were analyzed for mortality and heart failure hospitalization (HFH). Patients were stratified into those whose LVEDP decreased (post-TAVI LVEDP > 5 mmHg lower), didn't change (±5 mmHg) or increased (post-TAVI LVEDP > 5 mmHg higher).</p><p><strong>Results: </strong>A total of 1073 patients were included. The median follow-up period was 28.9 months with 15.5% followed up for over 5 years. Increase in LVEDP was associated with increased incidence of 5-year mortality (40.3% vs. 28.4% vs. 23.2%; p < 0.001) and HFH (23.3% vs. 10.0% vs. 7.1%; p < 0.001) compared to no change or decrease in LVEDP. On multivariate analysis, increase in LVEDP post-TAVI was an independent predictor of all-cause mortality and HFH. Elevated LVEDP (> 15 mmHg) alone post-TAVI was predictive of HFH but not mortality.</p><p><strong>Conclusions: </strong>Patients in whom LVEDP increases post-TAVI have a significantly higher incidence of mortality and HFH within 1 month, and this persists for at least 5-years post-procedure. According to our results, the change in LVEDP is a more powerful predictor of adverse clinical outcomes than elevated post-TAVI LVEDP alone.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708752","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":"Dedicated Sheathless System Versus Sheath-Based Approach for Transradial Percutaneous Coronary Intervention: Systematic Review and Meta-Analysis.","authors":"Mattia Basile, Carmine Salzillo, Emiliano Bianchini, Francesco Bianchini, Alfonso Jurado-Román, Achille Gaspardone, Francesco Burzotta, Gregory A Sgueglia","doi":"10.1002/ccd.31512","DOIUrl":"https://doi.org/10.1002/ccd.31512","url":null,"abstract":"<p><strong>Background: </strong>Transradial access (TRA) is the preferred approach for percutaneous coronary intervention (PCI), associated with improved patient comfort, lower vascular complications and lower mortality compared to transfemoral access. However, TRA presents challenges such as radial artery spasm (RAS), radial artery occlusion (RAO), and anatomical variability that have driven the development of the sheathless approach.</p><p><strong>Objectives: </strong>This meta-analysis evaluates the efficacy and safety of a dedicated sheathless system strategy versus conventional sheath-based techniques in TRA PCI.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of studies comparing sheathless and sheath-based approaches in TRA PCI, with outcomes including RAS, access site crossover, access-related bleeding, RAO, procedural success, and procedural metrics. Primary analysis was stratified by study design-randomized controlled trials (RCTs) versus observational studies (OBS)-with additional subgroup analysis based on sheath type. Data were pooled using random-effects models, and heterogeneity assessed via the I² statistic.</p><p><strong>Results: </strong>Eight studies (3 RCTs, 5 OBS) comprising 6380 patients were included. The sheathless approach significantly reduced RAS (OR 0.31; 95% CI: 0.10-0.97) and access site crossover (OR 0.34; 95% CI: 0.16-0.69) compared to the sheath-based approach, particularly in the conventional sheath subgroup. No significant differences were found in access-related bleeding, RAO, procedural success, or procedural metrics.</p><p><strong>Conclusions: </strong>This meta-analysis supports the sheathless system as a safe and effective alternative to sheath-based TRA PCI, reducing RAS, and crossover without increasing RAO or bleeding risk. These advantages may enhance procedural efficiency and patient comfort, especially in small radial arteries and extend its scope to newer applications.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708749","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":"Balloon-Assisted Subintimal Entry-Facilitated Tip Detection-Antegrade Dissection Reentry Technique: A Novel Antegrade Approach for Chronic Total Occlusion.","authors":"Vidya Gilang Rejeki, Yutaka Tadano, Tsutomu Fujita, Shoichi Kuramitsu","doi":"10.1002/ccd.31506","DOIUrl":"https://doi.org/10.1002/ccd.31506","url":null,"abstract":"<p><p>Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions with ambiguous proximal cap remains challenging. We present a successful CTO-PCI case involving proximal cap ambiguity, treated by combining balloon-assisted subintimal entry (BASE) and tip-detection antegrade dissection and re-entry (TD-ADR) techniques. The BASE-facilitated TD-ADR technique is a novel antegrade CTO-PCI approach and has the potential to enhance the safety and efficacy of antegrade CTO-PCI procedures.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691270","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":"Enhanced Drug Effect With Cutting Balloon Followed by Drug Coated Balloon in a Rabbit Model.","authors":"Manabu Shiozaki, Sho Torii, Yu Sato, Kazuki Aihara, Yuki Matsumoto, Norihito Nakamura, Daiki Suzuki, Ayako Yoshikawa, Yuji Ikari, Gaku Nakazawa","doi":"10.1002/ccd.31505","DOIUrl":"https://doi.org/10.1002/ccd.31505","url":null,"abstract":"<p><strong>Background: </strong>Drug-coated balloon (DCB) are effective treatment options for patients with coronary artery disease and using of scoring or cutting balloon before the DCB usage were recommended. However, the effectiveness of lesion preparation with cutting balloons (CB) followed by DCB (CB + DCB) has not been evaluated before.</p><p><strong>Aims: </strong>The aim of the current study was to compare the biological effect of various types of balloon angioplasty in a healthy rabbit iliac artery model.</p><p><strong>Methods: </strong>Each of the four kinds of treatments as balloon angioplasty (BA), CB alone, DCB alone, and CB + DCB were performed in the healthy iliac arteries of 12 rabbits, which were euthanized after 14 days. The treated iliac arteries were sequentially cut, stained with hematoxylin and eosin and Movat Pentachrome, and histopathologically evaluated.</p><p><strong>Results: </strong>The depth of medial smooth muscle cell (SMC) loss score, an indicator of drug effect, was highest with CB + DCB, followed by DCB, CB, and BA (CB + DCB vs. DCB vs. CB vs. BA: 3.83 (3.67-4.00) vs. 3.17 (2.67-3.67), 1.67 (1.67-2.08) vs. 1.50 (1.00-1.67), p < 0.0001). The angle with severe SMC loss was also the highest with CB + DCB group, followed by DCB group, CB group, and BA group (123.7 (104.5-132.2) vs. 52.1 (34.7-100.6), 0.0 (0.0-14.2) vs. 0.0 (0.0-0.0), respectively, p < 0.0001), suggesting a higher drug effect in CB + DCB compared with DCB alone.</p><p><strong>Conclusions: </strong>The drug effect of DCB was enhanced when CB was used before DCB treatment, suggesting the effectiveness of the combination therapy of CB and DCB.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662612","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 Guidewire Indicated for Coronary Fractional Flow Reserve Assessment: Structural Design, Deficiencies and Potential Solutions.","authors":"Wengang Liu, Jun Shi, Rong Shan, Yu Wang, Liangfeng Zhao, Honglei Zhou, Wei Li, Liuliu Feng","doi":"10.1002/ccd.31504","DOIUrl":"https://doi.org/10.1002/ccd.31504","url":null,"abstract":"<p><p>Coronary heart disease (CHD) is one of the leading causes of mortality worldwide. It is primarily caused by myocardial ischemia and hypoxia resulting from atherosclerotic plaques in the coronary arteries, leading to symptoms such as angina. The severity of CHD determines the treatment approach, which may include medication or interventional therapy. Therefore, accurately assessing the severity of myocardial ischemia is crucial for effective CHD management. In recent years, fractional flow reserve (FFR), derived from the relationship between flow and pressure, has gained widespread recognition for providing valuable information to guide coronary revascularization. Pressure guidewires equipped with pressure sensors at their tips are the most commonly used tools for clinical FFR assessment. These wires measure vessel pressure to determine the severity of coronary lesions. However, during their use, issues such as signal drift, tip breakage, core wire fractures, and coating detachment may occur. This article reviews the historical development of pressure guidewires, examines the general structure of two commonly used pressure guidewires available in the market, highlights typical issues encountered during clinical use, and proposes corresponding solutions.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662616","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 Coronary Calcification on Complete Revascularization in Patients With Acute Coronary Syndrome and Multivessel Disease.","authors":"William Camilleri, Hala Kakar, Jacob J Elscot, Eric Boersma, Nicolas M Van Mieghem, Roberto Diletti, Joost Daemen, Elena Ntantou, Jeroen Wilschut, Rutger Jan Nuis, Wijnand K Den Dekker","doi":"10.1002/ccd.31495","DOIUrl":"https://doi.org/10.1002/ccd.31495","url":null,"abstract":"<p><strong>Background: </strong>Coronary calcification is a well-known marker of atherosclerotic plaque burden and a determinant of stent under expansion with unfavorable long-term outcomes.</p><p><strong>Aims: </strong>This sub study of the randomized BIOVASC trial aimed to compare immediate complete revascularization (ICR) and staged complete revascularization (SCR) in patients with acute coronary syndrome (ACS) and multi vessel disease (MVD), stratified by calcification of the culprit lesion.</p><p><strong>Methods: </strong>The primary endpoint consisted of a composite of all-cause mortality, myocardial infarction, unplanned ischemia driven revascularization (UIDR) and cerebrovascular events at 2 year follow-up. Secondary endpoints included the individual components of the primary composite and major bleedings. We used cox regression models to relate study endpoints with randomized treatment stratified by calcification of the culprit lesion.</p><p><strong>Results: </strong>The BIOVASC trial enrolled 103 patients with a moderately or severely calcified culprit lesion. The composite primary outcome occurred in 8/57 (14.3%) versus 9/46 (19.7%) patients randomized to ICR and SCR (hazard ratio [HR] 0.66% and 95% confidence interval [CI] 0.25-1.71, p = 0.39). In the non-calcified culprit lesions, there were 83 events in the ICR (12.4%) and 82 events in the SCR (11.9%) (HR 1.01 [0.75-1.37], p = 0.94, P-interaction = 0.42). There was no evidence of a differential effect of ICR vs. SCR on the primary endpoint in relation to culprit lesion calcification (P-interaction = 0.42).</p><p><strong>Conclusion: </strong>No differential treatment effect of ICR versus SCR was observed when comparing the primary composite outcome between calcified and non-calcified culprit lesion.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662614","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 Implications for Fabric Leak After Watchman FLX Device Implantation: A Study Update.","authors":"Marco Frazzetto, Sung-Han Yoon, Steven J Filby","doi":"10.1002/ccd.31494","DOIUrl":"https://doi.org/10.1002/ccd.31494","url":null,"abstract":"","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656183","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":"Treatment of Residual Postsurgical Left Atrial Appendage Closure Using the Watchman Device Guided by CT Planning: A Case Report.","authors":"Yusef Saeed, Rafey Feroze, Marco Frazetto, Steven J Filby","doi":"10.1002/ccd.31483","DOIUrl":"https://doi.org/10.1002/ccd.31483","url":null,"abstract":"<p><p>Percutaneous and surgical approaches have been developed for left atrial appendage occlusion. Residual stump formation with a depth of ≥ 10 mm is a recognized complication after surgical LAAO using AtriClip (Atricure, Mason, Ohio). The standard imaging modality for preprocedural planning and postprocedural follow up during these procedures has been transesophageal echocardiography. The current case describes successful closure of a residual stump, measuring 13 mm in depth, using percutaneous LAAO, with CT imaging utilized for preprocedural planning and postprocedural follow up. Accordingly, this case demonstrates that CT imaging is a viable, convenient, and less invasive alternative for these situations.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656184","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}