Interventional Cardiology Review最新文献

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.

Several historical studies reported a higher rate of complications following transcatheter aortic valve replacement (TAVR) in women compared with men, especially major bleeding, vascular complications and stroke. More recent publications have demonstrated lower stroke rates following TAVR. The growing experience of modern TAVR operators played a crucial role in the reduction of early postprocedural stroke events. In addition, the improved transcatheter heart valve technology, the emphasis on a heart team-based selection process, and the inclusion of intermediate- and low-risk patients in the latest landmark randomised trials have all contributed to the lower stroke rates in contemporary trials. It is important to note, however, that at an individual level, stroke can significantly affect both quality of life and overall prognosis. Certain factors that increase the risk of periprocedural stroke include the distribution of calcification of native aortic valves, small aortic valve annuli, left ventricular dysfunction and fibrosis, and AF. These tend to occur more frequently in women. However, the role of cerebral embolic protection devices has not been shown to reduce procedure-related strokes in men or women. The overall incidence of factors predisposing to late-onset stroke is higher in women. Currently, there are no trials that have identified sex differences in the incidence and management of stroke following TAVR. This review aims to examine potential sex differences in the pathophysiology, preventive strategies and therapeutic options for stroke following TAVR.

Coronary artery calcification (CAC) remains one of the greatest challenges in percutaneous coronary interventions, since it adversely affects procedural and long-term clinical outcomes. Compared with angiography, intravascular imaging increases diagnostic accuracy of CAC and enables assessment of morphological features of CAC, which help determine the need for advanced calcium modification therapies, including speciality balloons, atherectomy and intravascular lithotripsy. Since the ultimate goal of the advanced calcium modification therapies is to induce calcium fracture and facilitate subsequent stent implantation, intravascular imaging can be used to confirm calcium fracture and optimise percutaneous coronary interventions. Being able to interpret and understand the role of intravascular imaging in the diagnosis and management of CAC is valuable in attempting to improve outcomes after percutaneous coronary interventions.

Pulmonary embolism represents a major cause of morbidity and mortality worldwide, and remains a diagnostic challenge due to its highly nonspecific clinical presentation. Early recognition is critical because timely diagnosis not only improves prognosis but also guides risk stratification, which is essential for therapeutic decision-making. Non-invasive diagnostic modalities - including clinical prediction rules, biomarkers, imaging techniques and bedside assessments - have become indispensable tools for rapid and accurate identification of patients with suspected pulmonary embolism. These methods enable clinicians to stratify risk, predict outcomes and tailor treatment strategies to individual patients, reducing both underdiagnosis and overtreatment. Despite their significant impact, limitations persist, such as access disparities, overdiagnosis of subsegmental events and interpretation challenges in special populations. Ongoing advances, including artificial intelligence and novel biomarkers, hold promise for refining diagnostic accuracy and personalised risk assessment. Ultimately, the integration of non-invasive tests into structured algorithms ensures earlier detection, better prognostic evaluation and improved clinical outcomes for patients with acute pulmonary embolism.

Treatment of pure aortic regurgitation (AR) has historically been addressed via surgical aortic valve repair or replacement. A less invasive option for patients affected by AR has been attempted with the advent of transcatheter aortic valve replacement (TAVR). Here, we review the rationale, benefits and challenges of TAVR for the treatment of native pure AR. In particular, we explore upcoming dedicated technologies with labelling for transcatheter treatment of AR, detailing both device and procedural specifics. Finally, evidence from recent studies conducted in patients with pure AR is appraised in light of available evidence from TAVR with non-dedicated devices in this setting.

Pulmonary embolism (PE) is a leading cause of morbidity and mortality, with clinical outcomes strongly influenced by the anatomical distribution of emboli. This review explores the impact of PE anatomy on ventilatory distress and haemodynamics, emphasising the distinction between proximal and distal emboli. Proximal emboli, located in the main or lobar pulmonary arteries, significantly impairing pulmonary flow, increase pulmonary artery pressure and cause severe right ventricular dysfunction, necessitating prompt intervention. Distal emboli, while less severe, still pose risks, especially in patients with cardiopulmonary comorbidities, potentially leading to localised ventilation-perfusion mismatch and hypoxaemia. Therapeutic approaches vary by clinical status and embolus location, with systemic thrombolysis or catheter-directed therapy preferred for unstable patients with usually proximal PE, while anticoagulation suffices in stable cases, most of which involve distal emboli. Understanding PE anatomy and its relationship with PE haemodynamic and ventilatory failure is critical for risk stratification, treatment guidance and improvement of patient outcomes.

Complete fracture of a guiding catheter is a rare, but potentially serious, complication of percutaneous coronary intervention. Options for removal include endovascular retrieval devices or surgery. A rare case of a fractured guiding catheter with its tip in the ascending aorta and its successful retrieval using a combination of home-made snare, kissing guiding catheter and balloon trekking technique is reported.