Pub Date : 2025-12-01DOI: 10.1016/j.jscai.2025.104004
Deanna Z.L. Khoo MBBS , Deborah J.H. Lee MBBS , Sanchalika Acharyya PhD, MPH , Heng Choon Pooh MStat , Aaron Wong MBBS , Poay Huan Loh MBBS , Syed Saqib Imran MBBS , Yew Seong Goh MBBS , Hee Hwa Ho MBBS , Fahim H. Jafary MBBS , Jason K.K. Loh MBBS , Bharat Khialani MBBS , Cliff K.F. Li MBBS , Randal J.B. Low MBBS , Thet Khaing MBBS , Eran Sim MBBS , Joshua Loh MBBS , Paul J.L. Ong MB BChir
Background
Use of stent retrievers in managing ischemic stroke has been shown to improve outcomes. Data on stent retrievers in managing intracoronary thrombus are limited. This study aimed to assess the safety and efficacy of the Solitaire revascularization device (Medtronic) in managing recalcitrant intracoronary thrombus.
Methods
Patients with acute coronary syndrome and residual large thrombus after treatment with conventional methods underwent treatment with the Solitaire device. The primary efficacy end point was the rate of successful recanalization, defined as Thrombolysis in Myocardial Infarction (TIMI) flow increase to ≥2 or thrombus grade (TG) decrease to ≤2 at postprocedure. Secondary end points included improvements in postprocedure TG and myocardial blush grade. The primary safety end point was occurrence of stroke.
Results
Between June 2019 and November 2022, 51 patients underwent thrombectomy with the Solitaire device. The estimated successful recanalization rate was 76.5% (95% CI, 62.0%-87.2%) after Solitaire use and 92.2% (95% CI, 81.1%-97.8%) at the end of the procedure. TG reduced to ≤2 in 28 (54.9%) patients after Solitaire and 43 (84.3%) patients at the end of the procedure. There was significant improvement in myocardial blush grade with an improvement rate of 40% (95% CI, 22.7%-59.4%) after Solitaire and 66.7% (95% CI, 47.2%-82.7%) at the end of procedure. There was no incidence of stroke postprocedurally or up to 30 days postdischarge.
Conclusions
The Solitaire device is an effective adjunctive tool in managing recalcitrant intracoronary thrombus, with a low risk of complications.
{"title":"Efficacy and Safety of Solitaire Revascularization Device in Managing Refractory Thrombus in Acute Coronary Syndrome","authors":"Deanna Z.L. Khoo MBBS , Deborah J.H. Lee MBBS , Sanchalika Acharyya PhD, MPH , Heng Choon Pooh MStat , Aaron Wong MBBS , Poay Huan Loh MBBS , Syed Saqib Imran MBBS , Yew Seong Goh MBBS , Hee Hwa Ho MBBS , Fahim H. Jafary MBBS , Jason K.K. Loh MBBS , Bharat Khialani MBBS , Cliff K.F. Li MBBS , Randal J.B. Low MBBS , Thet Khaing MBBS , Eran Sim MBBS , Joshua Loh MBBS , Paul J.L. Ong MB BChir","doi":"10.1016/j.jscai.2025.104004","DOIUrl":"10.1016/j.jscai.2025.104004","url":null,"abstract":"<div><h3>Background</h3><div>Use of stent retrievers in managing ischemic stroke has been shown to improve outcomes. Data on stent retrievers in managing intracoronary thrombus are limited. This study aimed to assess the safety and efficacy of the Solitaire revascularization device (Medtronic) in managing recalcitrant intracoronary thrombus.</div></div><div><h3>Methods</h3><div>Patients with acute coronary syndrome and residual large thrombus after treatment with conventional methods underwent treatment with the Solitaire device. The primary efficacy end point was the rate of successful recanalization, defined as Thrombolysis in Myocardial Infarction (TIMI) flow increase to ≥2 or thrombus grade (TG) decrease to ≤2 at postprocedure. Secondary end points included improvements in postprocedure TG and myocardial blush grade. The primary safety end point was occurrence of stroke.</div></div><div><h3>Results</h3><div>Between June 2019 and November 2022, 51 patients underwent thrombectomy with the Solitaire device. The estimated successful recanalization rate was 76.5% (95% CI, 62.0%-87.2%) after Solitaire use and 92.2% (95% CI, 81.1%-97.8%) at the end of the procedure. TG reduced to ≤2 in 28 (54.9%) patients after Solitaire and 43 (84.3%) patients at the end of the procedure. There was significant improvement in myocardial blush grade with an improvement rate of 40% (95% CI, 22.7%-59.4%) after Solitaire and 66.7% (95% CI, 47.2%-82.7%) at the end of procedure. There was no incidence of stroke postprocedurally or up to 30 days postdischarge.</div></div><div><h3>Conclusions</h3><div>The Solitaire device is an effective adjunctive tool in managing recalcitrant intracoronary thrombus, with a low risk of complications.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 12","pages":"Article 104004"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145754175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jscai.2025.104013
Eric A. Secemsky MD, MSc , Ehrin J. Armstrong MD , Venita Chandra MD , Raghu Kolluri MD, MS , Parag J. Patel MD, MS , Peter A. Schneider MD , Niten Singh MD
Care for patients with chronic limb-threatening ischemia (CLTI) is complex, and it is most effective when conducted with collaboration across multiple specialties. A recent upward trend in major limb amputation among patients with CLTI warrants a renewed effort to optimize care for this multifaceted condition. The Vascular InterVentional Advances (VIVA) Foundation, a not-for-profit 501(c)(3) organization, convened a Vascular Leaders Forum in 2024 to initiate an open, multispecialty discussion about the state of CLTI care in the United States and current challenges around delivery and access to such care. The forum comprised representatives from vascular surgery, interventional cardiology, interventional radiology, vascular medicine, podiatry, regulators, medical device manufacturers, patient advocacy, and the CLTI and CLTI caregiver population. This article explores the central themes of challenges in CLTI care and ways in which collaboration across specialties and care settings could improve CLTI outcomes. In summary, it was recommended that integrated CLTI care teams extend beyond vascular surgery, interventional cardiology, and interventional radiology to include vascular medicine, podiatry, wound care, diabetology, and dietetics. Meeting the increasing demand for CLTI revascularization will require these teams to span tertiary care hospitals, community hospitals, outpatient revascularization clinics, and primary care settings.
{"title":"Contemporary Chronic Limb-Threatening Ischemia Care in the United States—Part 1: A Path Toward Multispecialty Collaboration","authors":"Eric A. Secemsky MD, MSc , Ehrin J. Armstrong MD , Venita Chandra MD , Raghu Kolluri MD, MS , Parag J. Patel MD, MS , Peter A. Schneider MD , Niten Singh MD","doi":"10.1016/j.jscai.2025.104013","DOIUrl":"10.1016/j.jscai.2025.104013","url":null,"abstract":"<div><div>Care for patients with chronic limb-threatening ischemia (CLTI) is complex, and it is most effective when conducted with collaboration across multiple specialties. A recent upward trend in major limb amputation among patients with CLTI warrants a renewed effort to optimize care for this multifaceted condition. The Vascular InterVentional Advances (VIVA) Foundation, a not-for-profit 501(c)(3) organization, convened a Vascular Leaders Forum in 2024 to initiate an open, multispecialty discussion about the state of CLTI care in the United States and current challenges around delivery and access to such care. The forum comprised representatives from vascular surgery, interventional cardiology, interventional radiology, vascular medicine, podiatry, regulators, medical device manufacturers, patient advocacy, and the CLTI and CLTI caregiver population. This article explores the central themes of challenges in CLTI care and ways in which collaboration across specialties and care settings could improve CLTI outcomes. In summary, it was recommended that integrated CLTI care teams extend beyond vascular surgery, interventional cardiology, and interventional radiology to include vascular medicine, podiatry, wound care, diabetology, and dietetics. Meeting the increasing demand for CLTI revascularization will require these teams to span tertiary care hospitals, community hospitals, outpatient revascularization clinics, and primary care settings.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 12","pages":"Article 104013"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145754219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jscai.2025.103934
Eric A. Secemsky MD, MSc , Ehrin J. Armstrong MD , Venita Chandra MD , Raghu Kolluri MD, MS , Saher S. Sabri MD , Niten Singh MD
Head-to-head research comparing invasive revascularization strategies for chronic limb-threatening ischemia (CLTI) is sparse, partly due to challenges in conducting randomized controlled trials in the CLTI space. These include the expense of head-to-head trials, optimizing patient selection criteria for real-world applicability, and identifying optimal study end points. The Vascular InterVentional Advances (VIVA) Foundation, a 501(c)(3) not-for-profit organization, convened a Vascular Leaders Forum to initiate an open, multispecialty collaborative discussion of these challenges and ways to optimize the design of medical device trials in CLTI. This article summarizes the current landscape of clinical studies of CLTI revascularization strategies and options for designing comparative trials proposed by representatives from vascular surgery, interventional cardiology, interventional radiology, vascular medicine, podiatry, the U.S. Food and Drug Administration, and a medical device manufacturer. Four broad areas to optimize comparative trials of CLTI interventions were identified. First, primary end points should be carefully chosen with attention to clinical, patient-centric, imaging, and hierarchical considerations; standardization; and inclusion of guideline-directed medical therapy. Second, broader eligibility criteria can expand and hasten enrollment and are important for gathering evidence on outcomes in medically complex patients often encountered in real-world practice. Third, extending the primary end point timing to 12 months with additional follow-up out to 24 to 60 months would accommodate a longer period of device evaluation and the ability to enrich clinical end-point rates. Finally, innovative pragmatic trial designs and statistical methodologies are needed to conduct comprehensive, cost effective, relevant trials with sufficient statistical power and without prohibitively large sample sizes and study durations.
{"title":"Contemporary Chronic Limb-Threatening Ischemia Care in the United States—Part 2: Designing Clinical Device Trials","authors":"Eric A. Secemsky MD, MSc , Ehrin J. Armstrong MD , Venita Chandra MD , Raghu Kolluri MD, MS , Saher S. Sabri MD , Niten Singh MD","doi":"10.1016/j.jscai.2025.103934","DOIUrl":"10.1016/j.jscai.2025.103934","url":null,"abstract":"<div><div>Head-to-head research comparing invasive revascularization strategies for chronic limb-threatening ischemia (CLTI) is sparse, partly due to challenges in conducting randomized controlled trials in the CLTI space. These include the expense of head-to-head trials, optimizing patient selection criteria for real-world applicability, and identifying optimal study end points. The Vascular InterVentional Advances (VIVA) Foundation, a 501(c)(3) not-for-profit organization, convened a Vascular Leaders Forum to initiate an open, multispecialty collaborative discussion of these challenges and ways to optimize the design of medical device trials in CLTI. This article summarizes the current landscape of clinical studies of CLTI revascularization strategies and options for designing comparative trials proposed by representatives from vascular surgery, interventional cardiology, interventional radiology, vascular medicine, podiatry, the U.S. Food and Drug Administration, and a medical device manufacturer. Four broad areas to optimize comparative trials of CLTI interventions were identified. First, primary end points should be carefully chosen with attention to clinical, patient-centric, imaging, and hierarchical considerations; standardization; and inclusion of guideline-directed medical therapy. Second, broader eligibility criteria can expand and hasten enrollment and are important for gathering evidence on outcomes in medically complex patients often encountered in real-world practice. Third, extending the primary end point timing to 12 months with additional follow-up out to 24 to 60 months would accommodate a longer period of device evaluation and the ability to enrich clinical end-point rates. Finally, innovative pragmatic trial designs and statistical methodologies are needed to conduct comprehensive, cost effective, relevant trials with sufficient statistical power and without prohibitively large sample sizes and study durations.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 12","pages":"Article 103934"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145754220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jscai.2025.104045
Arash Salavitabar MD , Sara Conroy PhD , Isaac Kistler MS , Asaad Beshish MD , Ryan Callahan MD , Matthew A. Crystal MD , Howaida El-Said MD, PhD , Bryan Goldstein MD , Michael Hainstock MD , Ray Lowery BS , Amr Matoq MD , Daniel McLennan MBBS , George T. Nicholson MD , Brian P. Quinn MD , Shyam Sathanandam MD , Jessica Tang MD, MS , Sara M. Trucco MD , Wendy Whiteside MD , Darren P. Berman MD
Background
Percutaneous radiofrequency (RF) wire pulmonary valve perforation (PVP) in pulmonary atresia/intact ventricular septum (PA/IVS) is a high-risk procedure. This study compared procedural efficacy and complications between RF and chronic total occlusion (CTO) wire PVP.
Methods
This multicenter study included patients with PA/IVS who had PVP attempted at 13 centers. Outcomes of interest were efficacy and complications. Univariable logistic regression models were used to estimate odds ratios and risk differences.
Results
PVP was attempted in 206 patients; median age 3.0 days (1.0-6.0) and weight 3.1 kg (2.7-3.5). The RF PVP was attempted first in 165 (80.0%) patients, CTO in 27 (13.1%), and stiff end of the coronary wire in 14 (6.8%). The procedural success rate of 94% was similar between wire types. CTO group utilized smaller initial valvuloplasty balloons (2.25 mm [2-3] vs 4 mm [3-6]) and >2 balloons in 71% of cases (vs 18% in RF). Overall and major procedural complications occurred in 26.5% versus 12.5% (odds ratios [OR], 2.5 [0.8-11.1]; P = .15) and 14.8% vs 4.2% (OR, 4.0 [0.8-73.2]; P = .18), respectively, of RF versus CTO groups. Major postprocedural complications occurred in 12% versus 4.2% of the RF versus the CTO groups. Cases with multiple (vs single) PVP attempts had higher overall (40.4% vs 17.0%; OR, 3.3 [1.7-6.6]; P < .01) and major (24.6% vs 8.5%; OR, 3.5 [1.5-8.3], P < .01) procedural complication rates.
Conclusions
PVP remains an effective treatment strategy in PA/IVS. Complication rate differences between CTO and RF wires may be clinically relevant. Further studies with larger cohorts are warranted to confirm findings and guide optimal intervention strategies.
背景：肺闭锁/完整室间隔（PA/IVS）患者经皮射频（RF）穿刺肺动脉瓣穿孔（PVP）是一种高风险手术。本研究比较了射频和慢性全闭塞（CTO）钢丝PVP的手术疗效和并发症。方法这项多中心研究纳入了13个中心尝试PVP治疗的PA/IVS患者。关注的结果是疗效和并发症。单变量logistic回归模型用于估计优势比和风险差异。结果206例患者尝试了spvp；中位日龄3.0天（1.0-6.0），体重3.1 kg（2.7-3.5）。165例（80.0%）患者首次尝试射频PVP， 27例（13.1%）患者首次尝试CTO， 14例（6.8%）患者首次尝试冠状动脉钢丝僵硬端。手术成功率为94%，两种钢丝类型相似。CTO组使用较小的初始瓣膜成形术球囊（2.25 mm [2-3] vs 4 mm[3-6]）， 71%的病例使用2个球囊（RF组为18%）。RF组和CTO组的总并发症和主要手术并发症发生率分别为26.5%和12.5%（比值比[OR]， 2.5 [0.8-11.1]; P = 0.15）和14.8%对4.2%（比值比[OR]， 4.0 [0.8-73.2]; P = 0.18）。术后主要并发症发生率为12%，对照组为4.2%，对照组为4.2%。多次（与单次）PVP尝试的病例总体（40.4%对17.0%；OR, 3.3 [1.7-6.6]; P < 01）和主要（24.6%对8.5%；OR, 3.5 [1.5-8.3], P < 01）手术并发症发生率较高。结论spvp仍是治疗PA/IVS的有效策略。CTO和RF导线之间的并发症发生率差异可能具有临床意义。有必要进行更大规模的进一步研究，以确认研究结果并指导最佳干预策略。
{"title":"Percutaneous Pulmonary Valve Perforation in Pulmonary Atresia With Intact Ventricular Septum: Multicenter Comparison of Radiofrequency Versus Chronic Total Occlusion Wires","authors":"Arash Salavitabar MD , Sara Conroy PhD , Isaac Kistler MS , Asaad Beshish MD , Ryan Callahan MD , Matthew A. Crystal MD , Howaida El-Said MD, PhD , Bryan Goldstein MD , Michael Hainstock MD , Ray Lowery BS , Amr Matoq MD , Daniel McLennan MBBS , George T. Nicholson MD , Brian P. Quinn MD , Shyam Sathanandam MD , Jessica Tang MD, MS , Sara M. Trucco MD , Wendy Whiteside MD , Darren P. Berman MD","doi":"10.1016/j.jscai.2025.104045","DOIUrl":"10.1016/j.jscai.2025.104045","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous radiofrequency (RF) wire pulmonary valve perforation (PVP) in pulmonary atresia/intact ventricular septum (PA/IVS) is a high-risk procedure. This study compared procedural efficacy and complications between RF and chronic total occlusion (CTO) wire PVP.</div></div><div><h3>Methods</h3><div>This multicenter study included patients with PA/IVS who had PVP attempted at 13 centers. Outcomes of interest were efficacy and complications. Univariable logistic regression models were used to estimate odds ratios and risk differences.</div></div><div><h3>Results</h3><div>PVP was attempted in 206 patients; median age 3.0 days (1.0-6.0) and weight 3.1 kg (2.7-3.5). The RF PVP was attempted first in 165 (80.0%) patients, CTO in 27 (13.1%), and stiff end of the coronary wire in 14 (6.8%). The procedural success rate of 94% was similar between wire types. CTO group utilized smaller initial valvuloplasty balloons (2.25 mm [2-3] vs 4 mm [3-6]) and >2 balloons in 71% of cases (vs 18% in RF). Overall and major procedural complications occurred in 26.5% versus 12.5% (odds ratios [OR], 2.5 [0.8-11.1]; <em>P</em> = .15) and 14.8% vs 4.2% (OR, 4.0 [0.8-73.2]; <em>P</em> = .18), respectively, of RF versus CTO groups. Major postprocedural complications occurred in 12% versus 4.2% of the RF versus the CTO groups. Cases with multiple (vs single) PVP attempts had higher overall (40.4% vs 17.0%; OR, 3.3 [1.7-6.6]; <em>P</em> < .01) and major (24.6% vs 8.5%; OR, 3.5 [1.5-8.3], <em>P</em> < .01) procedural complication rates.</div></div><div><h3>Conclusions</h3><div>PVP remains an effective treatment strategy in PA/IVS. Complication rate differences between CTO and RF wires may be clinically relevant. Further studies with larger cohorts are warranted to confirm findings and guide optimal intervention strategies.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 12","pages":"Article 104045"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145754221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jscai.2025.103943
Muhammad Memon MD , Raef Ali Fadel DO , Herbert D. Aronow MD , Ahmad Jabri MD , Mohammad Alqarqaz MD , Khaldoon Alaswad MD , Asaad Nakhle MD , Mir Babar Basir DO , Pedro Villablanca MD
{"title":"MANTA vs Perclose for Large-Bore Femoral Closure in Impella-Assisted High-Risk Percutaneous Coronary Intervention: Retrospective Outcomes Study","authors":"Muhammad Memon MD , Raef Ali Fadel DO , Herbert D. Aronow MD , Ahmad Jabri MD , Mohammad Alqarqaz MD , Khaldoon Alaswad MD , Asaad Nakhle MD , Mir Babar Basir DO , Pedro Villablanca MD","doi":"10.1016/j.jscai.2025.103943","DOIUrl":"10.1016/j.jscai.2025.103943","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 12","pages":"Article 103943"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145754213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jscai.2025.104050
Tirayut Veerasathian MD, Schawanya K. Rattanapitoon MD, Nav La MD, PhD, Nathkapach K. Rattanapitoon PhD
{"title":"Revisiting Bioresorbable Scaffolds in Light of the SCAAR Study","authors":"Tirayut Veerasathian MD, Schawanya K. Rattanapitoon MD, Nav La MD, PhD, Nathkapach K. Rattanapitoon PhD","doi":"10.1016/j.jscai.2025.104050","DOIUrl":"10.1016/j.jscai.2025.104050","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 12","pages":"Article 104050"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145754214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Atrial septal defect (ASD) is a common congenital heart condition in adults. We present a case of successful transcatheter closure of a 1.5-cm sinus venosus ASD in a 34-year-old man with exertional dyspnea. Using an innovative technique, two 43-mm XXL covered CVS Optimus stents were sutured together for enhanced support and delivered via the jugular and femoral veins. This dual-stent approach provides advantages over traditional methods, reducing surgical risks and recovery times. However, surgical intervention remains preferred for complex anatomical variations. This case highlights the effectiveness of a novel transcatheter technique for sinus venosus ASD closure.
{"title":"Innovative Double-Covered Stent Connection With Suture Thread for Transcatheter Sinus Venosus Atrial Septal Defect Closure: Case Report","authors":"Ehsan Khalilipur MD , Ata Firouzi MD , Zahra Khajali MD , Armin Elahifar MD , Sheyda Rimaz MD , Mani Moayerifar MD , Mahboobeh Gholipour MD , Elmira Aghaee Kiasaraee MD","doi":"10.1016/j.jscai.2025.104020","DOIUrl":"10.1016/j.jscai.2025.104020","url":null,"abstract":"<div><div>Atrial septal defect (ASD) is a common congenital heart condition in adults. We present a case of successful transcatheter closure of a 1.5-cm sinus venosus ASD in a 34-year-old man with exertional dyspnea. Using an innovative technique, two 43-mm XXL covered CVS Optimus stents were sutured together for enhanced support and delivered via the jugular and femoral veins. This dual-stent approach provides advantages over traditional methods, reducing surgical risks and recovery times. However, surgical intervention remains preferred for complex anatomical variations. This case highlights the effectiveness of a novel transcatheter technique for sinus venosus ASD closure.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 12","pages":"Article 104020"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145754217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jscai.2025.104018
Matthew C. Schwartz MD , Jorge Alegria MD , Jonathan Schwartz MD , Joseph Paolillo MD
The Melody valve (Medtronic) is commonly used for pulmonary valve replacement in patients with dysfunctional right ventricle to pulmonary artery conduits or bioprosthetic pulmonary valves. Rare reports exist of its use in the aortic position, including only 1 prior description of its use in a patient with hypoplastic left heart syndrome. We describe a 31-year-old patient with hypoplastic left heart syndrome who had severe neoaortic valve stenosis and moderate regurgitation that was successfully treated with percutaneous Melody valve placement in the neoaortic position.
{"title":"Case Report of Melody Valve Placement to Treat Neoaortic Valve Stenosis in an Adult With Fontan Circulation","authors":"Matthew C. Schwartz MD , Jorge Alegria MD , Jonathan Schwartz MD , Joseph Paolillo MD","doi":"10.1016/j.jscai.2025.104018","DOIUrl":"10.1016/j.jscai.2025.104018","url":null,"abstract":"<div><div>The Melody valve (Medtronic) is commonly used for pulmonary valve replacement in patients with dysfunctional right ventricle to pulmonary artery conduits or bioprosthetic pulmonary valves. Rare reports exist of its use in the aortic position, including only 1 prior description of its use in a patient with hypoplastic left heart syndrome. We describe a 31-year-old patient with hypoplastic left heart syndrome who had severe neoaortic valve stenosis and moderate regurgitation that was successfully treated with percutaneous Melody valve placement in the neoaortic position.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 12","pages":"Article 104018"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145754223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jscai.2025.103997
Tayyab Shah MD , Chantal Holy MSc, PhD , Ali Almedhychy MD , Jeffrey W. Moses MD , Helen Parise ScD , Alejandro Lemor MD , William W. O’Neill MD , Alexandra J. Lansky MD
Background
This study compares outcomes between percutaneous ventricular assist device (PVAD)-supported and intra-aortic balloon pump (IABP)-supported high-risk percutaneous coronary intervention (HRPCI) in a large-scale, contemporary hospital administrative dataset.
Methods
Patients undergoing HRPCI supported by PVAD or IABP between January 1, 2018, and April 30, 2024, were identified in the Premier Healthcare Database. Patients were excluded if they had cardiogenic shock and/or STEMI on admission, received mechanical circulatory support and PCI on different days, required emergent procedures, had multiple mechanical circulatory support devices used, or received coronary artery bypass grafting surgery within the same admission. Variable rate propensity score matching was conducted with 87 preprocedural variables including patient demographic characteristics, comorbidities, prior procedures, prior complications, and provider/hospital factors. The primary end point was the 90-day mortality, and secondary end points included major adverse cardiac and cerebrovascular events (defined as death, myocardial infarction, or stroke), new cardiogenic shock, 30-day acute kidney injury, in-hospital blood transfusions, length of stay, and discharge disposition.
Results
A total of 2416 patients who underwent PVAD-assisted HRPCI and 847 patients who underwent IABP-assisted HRPCI (mean age, 72 ± 10.4 years; 66% women; 19% non-White) were matched with good balance among all matched variables. Compared with those who received IABP support, those who received PVAD support had lower 90-day mortality (7.9% vs 11.8%; P = .01), lower 90-day major adverse cardiac and cerebrovascular events (10.3% vs 14.9%; P < .001), less postprocedural cardiogenic shock (9.5% vs 23.5%; P < .001), and less acute kidney injury (9.9% vs 15.6%; P < .001). PVAD-supported patients had shorter mean lengths of stay (4.3 vs 5.7 days; P < .001) and were more likely to be discharged to home. There were no significant differences in rates of blood transfusions (11.3% vs 10.3%; P = .43) or vascular complications between groups.
Conclusions
This retrospective observational study suggests that PVAD-supported HRPCI in nonshock patients may be associated with improved clinical outcomes compared with IABP-supported HRPCI; however, future randomized trials are required to confirm this finding.
本研究比较了当代大型医院管理数据集中经皮心室辅助装置（PVAD）支持和主动脉内球囊泵（IABP）支持的高危经皮冠状动脉介入治疗（HRPCI）的结果。方法2018年1月1日至2024年4月30日期间接受PVAD或IABP支持的HRPCI患者在Premier Healthcare数据库中进行识别。如果患者在入院时发生心源性休克和/或STEMI，在不同日期接受机械循环支持和PCI，需要紧急手术，使用多种机械循环支持装置，或在同一入院期间接受冠状动脉搭桥术，则排除患者。对87个术前变量进行可变率倾向评分匹配，包括患者人口统计学特征、合并症、既往手术、既往并发症和提供者/医院因素。主要终点是90天死亡率，次要终点包括主要的心脑血管不良事件（定义为死亡、心肌梗死或中风）、新的心源性休克、30天急性肾损伤、院内输血、住院时间和出院处置。结果共匹配2416例pvad辅助HRPCI患者和847例iabp辅助HRPCI患者（平均年龄72±10.4岁，女性66%，非白人19%），各匹配变量间平衡良好。与接受IABP支持的患者相比，接受PVAD支持的患者90天死亡率较低（7.9% vs 11.8%; P = 0.01）， 90天主要心脑血管不良事件较低（10.3% vs 14.9%; P < 0.001），术后心源性休克较少（9.5% vs 23.5%; P < 0.001），急性肾损伤较少（9.9% vs 15.6%; P < 0.001）。支持pad的患者平均住院时间较短（4.3天vs 5.7天；P < .001），出院回家的可能性更大。两组患者输血率（11.3% vs 10.3%; P = 0.43）和血管并发症发生率无显著差异。结论：这项回顾性观察性研究表明，与iabp支持的HRPCI相比，pad支持的非休克患者HRPCI可能与改善的临床结果相关；然而，需要未来的随机试验来证实这一发现。
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Pub Date : 2025-12-01DOI: 10.1016/j.jscai.2025.104043
Talal El Zarif MD , Cesar Caraballo MD , Angela M. Victoria-Castro MD , Israel Safiriyu MD , Maria Gabriela Gastanadui MD , David M. Dudzinski MD , Balimkiz Senman MD , Carlos Alviar MD , Guido Tavazzi MD , Andrea Elliott MD , Aniket S. Rali MD , Mark Jacobs MD , Jason N. Katz MD, MHS , Ann Gage MD , P. Elliott Miller MD, MHS
Background
The Society for Cardiovascular Angiography & Intervention (SCAI) SHOCK stages classification schema risk-stratifies patients with cardiogenic shock (CS). The updated 2022 SCAI SHOCK stages removed the use of respiratory support, either noninvasive (NIV) or invasive mechanical ventilation (IMV), as a criterion. We sought to investigate the impact of receiving respiratory support on in-hospital mortality for patients with CS stratified by SCAI SHOCK stages.
Methods
Utilizing a nationally representative database, adults aged ≥18 years admitted from 2015 to 2023 with a diagnosis of CS were used to assess for the association between respiratory support, either NIV or IMV, on the first day of admission, with in-hospital mortality stratified by SCAI SHOCK stages B through E. We utilized inverse probability treatment weighting, adjusting for demographic characteristics, comorbidities, hospital characteristics, and vasoactive/mechanical circulatory support.
Results
We identified 317,325 patients with CS, including 2.4%, 39.0%, 34.2%, and 24.5% with SCAI stages B through E, respectively. Respiratory support was utilized in 38.0% (n = 120,594) of patients, with 5.4% receiving NIV, 33.8% receiving IMV, and 1.1% receiving both on the first day of admission. After inverse probability treatment weighting, respiratory support use remained associated with an increased mortality overall (weighted mean mortality increase of 18.3%; 95% CI, 17.9%-18.7%), when stratified by each SCAI SHOCK stage and in several key sensitivity analyses.
Conclusions
Compared with patients not receiving respiratory support, the use of respiratory support was associated with an increased mortality for each SCAI stage of CS and could be a simple, easily identifiable CS risk modifier.
{"title":"Respiratory Support and Mortality Risk Across the Spectrum of Cardiogenic Shock Severity","authors":"Talal El Zarif MD , Cesar Caraballo MD , Angela M. Victoria-Castro MD , Israel Safiriyu MD , Maria Gabriela Gastanadui MD , David M. Dudzinski MD , Balimkiz Senman MD , Carlos Alviar MD , Guido Tavazzi MD , Andrea Elliott MD , Aniket S. Rali MD , Mark Jacobs MD , Jason N. Katz MD, MHS , Ann Gage MD , P. Elliott Miller MD, MHS","doi":"10.1016/j.jscai.2025.104043","DOIUrl":"10.1016/j.jscai.2025.104043","url":null,"abstract":"<div><h3>Background</h3><div>The Society for Cardiovascular Angiography & Intervention (SCAI) SHOCK stages classification schema risk-stratifies patients with cardiogenic shock (CS). The updated 2022 SCAI SHOCK stages removed the use of respiratory support, either noninvasive (NIV) or invasive mechanical ventilation (IMV), as a criterion. We sought to investigate the impact of receiving respiratory support on in-hospital mortality for patients with CS stratified by SCAI SHOCK stages.</div></div><div><h3>Methods</h3><div>Utilizing a nationally representative database, adults aged ≥18 years admitted from 2015 to 2023 with a diagnosis of CS were used to assess for the association between respiratory support, either NIV or IMV, on the first day of admission, with in-hospital mortality stratified by SCAI SHOCK stages B through E. We utilized inverse probability treatment weighting, adjusting for demographic characteristics, comorbidities, hospital characteristics, and vasoactive/mechanical circulatory support.</div></div><div><h3>Results</h3><div>We identified 317,325 patients with CS, including 2.4%, 39.0%, 34.2%, and 24.5% with SCAI stages B through E, respectively. Respiratory support was utilized in 38.0% (n = 120,594) of patients, with 5.4% receiving NIV, 33.8% receiving IMV, and 1.1% receiving both on the first day of admission. After inverse probability treatment weighting, respiratory support use remained associated with an increased mortality overall (weighted mean mortality increase of 18.3%; 95% CI, 17.9%-18.7%), when stratified by each SCAI SHOCK stage and in several key sensitivity analyses.</div></div><div><h3>Conclusions</h3><div>Compared with patients not receiving respiratory support, the use of respiratory support was associated with an increased mortality for each SCAI stage of CS and could be a simple, easily identifiable CS risk modifier.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 12","pages":"Article 104043"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145754174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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