<div><h4>Utility of optical coherence tomography in acute coronary syndromes.</h4><i>Karimi Galougahi K, Dakroub A, Chau K, Mathew R, ... Shlofmitz R, Ali ZA</i><br /><AbstractText>Studies utilizing intravascular imaging have replicated the findings of histopathological studies, identifying the most common substrates for acute coronary syndromes (ACS) as plaque rupture, erosion, and calcified nodule, with spontaneous coronary artery dissection, coronary artery spasm, and coronary embolism constituting the less common etiologies. The purpose of this review is to summarize the data from clinical studies that have used high-resolution intravascular optical coherence tomography (OCT) to assess culprit plaque morphology in ACS. In addition, we discuss the utility of intravascular OCT for effective treatment of patients presenting with ACS, including the possibility of culprit lesion-based treatment by percutaneous coronary intervention.</AbstractText><br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 28 May 2023; epub ahead of print</small></div>

<div><h4>Cerebral embolic protection during transcatheter aortic valve replacement: Insights from a consecutive series with the Sentinel cerebral protection device.</h4><i>Wolfrum M, Moccetti F, Loretz L, Bossard M, ... Cuculi F, Toggweiler S</i><br /><b>Background</b><br />Growing interest in neuroprotection in transcatheter aortic valve replacement (TAVR) has catalyzed the development of cerebral protection systems (CPS).<br /><b>Objectives</b><br />Report insights from consecutive real-world patients undergoing TAVR with the Sentinel-CPS.<br /><b>Methods</b><br />Patients with severe aortic stenosis undergoing TAVR from April 2019 to May 2022 were enrolled in a prospective registry. The reason for unsuccessful Sentinel-CPS deployment and the amount of debris captured by the filters were prospectively recorded.<br /><b>Results</b><br />The Sentinal CPS was successfully deployed in 330 patients (85%, Group 1). Deployment was not attempted, unsuccessful or only partially successful in 59 patients (15%, Group 2), caused by anatomical factors such as tortuosity, heavy calcification or small dimensions of radial or brachial artery in 46, technical aspects such as puncture failure or dissection in 5 or use of right radial access for the pigtail in 6. Debris was captured in 98% of patients in Group 1. In 40%, the amount of debris was graded moderate or extensive. Predictors for moderate/extensive debris were moderate/severe aortic calcification (OR 1.50, CI 1.05-2.15, p = 0.03), pre- and postdilatation (OR 1.97, CI 1.02-3.79, p = 0.04 and OR 1.71, CI 1.01-2.89, p = 0.048). The risk of stroke was numerically lower in patients who underwent TAVR with the Sentinel CPS (2.1 vs. 5.1%, respectively, p = 0.15). There was no stroke during CPS deployment, but one patient had a stroke immediately after device retrieval.<br /><b>Conclusions</b><br />The Sentinel-CPS was successfully deployed in 85% of patients. Predictors for moderate/extensive debris captured were moderate/severe aortic calcification, pre- and postdilatation.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 26 May 2023; epub ahead of print</small></div>

<div><h4>Culprit lesion plaque characterization and thrombus grading by high-definition intravascular ultrasound in patients with ST-segment elevation myocardial infarction.</h4><i>Groenland FTW, Ziedses des Plantes AC, Neleman T, Scoccia A, ... Van Mieghem NM, Daemen J</i><br /><b>Background</b><br />Dedicated prospective studies investigating high-definition intravascular ultrasound (HD-IVUS)-guided primary percutaneous coronary intervention (PCI) are lacking. The aim of this study was to qualify and quantify culprit lesion plaque characteristics and thrombus using HD-IVUS in patients presenting with ST-segment elevation myocardial infarction (STEMI).<br /><b>Methods</b><br />The SPECTRUM study is a prospective, single-center, observational cohort study investigating the impact of HD-IVUS-guided primary PCI in 200 STEMI patients (NCT05007535). The first 100 study patients with a de novo culprit lesion and a per-protocol mandated preintervention pullback directly after vessel wiring were subject to a predefined imaging analysis. Culprit lesion plaque characteristics and different thrombus types were assessed. An IVUS-derived thrombus score, including a 1-point adjudication for a long total thrombus length, long occlusive thrombus length, and large maximum thrombus angle, was developed to differentiate between low (0-1 points) and high (2-3 points) thrombus burden. Optimal cut-off values were obtained using receiver operating characteristic curves.<br /><b>Results</b><br />The mean age was 63.5 (±12.1) years and 69 (69.0%) patients were male. The median culprit lesion length was 33.5 (22.8-38.9) mm. Plaque rupture and convex calcium were appreciated in 48 (48.0%) and 10 (10.0%) patients, respectively. Thrombus was observed in 91 (91.0%) patients (acute thrombus 3.3%; subacute thrombus 100.0%; organized thrombus 22.0%). High IVUS-derived thrombus burden was present in 37/91 (40.7%) patients and was associated with higher rates of impaired final thrombolysis in myocardial infarction flow (grade 0-2) (27.0% vs. 1.9%, p < 0.001).<br /><b>Conclusions</b><br />HD-IVUS in patients presenting with STEMI allows detailed culprit lesion plaque characterization and thrombus grading that may guide tailored PCI.<br /><br />© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 26 May 2023; epub ahead of print</small></div>

<div><h4>Predictors of target lesion failure after treatment of left main, bifurcation, or chronic total occlusion lesions with ultrathin-strut drug-eluting coronary stents in the ULTRA registry.</h4><i>de Filippo O, Bruno F, Pinxterhuis TH, Gąsior M, ... D\'Ascenzo F, ULTRA Collaborators</i><br /><b>Background</b><br />Data about the long-term performance of new-generation ultrathin-strut drug-eluting stents (DES) in challenging coronary lesions, such as left main (LM), bifurcation, and chronic total occlusion (CTO) lesions are scant.<br /><b>Methods</b><br />The international multicenter retrospective observational ULTRA study included consecutive patients treated from September 2016 to August 2021 with ultrathin-strut (<70 µm) DES in challenging de novo lesions. Primary endpoint was target lesion failure (TLF): composite of cardiac death, target-lesion revascularization (TLR), target-vessel myocardial infarction (TVMI), or definite stent thrombosis (ST). Secondary endpoints included all-cause death, acute myocardial infarction (AMI), target vessel revascularization, and TLF components. TLF predictors were assessed with Cox multivariable analysis.<br /><b>Results</b><br />Of 1801 patients (age: 66.6 ± 11.2 years; male: 1410 [78.3%]), 170 (9.4%) experienced TLF during follow-up of 3.1 ± 1.4 years. In patients with LM, CTO, and bifurcation lesions, TLF rates were 13.5%, 9.9%, and 8.9%, respectively. Overall, 160 (8.9%) patients died (74 [4.1%] from cardiac causes). AMI and TVMI rates were 6.0% and 3.2%, respectively. ST occurred in 11 (1.1%) patients while 77 (4.3%) underwent TLR. Multivariable analysis identified the following predictors of TLF: age, STEMI with cardiogenic shock, impaired left ventricular ejection fraction, diabetes, and renal dysfunction. Among the procedural variables, total stent length increased TLF risk (HR: 1.01, 95% CI: 1-1.02 per mm increase), while intracoronary imaging reduced the risk substantially (HR: 0.35, 95% CI: 0.12-0.82).<br /><b>Conclusions</b><br />Ultrathin-strut DES showed high efficacy and satisfactory safety, even in patients with challenging coronary lesions. Yet, despite using contemporary gold-standard DES, the association persisted between established patient- and procedure-related features of risk and impaired 3-year clinical outcome.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 26 May 2023; epub ahead of print</small></div>

<div><h4>Postprocedural trans-mitral gradient in patients with degenerative mitral regurgitation undergoing mitral valve transcatheter edge-to-edge repair.</h4><i>De Felice F, Paolucci L, Musto C, Cifarelli A, ... Popolo Rubbio A, Bedogni F</i><br /><b>Background</b><br />The relationship between high postprocedural mean gradient (ppMG) and clinical events following mitral valve transcatheter edge-to-edge repair (MV-TEER) in patients with degenerative mitral regurgitation (DMR) is still debated.<br /><b>Aim</b><br />The purpose of this study was to evaluate the effect of elevated ppMG after MV-TEER on clinical events in patients with DMR at 1-year follow-up.<br /><b>Methods</b><br />The study included 371 patients with DMR treated with MV-TEER enrolled in the \"Multi-center Italian Society of Interventional Cardiology (GISE) registry of trans-catheter treatment of mitral valve regurgitation\" (GIOTTO) registry. Patients were stratified in tertiles according to ppMG. Primary endpoint was a composite of all-cause death and hospitalization due to heart failure at 1-year follow-up.<br /><b>Results</b><br />Patients were stratified as follows: 187 with a ppMG ≤ 3 mmHg, 77 with a ppMG > 3/=4 mmHg, and 107 with a ppMG > 4 mmHg. Clinical follow-up was available in all subjects. At multivariate analysis, neither a ppMG > 4 mmHg nor a ppMG ≥ 5 mmHg were independently associated with the outcome. Notably, the risk of elevated residual MR (rMR > 2+) was significantly higher in patients belonging to the highest tertile of ppMG (p = 0.009). The association of ppMG > 4 mmHg and rMR ≥ 2+ was strongly and independently associated with adverse events (hazard ratio: 1.98; 95% confidence interval: [1.10-3.58]).<br /><b>Conclusions</b><br />In a real-world cohort of patients suffering DMR and treated with MV-TEER, isolated ppMG was not associated with the outcome at 1-year follow-up. A high proportion of patients showed both elevated ppMG and rMR and their combination appeared to be a strong predictor of adverse events.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 26 May 2023; epub ahead of print</small></div>

<div><h4>Anatomical predictors for suture-based closure of the patent foramen ovale: A multicenter experience.</h4><i>Witte LS, Renkens MPL, Gąsecka A, El Bouziani A, ... Leibundgut G, Voskuil M</i><br /><b>Background</b><br />NobleStitch EL is a novel suture-based technique used for patent foramen ovale (PFO) closure and an alternative to traditional double-disc devices without the need for antithrombotic therapy. However, successful closure rates are still unknown, and certain anatomies may be unfavorable for successful closure.<br /><b>Aims</b><br />We assessed the efficacy of the NobleStitch EL and sought to identify patient-related anatomical features associated with successful suture-based closure.<br /><b>Methods</b><br />We included 55 patients who underwent PFO closure with the NobleStitch EL in The Netherlands and Switzerland. Successful closure was defined as residual right-to-left shunt grade ≤1 with Valsalva maneuver at a cardiac ultrasound. Predefined possible anatomical determinants for effective closure included PFO length, atrial septal aneurysm, PFO entry- and exit diameter.<br /><b>Results</b><br />Successful closure was achieved in 33 patients (60%). The PFO length was shorter in patients with successful closure compared to unsuccessful closure with a median length of 9.6 mm (IQR 8.0-15.0) versus 13.3 mm (IQR 11.4-18.6) on preprocedural ultrasound (p = 0.041) and 9.9 mm (IQR 8.0-13.1) versus 12.5 mm (IQR 9.7-15.4) on angiography (p = 0.049). Additionally, the PFO exit diameter and PFO volume were smaller in patients with successful closure than unsuccessful closure, with a mean diameter of 7.0 ± 3.1 mm versus 9.5 ± 3.8 mm (p = 0.015) and a median volume of 381 mm<sup>3</sup> (IQR 286-894) versus 985 mm<sup>3</sup> (IQR 572-1550) (p = 0.016).<br /><b>Conclusion</b><br />In our study cohort, the successful PFO closure rate using NobleStitch EL was relatively low (60%). With this alternative procedure, patients with a small PFO driven by a short PFO tunnel length and small exit diameter seem to be eligible for successful suture-based closure.<br /><br />© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 24 May 2023; epub ahead of print</small></div>

<div><h4>Optical coherence tomography-derived predictors of stent expansion in calcified lesions.</h4><i>Ziedses des Plantes AC, Scoccia A, Neleman T, Groenland FTW, ... Van Mieghem NM, Daemen J</i><br /><b>Background</b><br />Severe coronary artery calcification is associated with stent underexpansion and subsequent stent failure.<br /><b>Aims</b><br />We aimed to identify optical coherence tomography (OCT)-derived predictors of absolute (minimal stent area [MSA]) and relative stent expansion in calcified lesions.<br /><b>Methods</b><br />This retrospective cohort study included patients who underwent percutaneous coronary intervention (PCI) with OCT assessment before and after stent implantation between May 2008 and April 2022. Pre-PCI OCT was used to assess calcium burden and post-PCI OCT was used to assess absolute and relative stent expansion.<br /><b>Results</b><br />A total of 361 lesions in 336 patients were analyzed. Target lesion calcification (defined as OCT-detected maximum calcium angle ≥ 30°) was present in 242 (67.0%) lesions. Following PCI, median MSA was 5.37 mm<sup>2</sup> in calcified lesions and 6.24 mm<sup>2</sup> in noncalcified lesions (p < 0.001). Median stent expansion was 78% in calcified lesions and 83% in noncalcified lesions (p = 0.325). In the subset of calcified lesions, average stent diameter, preprocedural minimal lumen area, and total calcium length were independent predictors of MSA in multivariable analysis (mean difference 2.69 mm<sup>2</sup> /mm<sup>2</sup> , 0.52 mm<sup>2</sup> /mm, and -0.28 mm<sup>2</sup> /5 mm, respectively, all p < 0.001). Total stent length was the only independent predictor of relative stent expansion (mean difference -0.465% per mm, p < 0.001). Calcium angle, thickness, and the presence of nodular calcification were not significantly associated with MSA or stent expansion in multivariable analyses.<br /><b>Conclusion</b><br />Calcium length appeared to be the most important OCT-derived predictor of MSA, whereas stent expansion was mainly determined by total stent length.<br /><br />© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 20 May 2023; epub ahead of print</small></div>

<div><h4>Percutaneous treatment of left circumflex coronary artery injury related to mitral valve surgery: Case series and systematic review of the literature.</h4><i>Benedetti A, Castaldi G, Poletti E, Moroni A, ... Agostoni P, Zivelonghi C</i><br /><AbstractText>Left circumflex coronary artery (LCx) injury related to mitral valve surgery is a rare complication. The best treatment option is not defined, and percutaneous coronary intervention (PCI) may represent an effective treatment to avoid prolonged myocardial ischemia. To evaluate feasibility and efficacy of PCI treatment, all records of LCx injury related to mitral valve surgery and treated with PCI were included after a systematic PubMed searching. Moreover, we retrospectively analyzed our single-center PCI database and patients fulfilling the inclusion criteria were included. Patients undergoing transcatheter mitral valve intervention, non-mitral valve surgery, conservatively or surgically treated after LCx injury were excluded. Data about patient characteristics, procedural details, PCI success, and in-hospital mortality were collected. Fifty-six patients were included, 58.9% were male (n = 33) and the median age was 60.5 years (IQR = 21.75). The majority had left dominant or codominant coronary system (62.2%, n = 28 and 15.6%, n = 7, respectively). Clinical manifestations ranged from hemodynamic stability (21.1%, n = 8) to hemodynamic instability (42.1%, n = 16) and cardiac arrest (18.4%, n = 7). On ECG, 23.5% of patients (n = 12) presented ST-segment depression, 58.8% (n = 30) ST-segment elevation, 7.8% (n = 4) atrioventricular block, and 29.4% (n = 15) ventricular arrhythmias. Left ventricle dysfunction was present in 52.3% (n = 22) of patients and wall motion abnormalities in 71.4% (n = 30). PCI success rate was 82.1% (n = 46) and in-hospital mortality 4.5% (n = 2). LCx injury related to mitral surgery is a rare complication characterized by an increased risk of mortality. PCI seems a feasible treatment option, still burdened by suboptimal results, probably related to the technical challenges posed by the surgical failure.</AbstractText><br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 20 May 2023; epub ahead of print</small></div>

<div><h4>Drug-coated balloon strategy following orbital atherectomy for calcified coronary artery compared with drug-eluting stent: One-year outcomes and optical coherence tomography assessment.</h4><i>Mitsui K, Lee T, Miyazaki R, Hara N, ... Nozato T, Ashikaga T</i><br /><b>Background</b><br />Percutaneous coronary intervention (PCI) for calcified coronary artery remains challenging in the drug-eluting stent (DES) era. While recent studies reported the efficacy of orbital atherectomy (OA) combined with DES for calcified lesion, the effectiveness of drug-coated balloon (DCB) following OA has not been fully elucidated.<br /><b>Methods</b><br />Between June 2018 and June 2021, 135 patients who received PCI for calcified de novo coronary lesions with OA were enrolled and divided into two groups; OA followed by DCB (n = 43) if the target lesion achieved acceptable preparation, or second- or third-generation DESs (n = 92) if the target lesion showed suboptimal preparation between June 2018 and June 2021. All patients underwent PCI with optical coherence tomography (OCT) imaging. The primary endpoint was 1-year major adverse cardiac event (MACE), that was a composite of cardiac death, nonfatal myocardial infarction, or target lesion revascularization.<br /><b>Results</b><br />Mean age was 73 years and 82% was male. In OCT analysis, maximum calcium plaque was thicker (median: 1050 µm [interquartile range (IQR): 945-1175 µm] vs. 960 µm [808-1100 µm], p = 0.017), calcification arc tended to larger (median: 265° [IQR: 209-360°] vs. 222° [162-305°], p = 0.058) in patients with DCB than in DES, and the postprocedure minimum lumen area was smaller in DCB compared with minimum stent area in DES (median: 3.83 mm<sup>2</sup> [IQR: 3.30-4.52 mm<sup>2</sup> ] vs. 4.86 mm<sup>2</sup> [4.05-5.82 mm<sup>2</sup> ], p < 0.001). However, 1 year MACE free rate was not significantly different between 2 groups (90.3% in DCB vs. 96.6% in DES, log-rank p = 0.136). In the subgroup analysis of 14 patients who underwent follow-up OCT imaging, late lumen area loss was lower in patients with DCB than DES, despite lower lesion expansion rate in DCB than DES.<br /><b>Conclusions</b><br />In calcified coronary artery disease, DCB alone strategy (if acceptable lesion preparation was performed with OA) was feasible compared with DES following OA with respect to 1-year clinical outcomes. Our finding indicated using DCB with OA might be reduce late lumen area loss for severe calcified lesion.<br /><br />© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 20 May 2023; epub ahead of print</small></div>

<div><h4>Intracardiac echocardiogram to diagnose infective endocarditis after transcatheter aortic valve-in-valve implantation.</h4><i>Ho CB, Vejlstrup NG, De Backer O, Søndergaard L</i><br /><AbstractText>A 70-year-old man with history of transcatheter aortic valve-in-valve implantation was admitted because of suspected infective endocarditis (IE). Transesophageal echocardiogram did not reveal any vegetations, as the metallic stent frames caused significant artifacts. Position emission tomography was also negative. Intracardiac echocardiogram (ICE) was performed retrogradely through the ascending aorta, which showed clear vegetations over the stent frame of the transcatheter heart valve. Endocarditis after transcatheter aortic valve implantation was not uncommon. With increasing use of valve-in-valve procedures, echocardiographic diagnosis of IE would be more challenging. This case demonstrated the advantage of ICE over conventional echocardiography in visualizing the neo-aortic valve complex for diagnosing IE.</AbstractText><br /><br />© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 20 May 2023; epub ahead of print</small></div>

<div><h4>What do we mean by complex percutaneous coronary intervention? An assessment of agreement amongst interventional cardiologists for defining complexity.</h4><i>Rjoob K, McGilligan V, McAllister R, Bond R, ... Peace A, EAPCI Innovation and Digital Cardiology Committee</i><br /><b>Background</b><br />In the last decade, percutaneous coronary intervention (PCI) has evolved toward the treatment of complex disease in patients with multiple comorbidities. Whilst there are several definitions of complexity, it is unclear whether there is agreement between cardiologists in classifying complexity of cases. Inconsistent identification of complex PCI can lead to significant variation in clinical decision-making.<br /><b>Aim</b><br />This study aimed to determine the inter-rater agreement in rating the complexity and risk of PCI procedures.<br /><b>Method</b><br />An online survey was designed and disseminated amongst interventional cardiologists by the European Association of Percutaneous Cardiovascular Intervention (EAPCI) board. The survey presented four patient vignettes, with study participants assessing these cases to classify their complexity.<br /><b>Results</b><br />From 215 respondents, there was poor inter-rater agreement in classifying the complexity level (k = 0.1) and a fair agreement (k = 0.31) in classifying the risk level. The experience level of participants did not show any significant impact on the inter-rater agreement of rating the complexity level and the risk level. There was good level of agreement between participants in terms of rating 26 factors for classifying complex PCI. The top five factors were (1) impaired left ventricular function, (2) concomitant severe aortic stenosis, (3) last remaining vessel PCI, (4) requirement fort calcium modification and (5) significant renal impairment.<br /><b>Conclusion</b><br />Agreement among cardiologists in classifying complexity of PCI is poor, which may lead to suboptimal clinical decision-making, procedural planning as well as long-term management. Consensus is needed to define complex PCI, and this requires clear criteria incorporating both lesion and patient characteristics.<br /><br />© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 20 May 2023; epub ahead of print</small></div>

<div><h4>Effectiveness, safety, and patient reported outcomes of a planned investment procedure in higher-risk chronic total occlusion percutaneous coronary intervention: Rationale and design of the invest-CTO study.</h4><i>Øksnes A, Skaar E, Engan B, Bleie Ø, ... Rotevatn S, McEntegart MB</i><br /><b>Background</b><br />The anatomical complexity of a chronic total occlusion (CTO) correlates with procedural failure and complication rates. CTO modification after unsuccessful crossing has been associated with subsequent higher technical success rates, but complication rates remain high with this approach. While successful CTO percutaneous coronary intervention (PCI) has been associated with improved angina and quality of life (QOL) this has not been demonstrated in anatomically high-risk CTOs. Whether a planned CTO modification procedure, hereafter named Investment procedure, could improve patient outcomes has never been investigated.<br /><b>Study design</b><br />Invest-CTO is a prospective, single-arm, international, multicenter study, evaluating the effectiveness and safety of a planned investment procedure, with a subsequent completion CTO PCI (at 8-12 weeks), in anatomically high-risk CTOs. We will enroll 200 patients with CTOs defined as high-risk according to our Invest CTO criteria at centers in Norway and United Kingdom. Patients with aorto-ostial lesions, occlusion within a previous stent, or a prior attempt at target vessel CTO PCI within 6 months will be excluded. The co-primary endpoints are cumulative procedural success (%) after both procedures, and a composite safety endpoint at 30 days after completion CTO PCI. Patient reported outcomes (PROs), treatment satisfaction, and clinical endpoints will be reported.<br /><b>Conclusion</b><br />This study will prospectively evaluate the effectiveness and safety of a planned two staged PCI procedure in the treatment of high-risk CTOs and may have the potential to change current clinical practice.<br /><br />© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 17 May 2023; epub ahead of print</small></div>

<div><h4>Comparison of quantitative flow ratio with instantaneous wave-free ratio and resting full-cycle ratio during daily routine in the catheterization laboratory.</h4><i>Stader J, Antoniadis M, Ussat M, Wachter R, ... Laufs U, Lenk K</i><br /><b>Background</b><br />Quantitative flow ratio (QFR) is a novel, software-based method to evaluate the physiology of coronary lesions. The aim of this study was to compare QFR with the established invasive measurements of coronary blood flow using instantaneous wave-free ratio (iFR) or resting full-cycle ratio (RFR) in daily cathlab routine.<br /><b>Methods</b><br />102 patients with stable coronary artery disease and a coronary stenosis of 40%-90% were simultaneously assessed with QFR and iFR or RFR. QFR-computation was performed by two certified experts using the appropriate software (QAngio XA 3D 3.2).<br /><b>Results</b><br />QFR showed a significant correlation (r = 0.75, p < 0.001) to iFR and RFR. The area under the receiver curve for all measurements was 0.93 (95% confidence interval, 0.87-0.98) for QFR compared to iFR or RFR. QFR based assessment required less time with a median of 501 s (IQR 421-659 s) compared to iFR or RFR which required a median of 734 s to obtain the result (IQR 512-967 s; p < 0.001). The median use of contrast medium was similar with 21 mL (IQR 16-30 mL) for the QFR-based and 22 mL (IQR 15-35 mL) for the iFR- or RFR-based diagnostic. QFR diagnostic required less radiation. The median dose area product for QFR was 307cGycm<sup>2</sup> (IQR 151-429 cGycm<sup>2</sup> ) compared to 599 cGycm<sup>2</sup> (IQR 345-1082 cGycm<sup>2</sup> ) for iFR or RFR, p < 0.001.<br /><b>Conclusion</b><br />QFR measurements of coronary artery blood flow correlate with iFR or RFR measurements and are associated with shorter procedure times and reduced radiation dose.<br /><br />© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 17 May 2023; epub ahead of print</small></div>

<div><h4>Anemia and periprocedural complications determine contrast-associated acute kidney injury after recanalization of chronic coronary occlusions in chronic kidney disease.</h4><i>Werner GS, Lorenz S, Dimitriadis Z, Krueger B</i><br /><b>Background</b><br />Contrast-associated acute kidney injury (CA-AKI) is a potential risk associated with the percutaneous coronary interventions (PCI) for chronic total coronary occlusions (CTO) particularly with pre-existing chronic kidney disease (CKD). The determinants of CA-AKI in patients with pre-existing CKD in an era of advanced strategies of CTO recanalization techniques need to be considered for a risk evaluation of the procedure.<br /><b>Methods</b><br />A consecutive cohort of 2504 recanalization procedures for a CTO between 2013 and 2022 was analyzed. Of these, 514 (20.5%) were done in patients with CKD (estimated glomerular filtration rate < 60 ml/min based on the most recently used CKD Epidemiology Collaboration equation).<br /><b>Results</b><br />The rate of patients classified to have CKD would be lower with 14.2% using the Cockcroft-Gault equation, and 18.1% using the modified Modification of Diet in Renal Disease equation. The technical success was high with 94.9% and 96.8% (p = 0.04) between patients with and without CKD. The incidence of CA-AKI was 9.9% versus 4.3% (p < 0.001). The major determinants of CA-AKI in patients with CKD were the presence of diabetes and a reduced ejection fraction, as well as periprocedural blood loss, whereas a higher baseline hemoglobin and the use of the radial approach prevented CA-AKI.<br /><b>Conclusions</b><br />In patients with CKD CTO PCI could be performed successfully at a higher cost of CA-AKI. Correcting preprocedural anemia and avoiding intraprocedural blood loss may reduce the incidence of CA-AKI.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 16 May 2023; epub ahead of print</small></div>

<div><h4>A machine learning algorithm to predict a culprit lesion after out of hospital cardiac arrest.</h4><i>Pareek N, Frohmaier C, Smith M, Kordis P, ... MacCarthy P, Shah AM</i><br /><b>Background</b><br />We aimed to develop a machine learning algorithm to predict the presence of a culprit lesion in patients with out-of-hospital cardiac arrest (OHCA).<br /><b>Methods</b><br />We used the King\'s Out-of-Hospital Cardiac Arrest Registry, a retrospective cohort of 398 patients admitted to King\'s College Hospital between May 2012 and December 2017. The primary outcome was the presence of a culprit coronary artery lesion, for which a gradient boosting model was optimized to predict. The algorithm was then validated in two independent European cohorts comprising 568 patients.<br /><b>Results</b><br />A culprit lesion was observed in 209/309 (67.4%) patients receiving early coronary angiography in the development, and 199/293 (67.9%) in the Ljubljana and 102/132 (61.1%) in the Bristol validation cohorts, respectively. The algorithm, which is presented as a web application, incorporates nine variables including age, a localizing feature on electrocardiogram (ECG) (≥2 mm of ST change in contiguous leads), regional wall motion abnormality, history of vascular disease and initial shockable rhythm. This model had an area under the curve (AUC) of 0.89 in the development and 0.83/0.81 in the validation cohorts with good calibration and outperforms the current gold standard-ECG alone (AUC: 0.69/0.67/0/67).<br /><b>Conclusions</b><br />A novel simple machine learning-derived algorithm can be applied to patients with OHCA, to predict a culprit coronary artery disease lesion with high accuracy.<br /><br />© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 16 May 2023; epub ahead of print</small></div>

<div><h4>Three-year outcomes for transcatheter repair in patients with mitral regurgitation from the CLASP study.</h4><i>Spargias K, Lim DS, Makkar R, Kar S, ... Webb JG, Szerlip M</i><br /><b>Background</b><br />Mitral valve transcatheter edge-to-edge repair (M-TEER) is an effective option for treatment of mitral regurgitation (MR). We previously reported favorable 2-year outcomes for the PASCAL transcatheter valve repair system.<br /><b>Objectives</b><br />We report 3-year outcomes from the multinational, prospective, single-arm CLASP study with analysis by functional MR (FMR) and degenerative MR (DMR).<br /><b>Methods</b><br />Patients with core-lab determined MR ≥ 3+ were deemed candidates for M-TEER by the local heart team. Major adverse events were assessed by an independent clinical events committee to 1 year and by sites thereafter. Echocardiographic outcomes were evaluated by the core laboratory to 3 years.<br /><b>Results</b><br />The study enrolled 124 patients, 69% FMR; 31% DMR (60% NYHA class III-IVa, 100% MR ≥ 3+). The 3-year Kaplan-Meier estimate for survival was 75% (66% FMR; 92% DMR) and freedom from heart failure hospitalization (HFH) was 73% (64% FMR; 91% DMR), with 85% reduction in annualized HFH rate (81% FMR; 96% DMR) (p < 0.001). MR ≤ 2+ was achieved and maintained in 93% of patients (93% FMR; 94% DMR) and MR ≤ 1+ in 70% of patients (71% FMR; 67% DMR) (p < 0.001). The mean left ventricular end-diastolic volume (181 mL at baseline) decreased progressively by 28 mL [p < 0.001]. NYHA class I/II was achieved in 89% of patients (p < 0.001).<br /><b>Conclusions</b><br />The 3-year results from the CLASP study demonstrated favorable and durable outcomes with the PASCAL transcatheter valve repair system in patients with clinically significant MR. These results add to the growing body of evidence establishing the PASCAL system as a valuable therapy for patients with significant symptomatic MR.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 13 May 2023; epub ahead of print</small></div>

<div><h4>Mild aortic insufficiency following transcatheter aortic valve replacement: A systematic review and meta-analysis.</h4><i>Hameed I, Ahmed A, Kumar A, Li E, ... Geirsson A, Williams ML</i><br /><b>Background</b><br />Post-procedural aortic insufficiency (AI) continues to be prevalent following transcatheter aortic valve replacement (TAVR). While several studies have assessed the outcomes of moderate-severe AI following TAVR, the incidence, predictors, and outcomes of mild AI remain unclear.<br /><b>Methods</b><br />A systematic literature review was performed to identify studies reporting on mild AI following TAVR. The primary outcome was pooled incidence of post-TAVR mild AI. Secondary outcomes included pooled incidence of mild AI at 30 days and long term. The pooled incidence of midterm mortality in patients with post-TAVR mild AI was also evaluated. The random effect generalized linear mixed-effects model with logit-transformed proportions and Hartung-Knapp adjustment was used to calculate pooled incidence rates. Meta-regression was performed to identify predictors of mild AI.<br /><b>Results</b><br />The pooled analysis included 19,241 patients undergoing TAVR across 50 studies. The mean age of patients ranged from 73 to 85 years, and female patients ranged from 20.0% to 83.3%. The overall pooled incidence of post-TAVR mild AI was 56.1% (95% confidence interval [CI] 0.31-0.64). The pooled incidence of mild AI at 30 days was 33.7% (95% CI 0.12-0.37). At mean follow-up of 1.15 years, the pooled incidence of mild AI was 37.0% (95% CI 0.16-0.45). The overall pooled incidence of Midterm mortality (mean follow-up 1.22 years) in patients with mild AI was 14.8% (95% CI 0.10-0.25). At meta-regression, none of the explored variables correlated with a difference in mild AI incidence.<br /><b>Conclusions</b><br />In published studies to date, 50% of patients undergoing TAVR develop mild AI postoperatively. In 37% of patients, this persists in long term. Though the incidence of AI is likely improving with newer generation TAVR valves, the prevalence and outcomes of mild AI should be closely monitored as TAVR volume and indications expand to younger patients with long life expectancy. The long-term outcomes of mild AI remain unclear. Further dedicated studies on post-TAVR mild AI are needed.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 12 May 2023; epub ahead of print</small></div>

<div><h4>Aortocoronary dissection during percutaneous coronary interventions for chronic total occlusion: Insights from the PROGRESS-CTO registry.</h4><i>Kostantinis S, Rempakos A, Simsek B, Karacsonyi J, ... Burke MN, Brilakis ES</i><br /><b>Background</b><br />Aortocoronary dissection is a potentially serious complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).<br /><b>Methods</b><br />We examined the incidence, mechanisms, treatment, and outcomes of aortocoronary dissection among 12,117 CTO PCIs performed between 2012 and 2022 in a large multicenter CTO PCI registry.<br /><b>Results</b><br />The incidence of aortocoronary dissection was 0.2% (n = 27). Most aortocoronary dissections occurred in the right coronary artery (96.3%, n = 26). The baseline clinical characteristics of patients with and without aortocoronary dissection were similar, except for dyslipidemia, which was less common in patients with aortocoronary dissection (70.4% vs. 86.0%; p = 0.019). The retrograde approach was used more commonly among cases complicated by aortocoronary dissection (59.3% vs. 31.0%; p = 0.002). Technical (74.1% vs. 86.6%; p = 0.049) and procedural (70.4% vs. 85.2%; p = 0.031) success rates were lower among aortocoronary dissection cases, with a similar incidence of in-hospital major adverse cardiovascular events (3.7% vs. 2.0%; p = 0.541). Of the 27 patients with aortocoronary dissection, 19 (70.4%) were treated with ostial stenting and 8 (29.6%) were treated conservatively without subsequent adverse clinical outcomes. No patients required emergency surgery. Follow-up was available for 22 patients (81.5%): during a mean follow up of 767 (±562) days, the incidence of in-stent restenosis was 11.1% (n = 3).<br /><b>Conclusions</b><br />Aortocoronary dissection occurred in 0.2% of CTO PCIs performed by experienced operators, was associated with lower technical and procedural success, and was treated most commonly with ostial stenting. None of the patients required emergency cardiac surgery.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 12 May 2023; epub ahead of print</small></div>

<div><h4>Predictors of bail-out stenting in patients with small vessel disease treated with drug-coated balloon percutaneous coronary intervention.</h4><i>Ghetti G, Bendandi F, Donati F, Ciurlanti L, ... Galié N, Taglieri N</i><br /><b>Background</b><br />Drug-coated balloons (DCBs) have shown comparable results with drug-eluting stents in small vessel disease (SVD) percutaneous coronary intervention (PCI) in terms of target vessel revascularization and a reduced incidence of myocardial infarction. However, the relatively high rate of bail-out stenting (BOS) still represents a major drawback of DCB PCI.<br /><b>Aims</b><br />The aim of the study was to investigate the clinical, anatomic, and procedural features predictive of BOS after DCB PCI in SVD.<br /><b>Methods</b><br />We included all consecutive patients undergoing PCI at our institution between January 2020 and May 2022 who were treated with DCB PCI of a de novo lesion in a coronary vessel with a reference vessel diameter (RVD) between 2.0 and 2.5 mm. Angiographic success was defined as a residual stenosis <30% without flow-limiting dissection. Patients who did not meet these criteria underwent BOS.<br /><b>Results</b><br />A total of 168 consecutive patients and 216 coronary stenoses were included. The rate of bail-out stent was 13.9%. On multivariate analysis, DCB/RVD ratio (odds ratio [OR]: 4.39, 95% confidence interval [CI]: 1.71-11.29, p < 0.01), vessel tortuosity (OR: 7.00, 95% CI: 1.66-29.62, p < 0.01), distal vessel disease (OR: 5.66, 95% CI: 2.02-15.83, p < 0.01), and high complexity (Grade C of ACC/AHA classification) coronary stenoses (OR: 6.31, 95% CI: 1.53-26.04, p = 0.01) were independent predictors of BOS.<br /><b>Conclusions</b><br />BOS is not an infrequent occurrence in DCB PCI of small vessels and is correlated with vessel tortuosity, distal diffuse vessel disease, higher lesion complexity, and balloon diameter oversizing.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 12 May 2023; epub ahead of print</small></div>

<div><h4>The contemporary role of protamine in the cardiac catheterization laboratory.</h4><i>Danek BA, Kearney KE, Chung CJ, Steinberg Z, ... McCabe JM, Azzalini L</i><br /><AbstractText>Access to the arterial circulation and full anticoagulation carries a risk of serious bleeding during and after percutaneous coronary intervention. Important sources of bleeding include the arterial access site and coronary artery perforation. Prompt and effective management of hemorrhagic complications is an essential interventional skill. Protamine sulfate is well-known as a heparin reversal agent. Despite this, there is heterogeneity in the use of protamine during interventional procedures. While protamine is generally well-tolerated, it is associated with a risk of hypersensitivity reaction, including anaphylaxis, among others. The purpose of this review is to summarize the existing evidence about and experience with the use of protamine sulfate in the setting of percutaneous coronary and structural interventional procedures.</AbstractText><br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 12 May 2023; epub ahead of print</small></div>

<div><h4>Quantitative flow ratio modulated by intracoronary optical coherence tomography for predicting physiological efficacy of percutaneous coronary intervention.</h4><i>Ding D, Tu S, Li Y, Li C, ... Wijns W, Burzotta F</i><br /><b>Background</b><br />The combination of coronary imaging assessment and blood flow perturbation estimation has the potential to improve percutaneous coronary intervention (PCI) guidance.<br /><b>Objectives</b><br />We aimed to evaluate a novel method for fast computation of Murray law-based quantitative flow ratio (μQFR) from coregistered optical coherence tomography (OCT) and angiography (OCT-modulated μQFR, OCT-μQFR) in predicting physiological efficacy of PCI.<br /><b>Methods</b><br />Patients treated by OCT-guided PCI in the OCT-arm of the Fractional Flow Reserve versus Optical Coherence Tomography to Guide RevasculariZAtion of Intermediate Coronary Stenoses trial (FORZA, NCT01824030) were included. Based on angiography and OCT before PCI, simulated residual OCT-μQFR was computed by assuming full stent expansion to the intended-to-treat segment. Plaque composition was automatically characterized using a validated artificial intelligence algorithm. Actual post-PCI OCT-μQFR pullback was computed based on coregistration of angiography and OCT acquired immediately after PCI. Suboptimal functional stenting result was defined as OCT-μQFR ≤ 0.90.<br /><b>Results</b><br />Paired simulated residual OCT-μQFR and actual post-PCI OCT-μQFR were obtained in 76 vessels from 74 patients. Simulated residual OCT-μQFR showed good correlation (r = 0.80, p < 0.001), agreement (mean difference = -0.02 ± 0.02, p < 0.001), and diagnostic concordance (79%, 95% confidence interval: 70%-88%) with actual post-PCI OCT-μQFR. Actual post-PCI in-stent OCT-μQFR had a median value of 0.02 and was associated with left anterior descending artery lesion location (β = 0.38, p < 0.001), higher baseline total plaque burden (β = 0.25, p = 0.031), and fibrous plaque volume (β = 0.24, p = 0.026).<br /><b>Conclusions</b><br />This study based on patients enrolled in a prospective OCT-guidance PCI trial shows that simulated residual OCT-μQFR had good correlation, agreement, and diagnostic concordance with actual post-PCI OCT-μQFR. In OCT-guided procedures, OCT-μQFR in-stent pressure drop was low and was significantly predicted by pre-PCI vessel/plaque characteristics.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 12 May 2023; epub ahead of print</small></div>

<div><h4>Retrograde percutaneous coronary intervention of chronic total occlusion via discontinuous septal channels.</h4><i>Zhang YJ, Ma WR, Xu B, Huang ZH, ... Werner GS, Zhang B</i><br /><b>Objectives</b><br />The study aims to investigate the safety and feasibility of retrograde CTO intervention via collateral connection grade 0 (CC-0) septal channel and to identify predictors of collateral tracking failure.<br /><b>Background</b><br />Guidewire crossing a collateral channel is a critical step for successful retrograde percutaneous coronary intervention (PCI) of chronic total occlusion (CTO).<br /><b>Methods</b><br />Retrograde PCI was attempted in 122 cases of CTO with CC-0 septal collaterals from December 2018 to May 2021. A hydrophilic polymer coating guidewire was used for crossing all intended CC-0 collaterals. A multivariable logistic regression analysis was performed to identify the predictors of guidewire tracking failure via the CC-0 collaterals.<br /><b>Results</b><br />Successful guidewire tracking via CC-0 septal channel was achieved in 98 (80.3%) of 122 cases. The independent predictors of CC-0 septal channel guidewire tracking failure included well-developed non-septal collateral (OR: 5.297, 95% CI: 1.107-25.353, p = 0.037) and the ratio length of posterior descending artery (PDA) versus the distance of PDA ostium to cardiac apex ≤2/3 (OR: 3.970, 95% CI: 1.454-10.835, p = 0.007). Collateral perforation, target vessel perforation, and cardiac tamponade occurred in 5 (4.1%), 3 (2.5%), and 6 (4.9%) cases, respectively. There were no complications requiring emergency cardiac surgery or revascularization of nontarget vessel.<br /><b>Conclusions</b><br />Retrograde PCI via CC-0 septal channels with a hydrophilic polymer-coated guidewire is feasible and safe in patients with CTO. Well-developed nonseptal collaterals and short PDA length influence the procedure success and the risk of guidewire tracking failure via CC-0 septal channels.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 10 May 2023; epub ahead of print</small></div>

<div><h4>Transcatheter edge-to-edge mitral valve repair for post-myocardial infarction papillary muscle rupture and acute heart failure: A systematic review.</h4><i>Calì F, Pagnesi M, Pezzola E, Montisci A, Metra M, Adamo M</i><br /><AbstractText>Papillary muscle rupture (PMR) is a rare complication of acute myocardial infarction (AMI) associated with high mortality and morbidity. Surgery is the gold-standard treatment for these patients, but it is burdened by a high perioperative risk due to hemodynamic instability. Mitral transcatheter edge-to-edge repair (M-TEER) was reported to be safe and effective in unstable patients with significant mitral regurgitation. However, data in patients with post-AMI PMR are limited to a few case reports. In this review, we summarized all data available regarding percutaneous treatment of post-AMI PMR. These results show that M-TEER is safe and effective in this setting with low in-hospital mortality and complications and high rate of significant mitral regurgitation reduction.</AbstractText><br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 10 May 2023; epub ahead of print</small></div>

<div><h4>The impact of moderate aortic stenosis in acute myocardial infarction: A multicenter retrospective study.</h4><i>Abraham B, Farina JM, Fath A, Abdou M, ... Brilakis ES, Arsanjani R</i><br /><b>Background</b><br />Aortic stenosis (AS) is associated with myocardial ischemia through different mechanisms and may impair coronary arterial flow. However, data on the impact of moderate AS in patients with acute myocardial infarction (MI) is limited.<br /><b>Aims</b><br />This study aimed to investigate the impact of moderate AS in patients presenting with acute myocardial infarction (MI).<br /><b>Methods</b><br />We conducted a retrospective analysis of all patients who presented with acute MI to all Mayo Clinic hospitals, using the Enterprise Mayo PCI Database from 2005 to 2016. Patients were stratified into two groups: moderate AS and mild/no AS. The primary outcome was all cause mortality.<br /><b>Results</b><br />The moderate AS group included 183 (13.3%) patients, and the mild/no AS group included 1190 (86.7%) patients. During hospitalization, there was no difference between both groups in mortality. Patients with moderate AS had higher in-hospital congestive heart failure (CHF) (8.2% vs. 4.4%, p = 0.025) compared with mild/no AS patients. At 1-year follow-up, patients with moderate AS had higher mortality (23.9% vs. 8.1%, p < 0.001) and higher CHF hospitalization (8.3% vs. 3.7%, p = 0.028). In multivariate analysis, moderate AS was associated with higher mortality at 1-year (odds ratio 2.4, 95% confidence interval [1.4-4.1], p = 0.002). In subgroup analyses, moderate AS increased all-cause mortality in STEMI and NSTEMI patients.<br /><b>Conclusion</b><br />The presence of moderate AS in acute MI patients was associated with worse clinical outcomes during hospitalization and at 1-year follow-up. These unfavorable outcomes highlight the need for a close follow-up of these patients and for timely therapeutic strategies to best manage these coexisting conditions.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 05 May 2023; epub ahead of print</small></div>

<div><h4>Intraprocedural delayed reassessment of paravalvular regurgitation in TAVR significantly reduces the use of postdilatation.</h4><i>De la Torre Hernandez JM, Veiga Fernandez G, Barrera S, Sainz Laso F, ... Gil Ongay A, Zueco J</i><br /><b>Objectives</b><br />We sought to investigate the effect of a 15-min delayed intraprocedural reassessment of paravalvular aortic regurgitation (PVR) after an immediate evaluation of posttranscatheter aortic valve replacement (TAVR) on the regurgitation grading and usage of postdilatation.<br /><b>Background</b><br />PVR after TAVR is associated with poor prognosis, but postdilatation may increase the risk of other complications.<br /><b>Methods</b><br />In a prospective cohort of consecutive patients treated with balloon-expandable valve ES-3 ultra, the degree of PVR was assessed immediately and 15 min after that first evaluation (excluded severe cases), with the indication of postdilatation based on the delayed assessment. As a control group, the previous consecutive series of patients also treated with the same model of valve prosthesis was used.<br /><b>Results</b><br />A total of 180 patients were included in the prospective study cohort and 152 in the retrospective control group. In the study group, the immediate PVR assessment showed none-trace 27.5%, mild 52%, moderate 19%, and severe 1.5%, and the delayed re-evaluation graded PVR as none-trace 83%, mild 15.6%, and moderate 1.2% (p < 0.001 as compared to immediate). In the control group, the immediate PVR assessment showed none-trace 33.5%, mild 52%, moderate 13%, and severe 1.5%. The rate of postdilatation was 2.8% in the study group versus 10.5% in the control group (p = 0.006). At discharge, no differences were observed between groups in PVR echocardiographic grading.<br /><b>Conclusions</b><br />A post-TAVR delayed intraprocedural reassessment of the PVR shows a clearly lower degree of regurgitation as compared to immediate evaluation, which significantly decreased the indication of postdilatation.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 01 May 2023; epub ahead of print</small></div>

<div><h4>The impact of a statewide payment reform on transcatheter aortic valve replacement (TAVR) utilization and readmissions.</h4><i>Yesantharao PS, Etchill EW, Zhou AL, Ong CS, ... Resar JR, Schena S</i><br /><b>Background</b><br />Transcatheter aortic valve replacement (TAVR) is an increasingly used but relatively expensive procedure with substantial associated readmission rates. It is unknown how cost-constrictive payment reform measures, such as Maryland\'s All Payer Model, impact TAVR utilization given its relative expense. This study investigated the impact of Maryland\'s All Payer Model on TAVR utilization and readmissions among Maryland Medicare beneficiaries.<br /><b>Methods</b><br />This was a quasi-experimental investigation of Maryland Medicare patients undergoing TAVR between 2012 and 2018. New Jersey data were used for comparison. Longitudinal interrupted time series analyses were used to study TAVR utilization and difference-in-differences analyses were used to investigate post-TAVR readmissions.<br /><b>Results</b><br />During the first year of payment reform (2014), TAVR utilization among Maryland Medicare beneficiaries dropped by 8% (95% confidence interval [CI]: -9.2% to -7.1%; p < 0.001), with no concomitant change in TAVR utilization in New Jersey (0.2%, 95% CI: 0%-1%, p = 0.09). Longitudinally, however, the All Payer Model did not impact TAVR utilization in Maryland compared to New Jersey. Difference-in-differences analyses demonstrated that implementation of the All Payer Model was not associated with significantly greater declines in 30-day post-TAVR readmissions in Maryland versus New Jersey (-2.1%; 95% CI: -5.2% to 0.9%; p =0.1).<br /><b>Conclusions</b><br />Maryland\'s All Payer Model resulted in an immediate decline in TAVR utilization, likely a result of hospitals adjusting to global budgeting. However, beyond this transition period, this cost-constrictive reform measure did not limit Maryland TAVR utilization. In addition, the All Payer Model did not reduce post-TAVR 30-day readmissions. These findings may help inform expansion of globally budgeted healthcare payment structures.<br /><br />© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 27 Apr 2023; epub ahead of print</small></div>

<div><h4>Relationship between coronary volume, myocardial mass, and post-PCI fractional flow reserve.</h4><i>Mileva N, Ohashi H, Paolisso P, Leipsic J, ... De Bruyne B, Collet C</i><br /><b>Background</b><br />Fractional flow reserve (FFR) measured after percutaneous coronary intervention (PCI) carries prognostic information. Yet, myocardial mass subtended by a stenosis influences FFR. We hypothesized that a smaller coronary lumen volume and a large myocardial mass might be associated with lower post-PCI FFR.<br /><b>Aim</b><br />We sought to assess the relationship between vessel volume, myocardial mass, and post-PCI FFR.<br /><b>Methods</b><br />This was a subanalysis with an international prospective study of patients with significant lesions (FFR ≤ 0.80) undergoing PCI. Territory-specific myocardial mass was calculated from coronary computed tomography angiography (CCTA) using the Voronoi\'s algorithm. Vessel volume was extracted from quantitative CCTA analysis. Resting full-cycle ratio (RFR) and FFR were measured before and after PCI. We assessed the association between coronary lumen volume (V) and its related myocardial mass (M), and the percent of total myocardial mass (%M) with post-PCI FFR.<br /><b>Results</b><br />We studied 120 patients (123 vessels: 94 left anterior descending arteries, 13 left Circumflex arteries, 16 right coronary arteries). Mean vessel-specific mass was 61 ± 23.1 g (%M 39.6 ± 11.7%). The mean post-PCI FFR was 0.88 ± 0.06 FFR units. Post-PCI FFR values were lower in vessels subtending higher mass (0.87 ± 0.05 vs. 0.89 ± 0.07, p = 0.047), and with lower V/M ratio (0.87 ± 0.06 vs. 0.89 ± 0.07, p = 0.02). V/M ratio correlated significantly with post-PCI RFR and FFR (RFR r = 0.37, 95% CI: 0.21-0.52, p < 0.001 and FFR r = 0.41, 95% CI: 0.26-0.55, p < 0.001).<br /><b>Conclusion</b><br />Post-PCI RFR and FFR are associated with the subtended myocardial mass and the coronary volume to mass ratio. Vessels with higher mass and lower V/M ratio have lower post-PCI RFR and FFR.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 27 Apr 2023; epub ahead of print</small></div>

<div><h4>Endovascular treatment of femoro-popliteal occlusions with retrograde tibial access after failure of the antegrade approach.</h4><i>Minici R, Serra R, De Rosi N, Ciranni S, ... Fontana F, Laganà D</i><br /><b>Background</b><br />Despite the development in endovascular technologies and the introduction of new tools in clinical practice, the endovascular crossing of femoropopliteal occlusions is not always possible with the antegrade approach, with a failure rate that can be up to 20%. This study aims to assess the feasibility, safety, and efficacy in terms of acute outcome of the endovascular retrograde crossing of femoro-popliteal occlusions with tibial access.<br /><b>Methods</b><br />This study is a single-centre, retrospective analysis of prospectively collected data of 152 consecutive patients, who had undergone, from September 2015 to September 2022, endovascular treatment of femoro-popliteal arterial occlusions with retrograde tibial access after the failure of the antegrade approach.<br /><b>Results</b><br />The median lesion length was 25 cm and 66 patients (43.4%) had a calcium grading according to the peripheral arterial calcium scoring system of 4. Angiographically, 44.7% of the lesions were TASC II category D. In all cases, successful cannulation and sheath introduction were performed with an average cannulation time of 150.4 s. Femoropopliteal occlusions were successfully crossed with the retrograde route in 94.1% of cases; the intimal approach was performed in 114 patients (79.7%). The mean time from puncture to retrograde crossing was 20.5 min. Acute vascular access-site complications were noted in 7 (4.6%) patients. Thirty-day major adverse cardiovascular events rate and 30-day major adverse limb events rate of 3.3% and 2%, respectively, were observed.<br /><b>Conclusions</b><br />The results of our study indicate that retrograde crossing of femoro-popliteal occlusions with tibial access is a feasible, effective, and safe approach in case of failed antegrade approach. The results presented represent one of the largest investigations ever published on tibial retrograde access and contribute to the small body of literature present on this topic to date.<br /><br />© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 19 Apr 2023; epub ahead of print</small></div>

<div><h4>Computed tomography-derived membranous septum length as predictor of conduction abnormalities and permanent pacemaker implantation after TAVI: A meta-analysis of observational studies.</h4><i>Sá MP, Van den Eynde J, Jacquemyn X, Erten O, ... Pibarot P, Ramlawi B</i><br /><b>Background</b><br />Permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) is associated with higher risk of mortality and rehospitalization for heart failure. Efforts to prevent conduction abnormalities (CA) requiring PPI after TAVI should be made. The membranous septum (MS) length and its interaction with implantation depth (ID-ΔMSID) could provide useful information about the risk of CA/PPI following TAVI.<br /><b>Objectives</b><br />To identify MS length and ΔMSID as predictors of CA/PPI following TAVI.<br /><b>Methods</b><br />Study-level meta-analysis of studies published by September 30, 2022.<br /><b>Results</b><br />Eighteen studies met our eligibility including 5740 patients. Shorter MS length was associated with a significantly higher risk of CA/PPI (per 1 mm decrease: odds ratio [OR] 1.60, 95% confidence interval [CI] 1.28-1.99, p < 0.001). Similarly, lower ΔMSID was associated with a significantly higher risk of CA/PPI (per 1 mm decrease: OR 1.75, 95% CI 1.32-2.31, p < 0.001). Meta-regression analyses revealed a statistically significant modulation of the effect of shorter MS length and lower ΔMSID on the outcome (CA/PPI) by balloon postdilatation (positive regression coefficients with p < 0.001); with increasing use of balloon postdilatation, the effect of shorter MS length and lower ΔMSID on the outcome increased. MS length and ΔMSID demonstrated excellent discriminative abilities, with diagnostic ORs equaling 9.49 (95% CI 4.73-19.06), and 7.19 (95% CI 3.31-15.60), respectively.<br /><b>Conclusion</b><br />Considering that short MS length and low ΔMSID are associated with higher risk of CA and PPI, we should include measurement of MS length in the pre-TAVI planning with MDCT and try to establish optimal ID values before the procedure to avoid CA/PPI.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 18 Apr 2023; epub ahead of print</small></div>

<div><h4>Left atrial appendage occlusion using hydrogel coils in a child.</h4><i>Mohammad Nijres B, Reinking B, Aldoss O</i><br /><AbstractText>Left atrial appendage occlusion in young children has not been reported before. Herein, we describe a successful occlusion using hydrogel coils in a toddler. The decision to occlude the appendage was made to mitigate the potential risk of systemic thromboembolism, given the child\'s unusual anatomy.</AbstractText><br /><br />© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 18 Apr 2023; epub ahead of print</small></div>

<div><h4>Cutting balloon for femoral arterial and venus obstructions due to suture-based closure devices: Case series.</h4><i>Merdler I, Bernardo NL, Ben-Dor I, Waksman R</i><br /><AbstractText>Suture-based vascular closure devices have been shown to be effective in hemostasis for procedures with vascular access. However, iatrogenic vascular occlusion may occur. The cutting balloon (CB) is a noncompliant balloon wrapped with 3-4 microsurgical blades that are intended to modify vascular lesions, but it may also be utilized to cut and release endovascular sutures. We report two cases in which the CB was employed as a bailout strategy to alleviate suture-related vascular occlusion after transcatheter aortic valve replacement. The CB can be effectively utilized to resolve suture-related vascular occlusion.</AbstractText><br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 16 Apr 2023; epub ahead of print</small></div>

<div><h4>The changing landscape of interventional cardiology: A survival guide in the era of health system consolidation.</h4><i>Cigarroa JE, Rooney C, Blankenship J, Duffy PL, ... Tukaye D, Box L</i><br /><AbstractText>Practice environments for interventional cardiologists have evolved dramatically and now include small independent practices, large cardiology groups, multispecialty groups, and large integrated health systems. Increasingly, cardiologists are employed by hospitals or health systems. Data from MedAxiom and the American College of Cardiology (ACC) demonstrate an exponential increase in the percentage of cardiologists in employed positions from 10% in 2009 to 87% in 2020. This white paper explores these profound changes, considers their impact on interventional cardiologists, and offers guidance on how interventional cardiologists can best navigate this challenging environment. Finally, the paper offers a potential model to improve the employed physician experience through greater physician involvement in decision making, which may increase jobs satisfaction.</AbstractText><br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 10 Apr 2023; epub ahead of print</small></div>

<div><h4>Impact of coronary artery disease on clinical outcomes after TAVR: Insights from the BRAVO-3 randomized trial.</h4><i>Feldman D, Cao D, Sartori S, Zhang Z, ... Mehran R, Dangas G</i><br /><b>Objective</b><br />To determine the prognostic impact of coronary artery disease (CAD) in patients randomized to bivalirudin or unfractionated heparin (UFH) during transcatheter aortic valve replacement (TAVR).<br /><b>Background</b><br />CAD is a common comorbidity among patients undergoing TAVR and studies provide conflicting data on its prognostic impact.<br /><b>Methods</b><br />The Bivalirudin on Aortic Valve Intervention Outcomes-3 (BRAVO-3) randomized trial compared the use of bivalirudin versus UFH in 802 high-surgical risk patients undergoing transfemoral TAVR for severe symptomatic aortic stenosis. Patients were stratified according to the presence or absence of history of CAD as well as periprocedural anticoagulation. The coprimary endpoints were net adverse cardiac events (NACE; a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding) and major Bleeding Academic Research Consortium (BARC) bleeding ≥3b at 30 days postprocedure.<br /><b>Results</b><br />Among 801 patients, 437 (54.6%) had history of CAD of whom 223 (51.0%) received bivalirudin. There were no significant differences in NACE (adjusted odds ratio [OR]: 1.04; 95% confidence interval [CI]: 0.69-1.58) or BARC ≥ 3b bleeding (adjusted OR: 0.84; 95% CI: 0.51-1.39) in patients with vs without CAD at 30 days. Among CAD patients, periprocedural use of bivalirudin was associated with similar NACE (OR: 0.80; 95% CI: 0.47-1.35) and BARC ≥ 3b bleeding (OR: 0.64; 95% CI: 0.33-1.25) compared with UFH, irrespective of history of CAD (p-interaction = 0.959 for NACE; p-interaction = 0.479 for major bleeding).<br /><b>Conclusion</b><br />CAD was not associated with a higher short-term risk of NACE or major bleeding after TAVR. Periprocedural anticoagulation with bivalirudin did not show any advantage over UFH in patients with and without CAD.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 10 Apr 2023; epub ahead of print</small></div>

<div><h4>Obesity and vascular complication in percutaneous transfemoral transcatheter aortic valve insertion.</h4><i>Hosseini M, Lahr BD, Greason KL, Arghami A, ... Eleid MF, Crestanello JA</i><br /><b>Background</b><br />Obesity has been associated with an increased risk of vascular complication during percutaneous coronary intervention, but there are no data on the risk of vascular complication during percutaneous transfemoral transcatheter aortic valve insertion (TAVI).<br /><b>Objectives</b><br />We hypothesized there would be a similar increased risk associated with TAVI.<br /><b>Methods</b><br />We reviewed the records of 1176 patients who received percutaneous transfemoral transcatheter aortic valve insertion from September 2015 to September 2020. All patients received 1) preoperative computed tomoraphy angiography assessment of the abdomen and pelvis to delineate iliofemoral artery anatomy, 2) ultrasound-guided percutaneous femoral arterial access, and 3) pre-closure of the delivery sheath femoral access site. Vascular complication was recorded based on definitions set forth by Valve Academic Research Consortium 3.<br /><b>Results</b><br />The median age of patients was 81 years, and 60% were men. The median body mass index (BMI) was 29 kg/m<sup>2</sup> (range, 11-67), and 91 (8%) patients had a value ≥40 kg/m<sup>2</sup> (i.e., morbid obesity). Delivery sheath size was 14-French in 859 (73%) patients, 16-French in 311 (26%), and 18-French in 6 (1%). Vascular complication occurred in 53 (5%) patients, including 39 (7%) among the first half of procedures and 14 (2%) among the second half (p < 0.001). When stratified by obesity status (BMI < or ≥30 kg/m<sup>2</sup> , p < 0.001), the complication rate was 4% in nonobese patients and 5% in obese patients. Multivariable analysis showed no overall association between risk of vascular complication and BMI categories (p = 0.583)BMI continuous values (p = 0.529), or sheath size (p = 0.217).<br /><b>Conclusions</b><br />Obesity is not associated with a vascular complication during percutaneous transfemoral transcatheter aortic valve insertion. The operation should not be denied in obese patients.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 10 Apr 2023; epub ahead of print</small></div>

<div><h4>Quantitative coronary three-dimensional geometry and its association with atherosclerotic disease burden and composition.</h4><i>A Prado GF, Blanco PJ, Bulant CA, Ares GD, ... Garcia-Garcia HM, Lemos PA</i><br /><b>Background</b><br />Isolate features of the coronary anatomy have been associated with the pathophysiology of atherosclerotic disease. Computational methods have been described to allow precise quantification of the complex three-dimensional (3D) coronary geometry. The present study tested whether quantitative parameters that describe the spatial 3D coronary geometry is associated with the extension and composition of the underlying coronary artery disease (CAD).<br /><b>Methods</b><br />Patients with CAD scheduled for percutaneous intervention were investigated with coronary computed tomography angiography (CCTA), and invasive coronary angiography, and virtual histology intravascular ultrasound (IVUS-VH). For all target vessels, 3D centerlines were extracted from CCTA images and processed to quantify 23 geometric indexes, grouped into 3 main categories as follows: (i) length-based; (ii) curvature-based, torsion-based, and curvature/torsion-combined; (iii) vessel path-based. The geometric variables were compared with IVUS-VH parameters assessing the extent and composition of coronary atherosclerosis.<br /><b>Results</b><br />A total of 36 coronary patients (99 vessels) comprised the study population. From the 23 geometric indexes, 18 parameters were significantly (p < 0.05) associated with at least 1 IVUS-VH parameter at a univariate analysis. All three main geometric categories provided parameters significantly related with atherosclerosis variables. The 3D geometric indexes were associated with the degree of atherosclerotic extension, as well as with plaque composition. Geometric features remained significantly associated with all IVUS-VH parameters even after multivariate adjustment for clinical characteristics.<br /><b>Conclusions</b><br />Quantitative 3D vessel morphology emerges as a relevant factor associated with atherosclerosis in patients with established CAD.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 05 Apr 2023; epub ahead of print</small></div>

<div><h4>Predictors of hemodynamic response to mitral transcatheter edge-to-edge repair.</h4><i>Samimi S, Chavez Ponce A, Alarouri HS, Shaer AE, ... Rihal CS, Alkhouli M</i><br /><b>Background</b><br />Improvement in left atrial pressure (LAP) during transcatheter edge-to-edge repair (TEER) is associated with improved outcomes. We sought to investigate the predictors of optimal hemodynamic response to TEER.<br /><b>Methods</b><br />We identified patients who underwent TEER at Mayo Clinic between May 2014 and February 2022. Patients with missing LAP data, an aborted procedure, and those undergoing a concomitant tricuspid TEER were excluded. We performed a logistic regression analysis to identify predictors of optimal hemodynamic response to TEER (defined as LAP ≤ 15 mmHg).<br /><b>Results</b><br />A total of 473 patients were included (Mean age 78.5 ± 9.4 years, 67.2% males). Overall, 195 (41.2%) achieved an optimal hemodynamic response after TEER. Patients who did not achieve an optimal response had higher baseline LAP (20.0 [17-25] vs. 15.0 [12-18] mmHg, p < 0.001), higher prevalence of AF (68.3% vs. 55.9%, p = 0.006), functional MR (47.5% vs. 35.9%, p = 0.009), annular calcification (41% vs. 29.2%, p = 0.02), lower left ventricular EF (55% vs. 58%, p = 0.02), and more frequent postprocedural severe MR (11.9% vs. 5.1%, p = 0.02) and elevated mitral gradient >5 mmHg (30.6% vs. 14.4%, p < 0.001). In the multivariate logistic regression analysis, AF (OR = 0.58; 95% CI = 0.35-0.96; p = 0.03), baseline LAP (OR = 0.80; 95% CI = 0.75-0.84; p < 0.001) and postprocedural mitral gradient <5 mmHg (OR = 0.35; 95% CI = 0.19-0.65; p < 0.001), were independent predictors of achieving an optimal hemodynamic response. In the multivariate model, residual MR was not independently associated with optimal hemodynamic response.<br /><b>Conclusions</b><br />Optimal hemodynamic response is achieved in 4 in 10 patients undergoing TEER. AF, higher baseline LAP, and higher postprocedural mitral gradient were negative predictors of optimal hemodynamic response after TEER.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 05 Apr 2023; epub ahead of print</small></div>

<div><h4>Transcatheter versus surgical treatment for isolated superior sinus venosus atrial septal defect.</h4><i>Brancato F, Stephenson N, Rosenthal E, Hansen JH, ... Caner S, Butera G</i><br /><b>Background</b><br />The superior sinus venosus atrial septal defect is a congenital communication between the left and right atria. Open surgical approach by patch closure has historically been the only treatment option. Recently, a transcatheter approach has been developed. This study aims to compare the efficacy and safety of surgical and transcatheter approach in treatment of sinus venosus atrial septal defect.<br /><b>Methods</b><br />Between March 2010 and December 2020, 58 patients (median age: 45.4, range 14.8-73.8) underwent either surgical or transcatheter correction of superior sinus venosus atrial septal defect with partial anomalous pulmonary venous drainage.<br /><b>Results</b><br />Twenty-four patients (median age: 35.4, range 14.8-66.8) underwent surgery while 34 patients (median age: 46.8, range 15.5-73.8) had a transcatheter treatment. During the catheterization era, 41 patients was considered suitable for a transcatheter closure. In 5 patients, surgery was the patient\'s or referring physician\'s choice. In 2 cases, the procedure was unsuccessful; the remaining 34 were successfully closed (94.4% of cases). Intensive care unit stay (median of 1 day, range 0.5-4, vs. 0, range 0-2, p < 0.0001) and hospital stay (median 7 days, range 2-15 vs. 2 days, range 1-12, p < 0.0001), were significantly longer in the surgery group. Total early complication rate, consisted on procedural and in-hospital complication, were higher in the surgical group (62.5% vs. 23.5%; p = 0.005). However, complications in both groups were clinically mild. At follow-up, a small residual shunt was present in 6 patients (surgery group: 2 pts; catheterization group: 4 pts; p: NS). Imaging studies showed significant improvement of right ventricular size and unobstructed pulmonary venous return in all patients. No late complications occurred at follow-up.<br /><b>Conclusions</b><br />Transcatheter correction of sinus venosus atrial septal defect is effective and safe in selected patients and may be considered as a valid alternative to surgery.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 01 Apr 2023; epub ahead of print</small></div>

<div><h4>Management of failed stenting of the unprotected left main coronary artery.</h4><i>Moroni A, Marin F, Venturi G, Scarsini R, ... De Maria GL, Banning AP</i><br /><AbstractText>Percutaneous coronary intervention (PCI) is increasingly accepted as treatment for unprotected left main coronary artery (ULMCA) disease especially in those patients who are unsuitable for cardiac surgery. Treatment of any stent failure is associated with increased complexity and worse clinical outcomes when compared with de novo lesion revascularization. Intracoronary imaging has provided new insight into mechanisms of stent failure and treatment options have developed considerably over the last decade. There is paucity of evidence on the management strategy for stent failure in the specific setting of ULMCA. Treating any left main with PCI requires careful consideration and consequently treatment of failed stents in ULMCA is complex and provides unique challenges. Consequently, we provide an overview of ULMCA stent failure, proposing a tailored algorithm to guide best management and decision in daily clinical practice, with a special focus on intracoronary imaging characterization of causal mechanisms and specific technical and procedural considerations.</AbstractText><br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 01 Apr 2023; epub ahead of print</small></div>

<div><h4>Impact of COVID-19 on percutaneous coronary intervention utilization and mortality in New York.</h4><i>Hannan EL, Zhong Y, Cozzens K, Osinaga A, ... Tamis-Holland J, King SB</i><br /><b>Background</b><br />COVID-19 has disrupted the care of all patients, and little is known about its impact on the utilization and short-term mortality of percutaneous coronary intervention (PCI) patients, particularly nonemergency patients.<br /><b>Methods</b><br />New York State\'s PCI registry was used to study the utilization of PCI and the presence of COVID-19 in four patient subgroups ranging in severity from ST-elevation myocardial infarction (STEMI) to elective patients before (December 01, 2018-February 29, 2020) and during the COVID-19 era (March 01, 2020-May 31, 2021), as well as to examine the impact of different COVID severity levels on the mortality of different types of PCI patients.<br /><b>Results</b><br />Decreases in the mean quarterly PCI volume from the prepandemic period to the first quarter of the pandemic ranged from 20% for STEMI patients to 61% for elective patients, with the other two subgroups having decreases in between these values. PCI quarterly volume rebounds from the prepandemic period to the second quarter of 2021 were in excess of 90% for all patient subgroups, and 99.7% for elective patients. Existing COVID-19 was rare among PCI patients, ranging from 1.74% for STEMI patients to 3.66% for elective patients. PCI patients with COVID-19 and acute respiratory distress syndrome (ARDS) who were not intubated, and PCI patients with COVID-19 and ARDS who were either intubated or were not intubated because of Do Not Resuscitate//Do Not Intubate status had higher risk-adjusted mortality ([adjusted ORs = 10.81 [4.39, 26.63] and 24.53 [12.06, 49.88], respectively]) than patients who never had COVID-19.<br /><b>Conclusions</b><br />There were large decreases in the utilization of PCI during COVID-19, with the percentage of decrease being highly sensitive to patient acuity. By the second quarter of 2021, prepandemic volumes were nearly restored for all patient subgroups. Very few PCI patients had current COVID-19 throughout the pandemic period, but the number of PCI patients with a COVID-19 history increased steadily during the pandemic. PCI patients with COVID-19 accompanied by ARDS were at much higher risk of short-term mortality than patients who never had COVID-19. COVID-19 without ARDS and history of COVID-19 were not associated with higher mortality for PCI patients as of the second quarter of 2021.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 01 Apr 2023; epub ahead of print</small></div>

<div><h4>Measures of social deprivation and outcomes after percutaneous coronary intervention.</h4><i>Torabi AJ, Von der Lohe E, Kovacs RJ, Frick KA, Kreutz RP</i><br /><b>Background</b><br />Disparities in socioeconomic status are a frequently cited factor associated with worse cardiovascular outcomes. The social deprivation index (SDI) can be used to quantify socioeconomic resources at the population level.<br /><b>Objectives</b><br />The aim of this study was to assess the association of SDI with clinical outcomes following percutaneous coronary interventions (PCI).<br /><b>Methods</b><br />This was a retrospective observational analysis of patients who underwent PCI and were included in a multicenter cardiac catheterization registry study. Baseline characteristics, congestive heart failure (CHF) readmission rates and survival were compared between patients with the highest and lower SDI. SDI was calculated based on the US community survey census tract-level data.<br /><b>Results</b><br />Patients within the highest SDI quintile (n = 1843) had more comorbidities and a higher risk of death [hazard ratio (HR): 1.22 (95% confidence interval, CI: 1.1-1.39, p = 0.004); log rank: p = 0.009] and CHF readmission [HR: 1.56 (1.39-1.75, p < 0.001); log rank: p < 0.001) as compared with those in the lower quintiles (n = 10,201) during mean follow-up of 3 years. Increased risk of highest SDI for all-cause mortality and CHF remained significant after adjustment in multivariable analysis for factors associated with highest SDI.<br /><b>Conclusions</b><br />Patients within the highest SDI quintile had a greater proportion of comorbidities as well as higher risk for adverse outcomes as compared with patients with a lower SDI following PCI.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 30 Mar 2023; epub ahead of print</small></div>

<div><h4>Zero-contrast IVUS-guided complex PCI in a patient with NSTE-ACS and severe renal impairment.</h4><i>Moretti F, Rondi M, Ottani F</i><br /><AbstractText>A 76-year-old male with severe comorbidities and multiple cardiovascular risk factors including stage IV chronic kidney disease presents with non-ST-elevation myocardial infarction. An ultra-low contrast invasive coronary angiography using the DyeVert system and iso-osmolar contrast agent revealed a multivessel disease with heavy calcifications involving the left main stem and its bifurcation requiring a complex percutaneous coronary intervention. Because of the high risk of contrast-induced acute kidney injury, a zero-contrast intervention was performed using intravascular ultrasound guidance and dedicated stenting techniques with optimal imaging, clinical, and renal outcomes. Zero-contrast policies can be safely implemented even in complex clinical scenarios but at least two orthogonal angiographic projections should always be acquired to rule out distal complications.</AbstractText><br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 30 Mar 2023; epub ahead of print</small></div>

<div><h4>Dobutamine stress echocardiography during transcatheter edge-to-edge mitral valve repair predicts residual mitral regurgitation.</h4><i>Meijerink F, Holierook M, Eberl S, Robbers-Visser D, ... Bouma BJ, Baan J</i><br /><b>Objectives</b><br />The current study sought to determine whether low-dose dobutamine stress echocardiography (DSE) during transcatheter edge-to-edge mitral valve repair (TMVR) can predict residual mitral regurgitation (MR) at discharge.<br /><b>Background</b><br />In most patients, TMVR can successfully reduce MR from severe to mild or moderate. However, general anesthesia during the intervention affects hemodynamics and MR assessment. At discharge transthoracic echocardiogram residual MR (>moderate) is present in 10%-30% of patients which is associated with worse clinical outcome.<br /><b>Methods</b><br />In consecutive patients the severity of MR was determined at baseline, immediately after TMVR clip implantation and subsequently during low-dose DSE (both under general anesthesia) and at discharge.<br /><b>Results</b><br />A total of 39 patients were included (mean age 76.1 ± 8.1 years, 39% male, 56% functional MR, 41% left ventricular ejection fraction < 45%). An increase of MR during DSE was seen in 11 patients, of whom 6 (55%) showed >moderate MR at discharge. None of the 28 patients without an increase of MR during DSE showed >moderate MR at discharge. The diagnostic performance of the test could be established at a sensitivity of 100% and a specificity of 85% in unselected patients.<br /><b>Conclusions</b><br />DSE during TMVR is a useful tool to predict residual MR at discharge. It could support procedural decision making, including implantation of additional clips and thus potentially improve clinical outcome.<br /><br />© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 30 Mar 2023; epub ahead of print</small></div>

<div><h4>Strategies and techniques for percutaneous Veno-Arterial ECMO cannulation and decannulation in children.</h4><i>Buyukgoz C, Sandhu H, Shah S, Rower K, ... Boston U, Sathanandam S</i><br /><b>Objectives</b><br />To describe the techniques used for percutaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulation and decannulation in children with the pediatric interventional cardiologist (PIC) as the primary operator, and present outcomes of this initial clinical experience.<br /><b>Background</b><br />Percutaneous VA-ECMO during cardiopulmonary resuscitation (CPR) has been successfully performed in adults, but currently, not much data exists on children.<br /><b>Methods</b><br />This is a single-center study including VA-ECMO cannulations performed by the PIC between 2019 and 2021. Efficacy was defined as the successful initiation of VA-ECMO without surgical cutdown. Safety was defined as the absence of additional procedures related to cannulation.<br /><b>Results</b><br />Twenty-three percutaneous VA-ECMO cannulations were performed by PIC on 20 children with 100% success. Fourteen (61%) were performed during ongoing CPR, and nine for cardiogenic shock. The Median age was 15 (0.15-18) years, and the median weight was 65 (3.3-180) kg. All arterial cannulations were via the femoral artery except in one, 8-week-old infant who was cannulated in the carotid artery. A distal perfusion cannula was placed in the ipsilateral limb in 17 (78%). The median time from initiating cannulation to ECMO flow was 35 (13-112) minutes. Two patients required arterial graft placement at the time of decannulation and one needed below-knee amputation. ECMO support was maintained for a median of 4 (0.3-38) days. Thirty-day survival was 74%.<br /><b>Conclusion</b><br />Percutaneous VA-ECMO cannulations can be effectively performed, even during CPR with the Pediatric Interventional Cardiologist being the primary operator. This is an initial clinical experience. Future outcome studies compared with standard surgical cannulations are necessary to advocate routine percutaneous VA-ECMO in children.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 30 Mar 2023; epub ahead of print</small></div>

<div><h4>Coronary artery disease and TAVI: Current evidence on a recurrent issue.</h4><i>Massussi M, Adamo M, Rosati F, Chizzola G, Metra M, Tarantini G</i><br /><AbstractText>Coronary artery disease (CAD) is a frequent finding in patients with aortic stenosis (AS). Concomitant coronary artery bypass and aortic valve replacement is considered the gold standard treatment in surgical candidates. However, limited evidence is available regarding the role of coronary revascularization in patients undergoing transcatheter aortic valve implantation (TAVI). How to evaluate CAD severity in patients with AS, whether percutaneous coronary intervention (PCI) needs to be performed and what is the timing for revascularization to minimize procedural risks, remains matters of debate. The aim of this review is to summarize epidemiology, diagnostic tools and possible options for CAD management in patients undergoing TAVI with specific focus on the pros and the cons of the different timing of PCI.</AbstractText><br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 30 Mar 2023; epub ahead of print</small></div>

<div><h4>Same day discharge versus overnight observation following chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry.</h4><i>Simsek B, Khatri J, Young L, Kostantinis S, ... Poommipanit PB, PROGRESS-CTO investigators</i><br /><b>Background</b><br />Same day discharge (SDD) following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.<br /><b>Methods</b><br />We evaluated the clinical, angiographic, and procedural characteristics of patients discharged the same day versus those kept for overnight observation in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO, NCT02061436).<br /><b>Results</b><br />Of the 7181 patients who underwent CTO PCI, 943 (13%) had SDD. The SDD rate increased from 3% in 2015 to 21% in 2022. Patients with SDD were less likely to have a history of heart failure (21% vs. 26%, p = 0.005), chronic lung disease (10% vs. 15%, p = 0.001), or anemia (12% vs. 19%, p < 0.001). Technical success (87% vs. 88%, p = 0.289) was similar, but in-hospital major adverse cardiovascular events (0.0% vs. 0.4%, p = 0.041) were lower in SDD. In multivariable logistic regression analysis, prior myocardial infarction odds ratio (OR): 0.71 (95% confidence interval [CI]: 0.59-0.87, p = 0.001), chronic lung disease OR: 0.64 (95% CI: 0.47-0.88, p = 0.006), and increasing procedure time OR: 0.93 (95% CI: 0.91-0.95, p < 0.001, per 10-min increase) were associated with overnight observation, while radial-only access OR: 2.45 (95% CI: 2.03-2.96, p < 0.001) had the strongest association with SDD. In the SDD, 2 (0.4%) of 514 patients were readmitted, due to retroperitoneal bleeding (n = 1) and ischemic stroke (n = 1).<br /><b>Conclusion</b><br />The overall frequency of SDD after CTO PCI was 13% and has been increasing over time. SDD is feasible in select patients following CTO PCI, and radial-only access had the strongest association with SDD.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 24 Mar 2023; epub ahead of print</small></div>

<div><h4>Plaque characterization of a saphenous vein graft by near-infrared spectroscopy and histopathology in a patient with a percutaneous coronary intervention.</h4><i>Mori H, Kurita T, Takasaki A, Dohi K</i><br /><AbstractText>Near-infrared spectroscopy (NIRS) is an intravascular imaging (IVUS) modality that detects lipid core plaques in the vessel wall, which are regarded as high-risk plaques for distal embolization in percutaneous coronary interventions (PCI). Saphenous vein graft (SVG) lesions have friable lipid-rich plaques and thrombus prone to distal embolization. The plaque characterization of SVG by NIRS was confirmed herein for the first time with histopathology before and after PCI. The present case was a man in his 60 s with a history of coronary artery bypass graft surgery. Coronary angiography revealed severe stenosis in multiple segments of the SVG to left circumflex artery (LCX). NIRS IVUS showed large amounts of lipidic materials at each segment before PCI. After balloon dilatation, NIRS IVUS revealed a marked reduction in yellow signals on chemography. A histopathological analysis of the captured specimen showed that it was mainly composed of fibrin and contained numerous histiocytes with foam cells, lymphocytes, and other cells, which was consistent with the histopathological findings of plaque rupture.</AbstractText><br /><br />© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 23 Mar 2023; epub ahead of print</small></div>

<div><h4>In vivo evaluation of intravascular lithotripsy in a healthy porcine coronary model.</h4><i>Yin J, Wang R, Chen H, Lu H, ... Shen L, Ge J</i><br /><b>Objectives</b><br />In this study, we aimed to investigate the vascular response to an intravascular lithotripsy (IVL) shockwave balloon in a healthy porcine coronary artery model.<br /><b>Background</b><br />IVL is a novel clinical technique for modifying heavily calcified atherosclerotic plaques.<br /><b>Methods</b><br />A total of 24 porcine coronary arteries were treated with IVL or plain old balloon angioplasty (POBA). Histology, histomorphometry, quantitative coronary angiography analysis (QCA), and optical coherence tomography (OCT) were performed postprocedure and at 1-month follow-up (1M-FU).<br /><b>Results</b><br />There was no significant difference in the late lumen loss and diameter stenosis (determined by QCA) and the minimal lumen area (evaluated by OCT) of the IVL and POBA groups at 1M-FU. Pathological analysis revealed that the lumen and neointima areas were similar between the two groups. However, the medial and adventitial layers were more prominent in the IVL than in the POBA group. The injury score and inflammation of the media and adventitia increased dramatically in the IVL group postprocedure and at 1M-FU. At 1M-FU, media fibrin deposition and adventitial fibrosis were also significantly increased in the IVL group. However, there was no significant difference in neointima fibrin deposition, endothelialization, and thrombosis between both groups. Layered separation of the media and adventitia was observed in the IVL group.<br /><b>Conclusion</b><br />The findings indicate that the IVL balloon did not cause serious intimal hyperplasia and endothelial damage compared with the effects of POBA in the healthy coronary artery. However, shock waves may cause unique damage to the vascular media and adventitia in the coronary artery, which was not observed in the peripheral artery.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 19 Mar 2023; epub ahead of print</small></div>

<div><h4>Angiography-derived functional assessment of left main coronary stenoses.</h4><i>Yuasa S, Lauri FM, Mejia-Renteria H, Liontou C, ... Sato T, Escaned J</i><br /><b>Objectives</b><br />We aimed to evaluate the diagnostic accuracy of quantitative flow ratio (QFR) in left main (LM) coronary stenoses, using Fractional Flow Reserve (FFR) as reference.<br /><b>Background</b><br />QFR has demonstrated a high accuracy in determining the functional relevance of coronary stenoses in non-LM. However, there is an important paucity of data regarding its diagnostic value in the specific anatomical subset of LM disease.<br /><b>Methods</b><br />This is a retrospective, observational, multicenter, international, and blinded study including patients with LM stenoses. Cases with significant ostial LM disease were excluded. QFR was calculated from conventional angiograms at blinded fashion with respect to FFR.<br /><b>Results</b><br />Sixty-seven patients with LM stenoses were analyzed. Overall, LM had intermediate severity, both from angiographic (diameter stenosis [%DS] 43.8 ± 11.1%) and functional perspective (FFR 0.756 ± 0.105). Mean QFR was 0.733 ± 0.159. Correlation between QFR and FFR was moderate (r = 0.590). Positive and negative predictive value, sensitivity and specificity were 85.4%, 64%, 85.4%, and 69.6% respectively. Classification agreement of QFR and FFR in terms of functional stenosis severity was 78.1%. Area under the receiver operating characteristics of QFR using FFR as reference was 0.82 [95% confidence interval [CI], 0.71-0.93], and significantly better than angiographic evaluation including %DS (area under the receiver-operating characteristic curve [AUC] 0.45 [95% CI, 0.32-0.58], p < 0.001) and minimum lumen diameter (AUC 0.60 [95% CI, 0.47-0.74], p < 0.001).<br /><b>Conclusions</b><br />Compared with FFR, QFR has acceptable diagnostic performance in determining the functional relevance of LM stenosis, being better than conventional angiographic assessment. Nonetheless, caution should be taken when applying functional angiography techniques for the assessment of LM stenosis given its particular anatomical characteristics.<br /><br />© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 19 Mar 2023; epub ahead of print</small></div>

<div><h4>Effects of delayed hospitalization on the 3-year clinical outcomes of patients with or without diabetes who had non-ST-segment-elevation myocardial infarction and underwent new-generation drug-eluting stent implantation.</h4><i>Kim YH, Her AY, Rha SW, Choi CU, ... Park SH, Jeong MH</i><br /><AbstractText>Clinical outcomes after non-ST-segment-elevation myocardial infarction (NSTEMI) in patients with (symptom-to-door time [SDT] ≥ 24 h) or without (SDT < 24 h) delayed hospitalization among patients with or without diabetes were compared. From the Korea Acute Myocardial Infarction Registry-National Institute of Health, a total of 4517 patients with NSTEMI who underwent new-generation drug-eluting stents implantation were recruited and they were classified into the diabetes mellitus (DM) and non-DM groups. These two groups were subdivided into groups with and without delayed hospitalization. The primary clinical outcome was the occurrence of major adverse cardiac and cerebrovascular events (MACCE), defined as all-cause death, recurrent myocardial infarction, repeat coronary revascularization, and stroke. The secondary clinical outcome was the occurrence of individual components of MACCE and stent thrombosis. Although after multivariable and propensity score-adjusted analyses in the DM group, the primary and secondary clinical outcomes between the SDT < 24 h and SDT ≥ 24 h groups were similar; in the non-DM group, all-cause (p = 0.003 and p = 0.007, respectively) and cardiac (p = 0.001 and p = 0.008, respectively) death rates were significantly higher in the SDT ≥ 24 h group than in the SDT < 24 h group. Our results suggested that there was no significant difference in prognosis between diabetic patients with and without delayed SDT, but delayed SDT was associated with poor prognosis in nondiabetic patients.</AbstractText><br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 15 Mar 2023; epub ahead of print</small></div>

<div><h4>Combined ascending aortobiiliac bypass and endovascular obliteration in the Bentall procedure for dual aortic aneurysms.</h4><i>Long Y, He B, Tsao N, Liu H</i><br /><AbstractText>Patients with Marfan syndrome who present with a dual aortic aneurysm are not uncommon in clinical practice; however, the management of these patients is a significant challenge. We present a unique case of aortic root aneurysm and challenging infrarenal abdominal aortic aneurysm (AAA) with a short and angulated neck. We performed simultaneous repair using the Bentall procedure and ascending aortobiiliac bypass. Endovascular obliteration of the AAA neck and bilateral common iliac arteries was also performed. The perioperative process was uneventful. Normal functioning of the mechanical valve and complete thrombosis of the AAA sac were confirmed on follow-up computed tomography and echocardiography. This report suggests that combined ascending aortobiiliac bypass and endovascular obliteration with the Bentall procedure for dual aortic aneurysm is a useful surgical strategy for patients with Marfan syndrome. Life-long follow-up and medication ought to be mandatory to prevent incomplete exclusion and bypass occlusion.</AbstractText><br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 15 Mar 2023; epub ahead of print</small></div>

<div><h4>Pre-stenting angiography-FFR based physiological map provides virtual intervention and predicts physiological and clinical outcomes.</h4><i>Dai N, Tang X, Chen Z, Huang D, ... Qian J, Ge J</i><br /><b>Background</b><br />Angiography-derived fractional flow reserve (FFR) (angio-FFR) has been validated against FFR and could provide virtual pullback. However, whether a physiological map can be generated by angio-FFR and its clinical value remains unclear. We aimed to investigate the feasibility of physiological map created from angio-FFR pullback and its value in predicting physiological and clinical outcomes after stenting.<br /><b>Methods</b><br />An angio-FFR physiological map was generated by overlaying the virtual pullback onto coronary angiogram, to calculate physiological stenosis severity, length, and intensity (Δangio-FFR/mm). This map in combination with virtual stenting was used to predict the best-case post-percutaneous coronary intervention (PCI) angio-FFR (angio-FFR<sub>predicted</sub> ) according to the stented segments, and this was compared with the actual achieved post-PCI angio-FFR (angio-FFR<sub>achieved</sub> ). Additionally, prognostic value of predicted angio-FFR was investigated.<br /><b>Results</b><br />Three hundred twenty-nine vessels with paired analyzable pre- and post-PCI angio-FFR were included. Physiological map was created successfully in all vessels. After successful PCI, angio-FFR<sub>predicted</sub> and angio-FFR<sub>achieved</sub> were significantly correlated (r = 0.82, p < 0.001) with small difference (mean difference: -0.010 ± 0.035). In the virtual PCI only covering the segment with high angio-FFR intensity, the same physiological outcome can be achieved with shorter stent length (14.1 ± 8.9 vs. 34.5 ± 15.8 mm, p < 0.001). Suboptimal angio-FFR<sub>predicted</sub> was associated with increased risk of 2-year vessel-oriented composite endpoint (adjusted hazard ratio: 3.71; 95% confidence interval: 1.50-9.17).<br /><b>Conclusions</b><br />Angio-FFR pullback could provide a physiological map of the interrogated coronary vessels by integrating angio-FFR pullback and angiography. Before a PCI, the physiological map can predict the physiological and clinical outcomes after stenting.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 15 Mar 2023; epub ahead of print</small></div>

<div><h4>Association between sex and long-term outcomes of endovascular treatment for peripheral artery disease.</h4><i>Ramkumar N, Suckow BD, Behrendt CA, Mackenzie TA, ... Brown JR, Goodney PP</i><br /><b>Background</b><br />Endovascular peripheral vascular intervention (PVI) has become the primary revascularization technique used for peripheral artery disease (PAD). Yet, there is limited understanding of long-term outcomes of PVI among women versus men. In this study, our objective was to investigate sex differences in the long-term outcomes of patients undergoing PVI.<br /><b>Methods</b><br />We performed a cohort study of patients undergoing PVI for PAD from January 1, 2010 to September 30, 2015 using data in the Vascular Quality Initiative (VQI) registry. Patients were linked to fee-for-service Medicare claims to identify late outcomes including major amputation, reintervention, major adverse limb event (major amputation or reintervention [MALE]), and mortality. Sex differences in outcomes were evaluated using cumulative incidence curves, Gray\'s test, and mixed effects Cox proportional hazards regression accounting for patient and lesion characteristics using inverse probability weighted estimates.<br /><b>Results</b><br />In this cohort of 15,437 patients, 44% (n = 6731) were women. Women were less likely to present with claudication than men (45% vs. 49%, p < 0.001, absolute standardized difference, d = 0.08) or be able to ambulate independently (ambulatory: 70% vs. 76%, p < 0.001, d = 0.14). There were no major sex differences in lesion characteristics, except for an increased frequency of tibial artery treatment in men (23% vs. 18% in women, p < 0.001, d = 0.12). Among patients with claudication, women had a higher risk-adjusted rate of major amputation (hazard ratio [HR] = 1.72, 95% confidence interval [CI]: 1.18-2.49), but a lower risk of mortality (HR = 0.86, 95% CI: 0.75-0.99). There were no sex differences in reintervention or MALE for patients with claudication. However, among patients with chronic limb-threatening ischemia, women had a lower risk-adjusted hazard of major amputation (HR = 0.79, 95% CI: 0.67-0.93), MALE (HR = 0.86, 95% CI: 0.78-0.96), and mortality (HR = 0.86, 95% CI: 0.79-0.94).<br /><b>Conclusion</b><br />There is significant heterogeneity in PVI outcomes among men and women, especially after stratifying by symptom severity. A lower overall mortality in women with claudication was accompanied by a higher risk of major amputation. Men with chronic limb-threatening ischemia had a higher risk of major amputation, MALE, and mortality. Developing sex-specific approaches to PVI that prioritizes limb outcomes in women can improve the quality of vascular care for men and women.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 15 Mar 2023; epub ahead of print</small></div>

<div><h4>Long-term durability of self-expanding and balloon-expandable transcatheter aortic valve prostheses: UK TAVI registry.</h4><i>Ali N, Hildick-Smith D, Parker J, Malkin CJ, ... Spence MS, Blackman DJ</i><br /><b>Background</b><br />With expansion of transcatheter aortic valve implantation (TAVI) into younger patients, valve durability is critically important.<br /><b>Aims</b><br />We aimed to evaluate long-term valve function and incidence of severe structural valve deterioration (SVD) among patients ≥ 10-years post-TAVI and with echocardiographic follow-up at least 5-years postprocedure.<br /><b>Methods</b><br />Data on patients who underwent TAVI from 2007 to 2011 were obtained from the UK TAVI registry. Patients with paired echocardiograms postprocedure and ≥5-years post-TAVI were included. Severe SVD was determined according to European task force guidelines.<br /><b>Results</b><br />221 patients (79.4 ± 7.3 years; 53% male) were included with median echocardiographic follow-up 7.0 years (range 5-13 years). Follow-up exceeded 10 years in 43 patients (19.5%). Valve types were the supra-annular self-expanding CoreValve (SEV; n = 143, 67%), balloon-expandable SAPIEN/XT (BEV; n = 67, 31%), Portico (n = 4, 5%) and unknown (n = 7, 3%). There was no difference between postprocedure and follow-up peak gradient in the overall cohort (19.3 vs. 18.4 mmHg; p = NS) or in those with ≥10-years follow-up (21.1 vs. 21.1 mmHg; p = NS). Severe SVD occurred in 13 patients (5.9%; median 7.8-years post-TAVI). Three cases (23.1%) were due to regurgitation and 10 (76.9%) to stenosis. Valve-related reintervention/death occurred in 5 patients (2.3%). Severe SVD was more frequent with BEV than SEV (11.9% vs. 3.5%; p = 0.02), driven by a difference in patients treated with small valves (BEV 28.6% vs. SEV 3.0%; p < 0.01).<br /><b>Conclusions</b><br />Hemodynamic function of transcatheter heart valves remains stable up to more than 10 years post-TAVI. Severe SVD occurred in 5.9%, and valve-related death/reintervention in 2.3%. Severe SVD was more common with BEV than SEV.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 15 Mar 2023; epub ahead of print</small></div>

<div><h4>Effectiveness of the vacuum assisted aspiration AngioVac system in the removal of intravascular masses.</h4><i>Nickell A, Sergev O, Alberto N, Bande D, Guerrero DM</i><br /><b>Background</b><br />Invasive procedures used to manage intravascular masses such as vegetation from endocarditis, deep vein thrombosis, and septic emboli are associated with high rates of complications and mortality, especially in patients with several pre-existing comorbidities. A minimally invasive technique that has become more popular in recent years is the AngioVac procedure. This single-centered, retrospective study focuses on patient presenting comorbidities and indications for the procedure as well as postprocedural outcomes.<br /><b>Methods</b><br />A total of 33 patients who underwent an AngioVac procedure at Sanford Health between March 2014 and October 2019 was reviewed. Data were collected on pre-existing comorbidities, indication of procedure, length of stay, and postoperative outcomes.<br /><b>Results</b><br />We evaluated a total of 33 patients who underwent an AngioVac procedure for removal of intravascular mass. The most common indications for the procedure were endocarditis (24/33, 73%); intracardiac mass (5/33, 15%); and deep vein thrombosis or pulmonary embolism (2/33, 6%). Post-procedural blood transfusion was required in nearly half (15/33, 45%). Almost all patients (31/33, 94%) required intraoperative vasopressor use. Nearly all patients (32/33, 97%) were directed to the intensive care unit following the procedure with an average length of stay of 8 days (interquartile range: 3-13). Most common complications seen after the procedure were shock requiring vasopressors, (13/33, 39%), pleural effusion (9/33, 27%), and sepsis (4/33, 12%). Procedural success in this single-centered experience was 85% (28/33), which was defined as size reduction of the initial vegetation by >50% in the absence of severe intraoperative complications and absence of need for further valvular surgical intervention.<br /><b>Conclusion</b><br />For surgically high-risk patients, the AngioVac procedure may offer a less invasive option in the management of right sided endocarditis requiring vegetation debulking, intravascular thrombi or cardiac masses.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 15 Mar 2023; epub ahead of print</small></div>

<div><h4>Clinical outcomes of left atrial appendage occlusion in patients with previous intracranial or gastrointestinal bleeding: Insights from the LOGIC (Left atrial appendage Occlusion in patients with Gastrointestinal or IntraCranial bleeding) International Multicenter Registry.</h4><i>Gallo F, Ronco F, D\'Amico G, Della Rocca DG, ... Natale A, Themistoclakis S</i><br /><b>Aims</b><br />To compare outcomes of patients who underwent left atrial appendage occlusion (LAAO) for nonvalvular atrial fibrillation (NVAF) and contraindication to anticoagulants due to history of either gastrointestinal (GI) or intracranial (IC) bleeding.<br /><b>Methods</b><br />Patients with NVAF that underwent LAAO for GI or IC bleeding from seven centers were included in this observational study. Baseline characteristics, procedural features, and follow-up data were collected, and compared between the two groups. The primary outcomes were incidence of ischemic and hemorrhagic events at 12-month.<br /><b>Results</b><br />Six hundred twenty-eight patients were included, 57% with previous GI-bleeding, and 43% with previous IC-bleeding. Median CHA 2 DS 2-VASc score was 4 (interquartile range [IQRs]: 3-5) for both GI-bleeding and IC-bleeding patients, while GI-bleeding patients had a higher HAS-BLED score (4 [IQRs: 3-4] vs. 3 [IQRs]: 2-3]; p = 0.001). At 12-month follow-up, relative risk reduction for stroke was similar between the two groups. The GI-bleeding group had more hemorrhagic events compared to IC-bleeding group (any bleeding 8.4% vs. 3.2%; p = 0.012; major bleeding BARC 3-5: 4.3% vs. 1.8; p = 0.010). At multivariate analysis history of GI bleeding was an independent predictor of hemorrhagic events (adjusted HR: 2.39, 95% confidence interval: 1.02-5.63; p = 0.047).<br /><b>Conclusions</b><br />Outcomes after LAAO may be affected by the different indications for the procedure. In our study, GI-bleeding and IC-bleeding as indication to LAAO differ in their baseline characteristics. LAAO confirms its efficacy in ischemic risk reduction in both groups, while GI bleeding seems to be an independent predictor of bleeding recurrence at 12 months behind the antithrombotic regimen.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 15 Mar 2023; epub ahead of print</small></div>

<div><h4>Coil embolization of asymptomatic left gastric artery aneurysm: Case report and literature review.</h4><i>Jia H, Xi Y, Yuan P, Guo W, Xiong J</i><br /><AbstractText>Patients with visceral artery aneurysms are rare, and the reported incidence of left gastric aneurysm (LGA) is only 4%. At present, although there is little knowledge about such disease, it is generally believed that appropriate treatment should be planned to prevent some dangerous aneurysms from rupturing. We introduced a case of 83-year-old patient with LGA who underwent endovascular aneurysm repair. The 6-month follow-up computed tomography angiography showed complete thrombosis in the aneurysm lumen. In addition, to insight the management strategy on LGAs deeply, a literature review concerning this entity published in recent 35 years was performed.</AbstractText><br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 11 Mar 2023; epub ahead of print</small></div>

<div><h4>Adjunctive techniques in endovascular repair of postcarotid endarterectomy pseudoaneurysm: Case report and literature review.</h4><i>Andrea E, Danilo M, Nicola GA, Pierluigi CA</i><br /><AbstractText>Pseudoaneurysm (PA) following carotid endarterectomy (CEA) is a rare and dangerous complication. In recent years endovascular approach has been preferred to open surgery as it is less invasive and reduces complications in an already operated neck, especially cranial nerve injuries. We report a case of large post-CEA PA causing dysphagia, successfully treated by deployment of two balloon-expandable covered stents and coil embolization of the external carotid artery. A literature review dealing with all cases of post-CEA PAs since 2000 treated by endovascular means is also reported. The research was conducted on Pubmed database using keywords \"carotid pseudoaneurysm after carotid endarterectomy,\" \"false aneurysm after carotid endarterectomy,\" \"postcarotid endarterectomy pseudoaneurysm,\" and \"carotid pseudoaneurysm.\"</AbstractText><br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 11 Mar 2023; epub ahead of print</small></div>

<div><h4>Transcatheter atrial septal defect closure late after completion of biventricular circulation in patients with pulmonary atresia intact ventricular septum or critical pulmonary stenosis.</h4><i>Yamda H, Muneuchi J, Sugitani Y, Ezaki H, ... Tanaka A, Watanabe M</i><br /><b>Objective</b><br />This study aimed to explore anatomical and hemodynamic features of atrial septal defect, which was treated by transcatheter device closure late after completion of biventricular circulation in patients with pulmonary atresia and intact ventricular septum (PAIVS) or critical pulmonary stenosis (CPS).<br /><b>Methods</b><br />We studied echocardiographic and cardiac catheterization data, including defect size, retroaortic rim length, single or multiple defects, the presence of malalignment atrial septum, tricuspid and pulmonary valve diameters, and cardiac chamber sizes, in patients with PAIVS/CPS who underwent transcatheter closure of atrial septal defect (TCASD), and compared to control subjects.<br /><b>Results</b><br />A total of 173 patients with atrial septal defect, including 8 patients with PAIVS/CPS, underwent TCASD. Age and weight at TCASD were 17.3 ± 18.3 years and 36.6 ± 13.9 kg, respectively. There was no significant difference in defect size (13.7 ± 4.0 vs. 15.6 ± 5.2 mm, p = 0.317) and the retro-aortic rim length (3.7 ± 4.3 vs. 3.6 ± 0.3.1 mm, p = 0.948) between the groups; however, multiple defects (50% vs. 5%, p < 0.001) and malalignment atrial septum (62% vs. 14%. p < 0.001) were significantly frequent in patients with PAIVS/CPS compared to control subjects. The ratio of pulmonary to systemic blood flow in patients with PAIVS/CPS was significantly lower than that in the control patients (1.2 ± 0.4 vs. 2.0 ± 0.7, p < 0.001); however, four out of eight patients with atrial septal defect associated with PAIVS/CPS had right-to-left shunt through a defect, who were evaluated by the balloon occlusion test before TCASD. The indexed right atrial and ventricular areas, the right ventricular systolic pressure, and mean pulmonary arterial pressure did not differ between the groups. After TCASD, the right ventricular end-diastolic area remained unchanged in patients with PAIVS/CPS, whereas it significantly decreased in control subjects.<br /><b>Conclusions</b><br />Atrial septal defect associated with PAIVS/CPS had more complex anatomy, which would be a risk for device closure. Hemodynamics should be individually evaluated to determine the indication for TCASD because PAIVS/CPS encompassed anatomical heterogeneity of the entire right heart.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 11 Mar 2023; epub ahead of print</small></div>

<div><h4>Endovascular repair using parallel grafts to treat a suprarenal pancreatitis-related abdominal aortic pseudoaneurysm.</h4><i>Zacà S, Patruno I, Pulli R, Angiletta D</i><br /><AbstractText>Arterial pseudoaneurysms represent an uncommon complication of acute pancreatic inflammation or chronic pancreatitis. We describe a contained rupture of a suprarenal abdominal aortic pseudoaneurysm. An aorto-uni-iliac stent-graft was adopted as the aortic main body and was combined with two chimneys and two periscope stents for celiac/superior mesenteric artery and renal arteries, respectively. The procedure was complicated by the entrapment of the celiac sheath into the barbs of the aortic stent-graft and the attempts to remove the sheath resulted in an upward migration of the stent-grafts. A bail-out endovascular procedure was used to reline the stent-grafts and the pseudoaneurysmal sac was embolized with coils.</AbstractText><br /><br />© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 08 Mar 2023; epub ahead of print</small></div>

<div><h4>Impact of calcification on clinical outcomes after drug-coated balloon angioplasty for superficial femoral artery disease: Assessment using the peripheral artery calcification scoring system.</h4><i>Mori S, Takahara M, Nakama T, Tobita K, ... Yamawaki M, Ito Y</i><br /><b>Purpose</b><br />To investigate whether the severity of calcification assessed by the peripheral artery calcification scoring system (PACSS) was associated with clinical outcomes of drug-coated balloon (DCB) angioplasty for femoropopliteal lesions.<br /><b>Materials and methods</b><br />We retrospectively analyzed 733 limbs with intermittent claudication of 626 patients, who underwent DCB angioplasty for de novo femoropopliteal lesions between January 2017 and February 2021 at seven cardiovascular centers in Japan. The patients were categorized using the PACSS classification (grades 0-4: no visible calcification of the target lesion, unilateral wall calcification < 5 cm, unilateral calcification ≥ 5 cm, bilateral wall calcification < 5 cm, and bilateral calcification ≥ 5 cm, respectively). The main outcome was primary patency at 1 year. The Cox proportional hazards analysis was used to explore whether the PACSS classification was an independent predictor of clinical outcomes.<br /><b>Results</b><br />The distribution of PACSS was grade 0 in 38%, grade 1 in 17%, grade 2 in 7%, grade 3 in 16%, and grade 4 in 23%. The 1-year primary patency rates in these grades, respectively, were 88.2%, 89.3%, 71.9%, 96.5%, and 82.6%, respectively (p < 0.001). Multivariate analysis disclosed that PACSS grade 4 (hazard ratio: 1.82, 95% confidence interval 1.15-2.87, p = 0.010) was associated with restenosis.<br /><b>Conclusion</b><br />The PACSS grade 4 calcification was independently associated with poor clinical outcomes after DCB angioplasty for de novo femoropopliteal lesions.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 08 Mar 2023; epub ahead of print</small></div>

<div><h4>Gender differences in percutaneous coronary intervention for chronic total occlusions from the ERCTO study.</h4><i>Avran A, Zuffi A, Gobbi C, Gasperetti A, ... Biondi-Zoccai G, Di Mario C</i><br /><b>Background</b><br />Gender-specific data addressing percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) in female patients are scarce and based on small sample size studies.<br /><b>Aims</b><br />We aimed to analyze gender-differences regarding in-hospital clinical outcomes after CTO-PCI.<br /><b>Methods</b><br />Data from 35,449 patients enrolled in the prospective European Registry of CTOs were analyzed. The primary outcome was the comparison of procedural success rate in the two cohorts (women vs. men), defined as a final residual stenosis less than 20%, with Thrombolysis In Myocardial Infarction grade flow = 3. In-hospital major adverse cardiac and cerebrovascular events (MACCEs) and procedural complications were deemed secondary outcomes.<br /><b>Results</b><br />Women represented 15.2% of the entire study population. They were older and more likely to have hypertension, diabetes, and renal failure, with an overall lower J-CTO score. Women showed a higher procedural success rate (adjusted OR [aOR] = 1.115, confidence interval [CI]: 1.011-1.230, p = 0.030). Apart from previous myocardial infarction and surgical revascularization, no other significant gender differences were found among predictors of procedural success. Antegrade approach with true-to-true lumen techniques was more commonly used than retrograde approach in females. No gender differences were found regarding in-hospital MACCEs (0.9% vs. 0.9%, p = 0.766), although a higher rate of procedural complications was observed in women, such as coronary perforation (3.7% vs. 2.9%, p < 0.001) and vascular complications (1.0% vs. 0.6%, p < 0.001).<br /><b>Conclusions</b><br />Women are understudied in contemporary CTO-PCI practice. Female sex is associated with higher procedural success after CTO-PCI, yet no sex differences were found in terms of in-hospital MACCEs. Female sex was associated with a higher rate of procedural complications.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 08 Mar 2023; epub ahead of print</small></div>

<div><h4>Three-year clinical outcomes of the novel sirolimus-eluting bioresorbable scaffold for the treatment of de novo coronary artery disease: A prospective patient-level pooled analysis of NeoVas trials.</h4><i>Wang X, Li Y, Fu G, Xu B, ... Han Y, NeoVas OPC Investigators</i><br /><b>Objectives</b><br />We aimed to evaluate the long-term outcomes of the novel NeoVas sirolimus-eluting bioresorbable scaffold (BRS) for the treatment of de novo coronary artery disease.<br /><b>Background</b><br />The long-term safety and efficacy of the novel NeoVas BRS are still needed to be elucidated.<br /><b>Methods</b><br />A total of 1103 patients with de novo native coronary lesions for coronary stenting were enrolled. The primary endpoint of target lesion failure (TLF) was defined as a composite of cardiac death (CD), target vessel myocardial infarction (TV-MI), or ischemia-driven-target lesion revascularization (ID-TLR).<br /><b>Results</b><br />A three-year clinical follow-up period was available for 1,091 (98.9%) patients. The cumulative TLF rate was 7.2% with 0.8% for CD, 2.6% for TV-MI, and 5.1% for ID-TLR. Additionally, 128 (11.8%) patient-oriented composite endpoint and 11 definite/probable stent thromboses (1.0%) were recorded.<br /><b>Conclusions</b><br />The extended outcomes of the NeoVas objective performance criterion trial demonstrated a promising 3-year efficacy and safety of the NeoVas BRS in low-risk patients with low complexity in terms of lesions and comorbidities.<br /><br />© 2022 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 07 Mar 2023; epub ahead of print</small></div>

<div><h4>Characterization and treatment of thoracic duct obstruction in patients with lymphatic flow disorders.</h4><i>Srinivasan A, Smith C, Krishnamurthy G, Escobar F, Biko D, Dori Y</i><br /><b>Purpose</b><br />The contribution of thoracic duct obstruction to lymphatic flow disorders has not been well-characterized. We describe imaging findings, interventions, and outcomes in patients with suspected duct obstruction by imaging or a lympho-venous pressure gradient (LVPG).<br /><b>Materials and methods</b><br />Clinical, imaging, and interventional data, including the LVPG, of patients with flow disorders and imaging features of duct obstruction who underwent lymphatic intervention were retrospectively reviewed, collated, and analyzed with descriptive statistics.<br /><b>Results</b><br />Eleven patients were found to have obstruction, median age 10.4 years (interquartile range: 8-14.9 years). Pleural effusions were seen in 8/11 (72%), ascites in 8/11 (72%), both in 5/11 (45%), and protein-losing enteropathy in 5 (45%). Eight patients (72%) had congenital heart disease. The most common site of obstruction was at the duct outlet in 7/11 patients (64%). Obstruction was secondary to extrinsic compression or ligation 4 patients (36%). Nine patients (82%) underwent interventions, with balloon dilation in 7/9 (78%), massive lymphatic malformation drainage and sclerotherapy in 1, and lympho-venous anastomosis in 1. There was resolution of symptoms in 7/9 (78% who underwent intervention, with worsening in 1 patient and no change in 1. In these patients, preprocedure mean LVPG was 7.9 ± 5.7 mmHg and postprocedure gradient was 1.6 ± 1.9 mmHg (p = 0.014). Five patients in this series underwent intervention solely to alleviate duct obstruction and in 4/5 (80%) this led to resolution of symptoms (p = 0.05).<br /><b>Conclusion</b><br />Duct obstruction may be seen in lymphatic flow disorders and can occur from intrinsic and extrinsic causes. Stenosis at the outlet was most common. Obstruction can be demonstrated by an elevated LVPG, and interventions to alleviate the obstruction can be beneficial.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 06 Mar 2023; epub ahead of print</small></div>

<div><h4>Feasibility and impact of extra-vascular ultrasound-guided endovascular treatment for infrapopliteal artery occlusive disease.</h4><i>Tokuda T, Oba Y, Kagase A, Matsuda H, ... Ito T, Hirano K</i><br /><b>Purpose</b><br />This study aimed to examine the feasibility and impact of extra-vascular ultrasound (EVUS)-guided intervention for infrapopliteal (IP) artery occlusive disease.<br /><b>Materials and methods</b><br />A retrospective analysis was performed using data collected from patients who underwent endovascular treatment (EVT) for IP artery occlusive disease between January 2018 and December 2020 at our institution. A total of 63 consecutive de novoocclusive lesions were compared according to the recanalization method utilized. Propensity score matching analysis was performed to compare the clinical outcomes of the methods utilized. The prognostic value was analyzed based on the technical success rate, distal puncture rate, radiation exposure, amount of contrast media, postprocedural skin perfusion pressure (SPP), and procedural complication rate.<br /><b>Results</b><br />Eighteen matched pairs of patients were analyzed using propensity score-matched analysis. Radiation exposure was significantly lower in the EVUS-guided group than in the angio-guided group, with 135 and 287 mGy (p = 0.04) exposure on average, respectively. There were no significant differences between the two groups in terms of technical success rate, distal puncture rate, the amount of contrast media, postprocedural SPP, and procedural complication rate.<br /><b>Conclusion</b><br />EVUS-guided EVT for IP occlusive disease achieved a feasible technical success rate and significantly reduced radiation exposure.<br /><br />© 2023 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 06 Mar 2023; epub ahead of print</small></div>