Interventional Cardiology Review最新文献

Background: Despite class 1 recommendations and clinical evidence supporting optical coherence tomography (OCT), its adoption is limited. While randomised controlled trials show clinical benefits of OCT under strict protocols, its real-world performance is unclear.

Aims and methods: All-comEr Registry of OCT (AERO) to Investigate the MLD-MAX Algorithm for OCT-guided-precision-PCI in Daily Routine (ILUMIEN-V-AERO; NCT05324683) is a prospective, multicentre OCT registry aiming to recruit 2,000 patients across sites in the UK, Germany and Saudi Arabia. The study seeks to evaluate the real-world use of an algorithmic approach to OCT-guided percutaneous coronary intervention (PCI) (MLD-MAX) and directly compares its outcomes to those from the ILUMIEN-IV randomised controlled trial. The primary endpoint for this comparison is post-PCI minimum stent area relative to the reference segments. Secondary endpoints include OCT imaging assessments (minimum stent area, edge dissection, stent malapposition, mean stent expansion, plaque protrusion, reference segment disease), procedural outcomes (procedural and fluoroscopy time, contrast use, renal replacement therapy) and clinical endpoints (a composite endpoint of target lesion failure [cardiac death, ischaemia-driven target lesion revascularisation, target vessel MI] and unplanned hospitalisation for unstable angina). All patients will undergo clinical follow-up at 30 days and 6 months to assess target lesion failure. Beyond the inclusion criteria of the ILUMIEN-IV trial, this study will explore the role of OCT in diagnosing acute coronary syndrome, its application in guiding drug-coated balloon PCI and the impact of core laboratory support and critical evaluation on operator performance.

Conclusion: ILUMIEN-V-AERO is a large, prospective registry designed to assess the real-world performance of OCT and provide insights into its role in underexplored areas of PCI guidance.

Pulmonary embolism (PE) presents both acute and chronic complications that significantly affect patient outcomes. Acute complications include syncope or sudden death, often resulting from severe hypoxaemia or right ventricular failure; and early recurrence of the embolic event. Chronic complications, which can develop over time, are often grouped under post-embolic syndrome (PES), a condition affecting more than half of PE survivors. Symptoms of PES include persistent dyspnoea and reduced exercise tolerance. PES is associated with several serious conditions, such as chronic thromboembolic pulmonary hypertension, chronic thromboembolic pulmonary disease, right ventricular dysfunction, physical deconditioning, and psychological harm. Although promising catheter-directed therapies are under investigation for acute PE treatment, their effectiveness in preventing chronic complications has yet to be confirmed by large-scale randomised controlled trials.

Transcatheter aortic valve replacement (TAVR) has developed into a viable treatment for aortic regurgitation (AR), particularly in high-risk or elderly patients unable to undergo surgery. Early generation devices encountered significant challenges, including high mortality rates, residual paravalvular leaks, and complications such as valve embolisation. However, advancements in TAVR technology, including self-expanding and balloon-expandable devices, have improved procedural outcomes. Dedicated devices, such as the Trilogy system (JenaValve) and J-Valve (Edwards Lifesciences), specifically designed for AR, have demonstrated superior performance with reduced complications and better patient survival. Other devices, such as Cusper (Cuspa) and the Zeta/Alpha systems (Laguna Tech), show potential for treating complex AR cases, including those with non-calcified valves or active endocarditis. These innovations offer hope for patients with severe AR, highlighting the need for tailored approaches based on individual anatomical and pathological variations.

Transcatheter aortic valve (TAV) implantation is an established treatment strategy for patients with severe aortic stenosis across the spectrum of surgical risk profiles. Numerous randomised controlled trials have consistently demonstrated the safety and efficacy of TAV implantation compared with surgical aortic valve replacement, prompting an expansion of indications towards lower surgical risk, often younger, patients. In parallel, the number and types of TAV prosthesis have also increased. Although all devices have generally demonstrated favourable procedural and longer-term clinical outcomes, variations in frame design, material properties and leaflet configurations render specific devices more favourable in certain settings. In this review, we describe key differences in TAV design and how this may affect the choice of TAV prosthesis in the challenging clinical scenarios of patients with small annuli, coronary disease, long life expectancy, risk of permanent pacing and aortic regurgitation, which are expected to be encountered more frequently as indications for TAV implantation expand.

Aortopulmonary window (APW) is a rare congenital heart defect that may progress to pulmonary hypertension if untreated. Presented here is the case of a 25-year-old woman with type 1 APW diagnosed in childhood who presented with chest pain, headache, dyspnoea, and transient loss of consciousness. Imaging confirmed severe pulmonary hypertension (mean pulmonary artery pressure 50 mmHg) and a positive vasoreactivity test, allowing for percutaneous closure. A 14 mm Amplatzer Septal Occluder was implanted under transoesophageal echocardiographic and fluoroscopic guidance. Postoperative complications comprised non-immune haemolytic anaemia and haematuria, likely due to minimal residual shunting, both managed conservatively. At 3-month follow-up, echocardiography showed stable device position, no residual shunt, pulmonary pressure reduction (36 mmHg), and mildly decreased systolic function with persistent left-sided dilation. This case supports the feasibility of percutaneous APW closure in selected adults with reversible pulmonary hypertension and highlights the need for structured echocardiographic and haemodynamic follow-up.

There are several circumstances where transcatheter interventions should be undertaken during pregnancy. Decisions should be made as soon as problems become evident or they begin to deteriorate. If the patient is not amenable to medical therapy alone, a transcatheter intervention should not be postponed in favour of fetal health. Transcatheter interventions during pregnancy have favourable outcomes when performed with indications, but more data are needed on transcatheter valve replacement during pregnancy.

Atrial septal defect and patent foramen ovale are common congenital heart defects in adults, often treated with atrial septal occluders (ASOs) via percutaneous closure. Transseptal puncture (TSP) for left atrial interventions in patients with ASOs presents procedural challenges, requiring detailed pre-procedural planning and imaging. Transoesophageal echocardiography and cardiac CT help identify optimal puncture sites, either through the native septum or across the ASO. Advanced techniques, such as balloon-assisted tracking and radiofrequency energy delivery, aid in navigating the device. TSP is frequently performed for procedures such as pulmonary vein isolation, left atrial appendage occlusion, and mitral valve interventions. While generally safe and effective, TSP can lead to complications including residual shunting and device deformation, or procedural delays. Specialised expertise and multimodality imaging are crucial for optimising success and minimising risks. This review outlines TSP techniques, clinical applications and strategies for navigating ASOs during left atrial interventions.

Background: Coronary arterial calcification impedes safe and predictable percutaneous coronary intervention (PCI), and guidelines recommend calcium modification. Several interventional techniques exist, but the most optimal technique remains unclear. The aim of this study was therefore to assess the effects of PCI strategies for calcified lesions on all-cause mortality and serious adverse events.

Methods: A systematic review with meta-analysis and trial sequential analysis of randomised trials was conducted to compare any lesion preparation or stenting technique in patients undergoing PCI for moderately or severely calcified coronary lesions according to a published protocol. CENTRAL, MEDLINE, Embase and other sources were searched up to 8 May 2025.

Results: Out of 7,172 identified records, 31 eligible trials (8,453 participants) assessed 16 lesion preparation techniques (4,392 participants) and five stenting/scaffold techniques (4,061 participants). Lesion preparation comparisons were generally underpowered, and all showed no effect on all-cause mortality or serious adverse events. For stenting strategies, meta-analysis and trial sequential analysis showed that an effect of stent polymer coating (bioresorbable, permanent or polymer-free) on all-cause mortality or serious adverse events could be rejected.

Conclusion: For patients undergoing PCI for moderately or severely calcified coronary lesions, there appears to be no significant differences between lesion preparation techniques regarding all-cause mortality or serious adverse events. Current evidence is underpowered and of low certainty, highlighting the clinical equipoise between available calcium modification techniques and the necessity for adequately powered randomised trials.

Calcific coronary artery disease presents unique challenges in achieving optimal stent deployment, which is crucial for long-term procedural success. Intravascular lithotripsy (IVL), introduced to the UK in 2018, has revolutionised the treatment of calcific lesions through its simplicity of use and ability to modify calcium safely and effectively. This expert opinion explores the evolution of IVL technology, its mechanism of action, and suggested refinement in its application based on the evidence and experience of the authors. Emphasis is placed on optimising IVL usage across various calcific scenarios, including concentric, nodular and eccentric calcium, and large bifurcations. Lessons from peripheral vascular studies, such as balloon oversizing strategies, are discussed to enhance the optimal usage of IVL in coronary interventions. By proposing new iterations in IVL usage, and emphasising its safety and efficacy, this article aims to refine the interventional community's approach to tackling calcific coronary disease with IVL.

Implantation of a left ventricular assist device in the presence of a pre-existing patent foramen ovale or an iatrogenic atrial septal defect (ASD) may predispose patients to significant right-to-left shunting, resulting in critical hypoxaemia. In such cases, the appropriate treatment modality has been intervention with transoesophageal echocardiography-guided ASD closure using fluoroscopy. ASD closure without fluoroscopy to reduce radiation exposure has been discussed but not properly explored. We present a case of a 72-year-old patient with a history of left ventricular assist device placement complicated by critical hypoxaemia secondary to a large residual ASD who underwent emergency bedside treatment using transoesophageal echocardiography without fluoroscopy. Although ASD closure without fluoroscopy is not well established, this case highlights a novel technique to promptly and successfully treat critical hypoxaemia in patients with significant shunting.