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Is Minimum Lumen Diameter the Main Determinant of the Diagnostic Performance of Angiography-Based Vessel Fractional Flow Reserve? 最小管腔直径是基于血管造影的血管分流储备诊断性能的主要决定因素吗?
Pub Date : 2026-01-01 DOI: 10.1016/j.jscai.2025.104055
Asahi Oshima MD , Tsung-Ying Tsai MD, PhD , Chun-Chin Chang MD, PhD , Kai Ninomiya MD, PhD , Kotaro Miyashita MD , Akihiro Tobe MD , Nozomu Kanehama MD , Chun-Ting Shih MD , Adrian Bednarek , Ryo Torii PhD , Scot Garg MD, PhD , Albert Chinhenzva MSc, MPH , Yoshinobu Onuma MD, PhD , Patrick W. Serruys MD, PhD
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引用次数: 0
First Report of Intentional Intraplaque Lithotripsy After Aggressive Wire Recanalization in Calcified Atheroma and Dilatation (ARCADIA-SHOCK) 钙化动脉粥样硬化和扩张患者主动导线再通后有意的斑块内碎石术首例报道(ARCADIA-SHOCK)
Pub Date : 2026-01-01 DOI: 10.1016/j.jscai.2025.104106
Jeffrey C.Y. Lee MBBS , Timothy H.H. Kam MD , Yasunari Sakamoto MD , Guangming Tan MBChB , Bryan P. Yan MBBS, MD
Eccentric calcified plaque remains a challenge in the endovascular treatment of peripheral arterial disease despite technological advancements. The "aggressive wire recanalization in calcified atheroma and dilatation" technique was invented to overcome this by intentional intraplaque wiring followed by atherectomy; however, distal embolization can ensue. Substitution with intravascular lithotripsy may be safer and equally effective. To the best of our knowledge, we performed the first case of intentional intraplaque lithotripsy to successfully treat a claudicant patient with heavily calcified bilateral superficial femoral arteries without complications. This may be considered a new technique variation to treat eccentric calcium.
尽管技术进步,偏心钙化斑块仍然是外周动脉疾病血管内治疗的一个挑战。“钙化动脉粥样硬化和扩张的积极导线再通”技术的发明就是为了克服这一问题,通过有意在斑块内布线,然后进行动脉粥样硬化切除术;然而,远端栓塞可能随之而来。用血管内碎石术替代可能更安全,同样有效。据我们所知,我们进行了第一例有意的斑块内碎石术,成功地治疗了双侧股浅动脉严重钙化的跛行患者,没有并发症。这可能被认为是治疗偏心钙的一种新技术变异。
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引用次数: 0
Pharmacokinetic Profile of Everolimus Eluted From the Esprit BTK Scaffold: A LIFE-BTK Pharmacokinetics Substudy Esprit BTK支架洗脱依维莫司的药代动力学特征:LIFE-BTK药代动力学亚研究
Pub Date : 2026-01-01 DOI: 10.1016/j.jscai.2025.104107
Jen-Kuang Lee MD , Richard Pin MD , Shirley Jansen MBChB, PhD , Anderson P. Mehrle MD , Yazan Khatib MD , Prakash Krishnan MD , Brian G. DeRubertis MD , Ramon L. Varcoe MBBS, MS, PhD, MMed , Anette Popiel MS , Sandeep C. Pingle MD, PhD , Karine Ruster PhD , Sahil A. Parikh MD

Background

The most severe manifestation of peripheral artery disease, chronic limb-threatening ischemia, is associated with limited treatment options for below-the-knee (BTK) arteries. The Esprit BTK everolimus-eluting resorbable scaffold system (Abbott), now approved by the U.S. Food and Drug Administration for the treatment of infrapopliteal lesions in patients with chronic limb-threatening ischemia, was evaluated in the LIFE-BTK randomized controlled trial. LIFE-BTK included a nonrandomized substudy evaluating the pharmacokinetic (PK) profile of everolimus eluted from the scaffold.

Methods

The PK substudy enrolled 9 subjects across 2 treatment groups (with or without drug-coated balloon use for inflow lesion and/or nontarget lesion treatment). Blood concentration-time profiles and PK parameters were determined at multiple time points and compared with prior PK results from the Absorb bioresorbable vascular scaffold.

Results

The number of implanted scaffolds averaged 6.6 ± 0.9, with a total length ranging from 180 to 256 mm and an everolimus dose ranging from 1397 to 2074 μg per subject. The last time point at which everolimus could be quantified ranged from 168 to 720 hours, and in most cases, the blood concentrations dropped below the lower limit of quantification (0.1 ng/mL) before 720 hours. Peak blood everolimus levels were followed by a biexponential decline, with terminal phase half-life ranging from 65.6 to 211.2 hours. A regression analysis using dose-normalized maximum blood everolimus concentration and area under the blood concentration-time curve confirmed similar everolimus exposure across the treatment groups.

Conclusions

The present substudy assessed the PK of everolimus delivered by Esprit BTK in the planned treatment of narrowed infrapopliteal lesions. This study confirms that the PK profile of everolimus eluted from the Esprit BTK scaffold results in limited systemic exposure and is considered to be safe and well tolerated.
外周动脉疾病最严重的表现是慢性肢体威胁缺血,这与膝关节以下(BTK)动脉的治疗选择有限有关。Esprit BTK依维莫司洗脱可吸收支架系统(Abbott)目前已被美国食品和药物管理局批准用于治疗慢性肢体缺血患者的腘下动脉病变,并在LIFE-BTK随机对照试验中进行了评估。LIFE-BTK包括一项非随机亚研究,评估从支架洗脱的依维莫司的药代动力学(PK)谱。方法PK亚研究分为2个治疗组(有或没有使用药物包被球囊治疗流入性病变和/或非靶性病变),共9名受试者。在多个时间点测定血药浓度-时间曲线和PK参数,并与之前吸收生物可吸收血管支架的PK结果进行比较。结果植入支架平均6.6±0.9个,总长度为180 ~ 256 mm,依维莫司剂量为1397 ~ 2074 μg /例。依维莫司最后可定量的时间点为168 ~ 720小时,多数病例在720小时前血药浓度降至定量下限(0.1 ng/mL)以下。依维莫司血药浓度达到峰值后呈双指数下降,终末半衰期为65.6 ~ 211.2小时。使用剂量归一化的最大依维莫司血药浓度和血药-时间曲线下面积进行回归分析,证实各治疗组依维莫司暴露相似。结论本亚研究评估了依维莫司在Esprit BTK计划治疗腘窝下狭窄病变中的PK。该研究证实,从Esprit BTK支架中洗脱的依维莫司的PK谱导致有限的全身暴露,被认为是安全且耐受性良好的。
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引用次数: 0
Clinical Presentation, Management, and Outcomes of Access-Related Radial Artery Pseudoaneurysms: A Single-Center, Retrospective Cohort Study 通道相关桡动脉假性动脉瘤的临床表现、治疗和预后:一项单中心、回顾性队列研究
Pub Date : 2026-01-01 DOI: 10.1016/j.jscai.2025.104065
Michael Vlach MD , Aqsa Choudhry MSc , Rhythm Vasudeva MD , Mohinder Vindhyal MD , Prasad Gunasekaran MD , Gaurav Parmar MD , Georges Haj MD , J.D. Serfas MD , Mark Wiley MD , Peter Tadros MD , Eric Hockstad MD , Anthony Spaedy MD , Seth Decamp MD , Kamal Gupta MD

Background

Radial artery pseudoaneurysm (RAP) is a rare complication of procedural radial access. There is a paucity of data regarding clinical presentation, characteristics, and management.

Methods

We identified patients with RAP by querying our center’s electronic medical records. A manual chart review was performed, and a descriptive analysis was conducted.

Results

We identified 35 patients with RAP (mean age, 68.3 years; 62.9% women). Of these, 71.4 % of pseudoaneurysms were caused by arterial access for coronary procedures. Sixty percent were on anticoagulation. The most common symptoms were swelling (88.6%) and pain (45.7%). The median time from procedure to diagnosis was 13 days (IQR, 1-33.5 days), and the median time from procedure to symptom onset was 1 day (IQR, 0-8.5 days). Initial treatment modality was mechanical compression in 19 patients (54.3%). Of those who underwent compression, the RAP thrombosed in 9 patients (47.4%) and failed in 10 patients (52.6%) who then underwent successful surgical repair. Those with RAP resolution with compression had a shorter time to ultrasound diagnosis (1 vs 6.5 days) and smaller size (1.6 vs 2.4 cm). Surgery was successful in all but 1 patient.

Conclusion

Study findings show that RAPs often present several days after the index procedure, although symptoms occur much earlier. The RAPs occur disproportionately in women and those on anticoagulation. Compression is successful in only half the patients. Earlier presentation and smaller size predict success. Surgery is almost universally successful, and thrombin injection is rarely used. Our results suggest a need for prospective studies to assess strategies for earlier identification of RAP.
桡动脉假性动脉瘤(RAP)是手术桡动脉入路中一种罕见的并发症。缺乏关于临床表现、特征和管理的数据。方法通过查询本中心电子病历对RAP患者进行鉴定。进行手工图表回顾,并进行描述性分析。结果35例RAP患者(平均年龄68.3岁,女性62.9%)。其中,71.4%的假性动脉瘤是由冠状动脉手术引起的。60%的患者使用抗凝剂。最常见的症状是肿胀(88.6%)和疼痛(45.7%)。从手术到诊断的中位时间为13天(IQR, 1-33.5天),从手术到症状出现的中位时间为1天(IQR, 0-8.5天)。19例患者(54.3%)的初始治疗方式为机械压迫。在接受压迫的患者中,9例(47.4%)患者RAP血栓形成,10例(52.6%)患者RAP血栓形成失败,这些患者随后接受了成功的手术修复。RAP分辨率压缩组超声诊断时间较短(1天vs 6.5天),尺寸较小(1.6厘米vs 2.4厘米)。除1例患者外,其余患者手术均成功。结论研究结果显示,尽管症状出现得更早,但rap通常在指数手术后几天出现。rap在女性和抗凝治疗患者中不成比例地发生。只有一半的病人按压成功。更早的展示和更小的尺寸预示着成功。手术几乎是普遍成功的,凝血酶注射很少使用。我们的结果表明需要前瞻性研究来评估早期识别RAP的策略。
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引用次数: 0
Simultaneous Dual Left Atrial Appendage Occlusion Devices in a Single Setting—A Case Report 同时双左心耳闭塞装置一例报告
Pub Date : 2026-01-01 DOI: 10.1016/j.jscai.2025.104042
Asim Mohiuddin MD, Mohammed Salih MD, Abdallah Assaf MD, Adam Abd El-Kader MS, Will Hobbs MS, Ahmed Elkaialy MD, Ralph Matar MD, Karim Al-Azizi MD
Left atrial appendage occlusion has become an important minimally invasive treatment option for patients with atrial fibrillation who previously interrupted or permanently discontinued oral anticoagulation due to bleeding risks or complications. The effectiveness of the therapy relies on the safety of device deployment and the complete closure of the left atrial appendage (LAA) with no peridevice leaks. The variability of the LAA anatomy seen on preprocedural imaging requires a tailored approach for successful exclusion. We hereby present a patient with a large multilobar LAA that required 2 simultaneous Amulet devices to achieve complete exclusion of the appendage.
对于因出血风险或并发症而中断或永久停止口服抗凝治疗的心房颤动患者,左心耳闭塞已成为一种重要的微创治疗选择。治疗的有效性依赖于装置部署的安全性和左心房附件(LAA)的完全关闭,没有装置周围泄漏。手术前影像学上看到的LAA解剖结构的可变性需要量身定制的方法来成功排除。我们在此报告一位患有大多叶LAA的患者,需要同时使用2个护身符装置来实现完全排除附属物。
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引用次数: 0
A New Lens on Radiation Risk: Why Outliers Matter 辐射风险的新视角:为什么异常值很重要
Pub Date : 2026-01-01 DOI: 10.1016/j.jscai.2025.104118
Zaid Almarzooq MD, MPH , Celina M. Yong MD, MBA, MSc
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引用次数: 0
Sex-Specific Coronary Artery Calcium Score Thresholds Predictive of Obstructive Coronary Artery Disease: Ready for Prime Time? 性别特异性冠状动脉钙评分阈值预测阻塞性冠状动脉疾病:准备好黄金时间了吗?
Pub Date : 2026-01-01 DOI: 10.1016/j.jscai.2025.104113
Khansa Ahmad MD , Islam Y. Elgendy MD
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引用次数: 0
Standards for Comparative Radiation Protection Research 比较辐射防护研究标准
Pub Date : 2026-01-01 DOI: 10.1016/j.jscai.2025.104051
Rhian E. Davies DO, MS, David A. Cox MD, Lancer Smith MS
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引用次数: 0
National Trends in Impella Utilization for Older Adult Patients With ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock 老年st段抬高型心肌梗死合并心源性休克患者使用Impella的全国趋势
Pub Date : 2026-01-01 DOI: 10.1016/j.jscai.2025.104056
Andres Cordova Sanchez MD , Jesse Kane MD , Tanush Gupta MD , Hanna R. Murphy PhD , Alyssa H. Harris MPH , Harold L. Dauerman MD

Background

Current guidelines recommend implantation of a microaxial flow pump (mAFP) for selected patients with ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (STEMI-CS). Although the DanGer Shock trial showed a mortality benefit with mAFP, a secondary analysis suggested that older adult patients may not experience the same benefit. This study evaluated the temporal trends in mAFP utilization and hospital mortality in older (≥75 years) vs younger STEMI-CS patients.

Methods

Using the International Classification of Diseases, 10th Revision (ICD-10-CM) procedure codes from 344 hospitals with continuous data between 2016 and 2024 from the Vizient Clinical Data Base, we identified 20,692 patients undergoing percutaneous coronary intervention (PCI) for STEMI-CS. Temporal trends in mAFP use and mortality were stratified by older (≥75 years) vs younger age groups. Multivariable logistic regressions identified the predictors of hospital mortality.

Results

Among 20,692 STEMI-CS patients undergoing PCI, 25% were ≥75 years. Older age was the strongest independent predictor of hospital mortality for STEMI-CS patients (odds ratio, 1.87; 95% CI, 1.75-2.00). Between 2016 and 2024, mAFP use for STEMI-CS increased from 9.3% to 21.5% in patients ≥75 years old and from 14% to 25.6% in patients <75 years old (P value for trend = .05 and .02, respectively). Mortality declined in mAFP patients <75 years old (45% in 2016 vs 38% in 2024; P = .003). The mortality rate for older PCI patients with STEMI-CS and mAFP utilization was consistently above 50%.

Conclusions

Approximately 1 in 5 older STEMI-CS patients received mAFP, with use more than doubling since 2016. Although mortality declined significantly in mAFP-treated younger STEMI-CS PCI patients, mortality in the older group remained approximately 60% higher than that of younger patients at all time points.
背景:目前的指南推荐对st段抬高型心肌梗死(STEMI)合并心源性休克(STEMI- cs)的患者植入微轴流泵(mAFP)。尽管DanGer Shock试验显示mAFP对死亡率有好处,但一项二次分析表明,老年患者可能没有同样的好处。本研究评估老年(≥75岁)与年轻STEMI-CS患者mAFP使用和住院死亡率的时间趋势。方法使用国际疾病分类第十版(ICD-10-CM)程序代码,从344家医院(2016 - 2024年来自Vizient临床数据库的连续数据)中筛选出20,692例经皮冠状动脉介入治疗(PCI)的STEMI-CS患者。mAFP使用和死亡率的时间趋势按老年(≥75岁)和年轻年龄组分层。多变量logistic回归确定了医院死亡率的预测因子。结果在20692例接受PCI的STEMI-CS患者中,25%的患者年龄≥75岁。年龄是STEMI-CS患者住院死亡率最强的独立预测因子(优势比1.87;95% CI 1.75-2.00)。2016年至2024年间,≥75岁的STEMI-CS患者使用mAFP从9.3%增加到21.5%,75岁的患者从14%增加到25.6% (P值为趋势值= 0.05和P值= 0.05)。02年,分别)。75岁以上的mAFP患者死亡率下降(2016年为45%,2024年为38%;P = 0.003)。STEMI-CS和mAFP使用的老年PCI患者的死亡率始终高于50%。结论:大约1 / 5的老年STEMI-CS患者接受了mAFP治疗,自2016年以来使用了一倍多。尽管mafp治疗的年轻STEMI-CS PCI患者死亡率显著下降,但在所有时间点,老年组的死亡率仍比年轻患者高约60%。
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引用次数: 0
Cover 封面
Pub Date : 2026-01-01 DOI: 10.1016/j.jscai.2025.104197
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引用次数: 0
期刊
Journal of the Society for Cardiovascular Angiography & Interventions
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