Journal of the Society for Cardiovascular Angiography & Interventions最新文献

英文中文

Comment on “Comparative Effectiveness of 2 Next-Generation Scatter Radiation Shielding Systems” 对“两种新一代散射辐射屏蔽系统的有效性比较”的评论

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2026-01-01 DOI: 10.1016/j.jscai.2025.104052

David G. Rizik MD

引用次数: 0

Response to Letters to the Editor Re: “Comparative Effectiveness of 2 Next-Generation Scatter Radiation Shielding Systems” 回复编者回复：“两种新一代散射辐射屏蔽系统的效能比较”

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2026-01-01 DOI: 10.1016/j.jscai.2025.104071

Robert F. Riley MD, Stephen Kidd MD, Brian Stegman MD, Thom G. Dahle MD

引用次数: 0

Efficacy and Safety of Solitaire Revascularization Device in Managing Refractory Thrombus in Acute Coronary Syndrome 接龙血运重建器治疗急性冠脉综合征难治性血栓的疗效和安全性

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-12-01 DOI: 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.

背景：在缺血性卒中治疗中使用支架回收器已被证明可以改善预后。关于支架回收器治疗冠状动脉内血栓的数据是有限的。本研究旨在评估Solitaire血运重建器（Medtronic）治疗顽固性冠状动脉内血栓的安全性和有效性。方法对经常规方法治疗后急性冠脉综合征合并大血栓残留的患者，应用Solitaire装置治疗。主要疗效终点为成功再通率，定义为术后心肌梗死溶栓（TIMI）血流增加至≥2或血栓分级（TG）降低至≤2。次要终点包括术后TG和心肌红晕等级的改善。主要的安全终点是卒中的发生。结果在2019年6月至2022年11月期间，51名患者使用Solitaire装置进行了血栓切除术。使用接龙后估计再通成功率为76.5% (95% CI, 62.0%-87.2%)，手术结束时估计再通成功率为92.2% （95% CI, 81.1%-97.8%）。接龙后28例（54.9%）患者TG降至≤2，手术结束时43例（84.3%）患者TG降至≤2。接龙后心肌红肿分级改善显著，改善率为40% (95% CI, 22.7%-59.4%)，手术结束时改善率为66.7% （95% CI, 47.2%-82.7%）。手术后或出院后30天内均无卒中发生。结论接龙器是治疗顽固性冠状动脉内血栓的有效辅助工具，并发症发生率低。

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引用次数: 0

Contemporary Chronic Limb-Threatening Ischemia Care in the United States—Part 1: A Path Toward Multispecialty Collaboration 当代美国慢性肢体威胁缺血护理第一部分：多专业合作之路

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-12-01 DOI: 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.

慢性肢体威胁缺血（CLTI）患者的护理是复杂的，当多个专业合作时，它是最有效的。最近，CLTI患者主要肢体截肢的上升趋势保证了对这种多方面疾病的优化护理的新努力。血管介入进展（VIVA）基金会是一个非营利性的501(c)(3)组织，于2024年召开了一个血管领袖论坛，就美国CLTI护理状况以及目前在提供和获得此类护理方面面临的挑战发起了一个开放的、多专业的讨论。该论坛由来自血管外科、介入心脏病学、介入放射学、血管医学、足病学、监管机构、医疗器械制造商、患者倡导以及CLTI和CLTI护理人员的代表组成。本文探讨了CLTI护理挑战的中心主题，以及跨专业和护理环境合作可以改善CLTI结果的方式。总之，建议综合的CLTI护理团队超越血管外科、介入心脏病学和介入放射学，包括血管医学、足病学、伤口护理、糖尿病学和营养学。为了满足对CLTI血运重建术日益增长的需求，这些团队需要跨越三级保健医院、社区医院、门诊血运重建术诊所和初级保健机构。

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引用次数: 0

Contemporary Chronic Limb-Threatening Ischemia Care in the United States—Part 2: Designing Clinical Device Trials 当代美国慢性肢体威胁缺血护理：第二部分：设计临床设备试验

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-12-01 DOI: 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.

比较慢性肢体威胁缺血（CLTI）侵袭性血供重建术的头对头研究很少，部分原因是在CLTI领域进行随机对照试验存在挑战。这些包括正面试验的费用，优化现实世界适用性的患者选择标准，以及确定最佳研究终点。血管介入进展（VIVA）基金会，一个501(c)(3)非营利组织，召集了一个血管领导者论坛，发起了一个开放的，多专业的合作讨论这些挑战和优化CLTI医疗器械试验设计的方法。本文总结了血管外科、介入心脏病学、介入放射学、血管医学、足病学、美国食品和药物管理局以及一家医疗器械制造商代表提出的CLTI血运重建策略和设计比较试验的临床研究现状。确定了四个广泛的领域来优化CLTI干预措施的比较试验。首先，应仔细选择主要终点，注意临床、以患者为中心、影像学和分层考虑；标准化;包括指导方针导向的医学治疗。其次，更广泛的资格标准可以扩大和加速登记，对于收集在现实世界中经常遇到的医学复杂患者的结果的证据很重要。第三，将主要终点时间延长至12个月，并将额外的随访时间延长至24至60个月，将适应更长的设备评估期，并能够提高临床终点率。最后，需要创新实用的试验设计和统计方法，以进行全面、具有成本效益、相关的试验，具有足够的统计能力，而不是过于庞大的样本量和研究持续时间。

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引用次数: 0

Percutaneous Pulmonary Valve Perforation in Pulmonary Atresia With Intact Ventricular Septum: Multicenter Comparison of Radiofrequency Versus Chronic Total Occlusion Wires 经皮肺动脉瓣穿孔并发完整室间隔肺动脉闭锁：多中心射频与慢性全闭塞钢丝的比较

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-12-01 DOI: 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。

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引用次数: 0

MANTA vs Perclose for Large-Bore Femoral Closure in Impella-Assisted High-Risk Percutaneous Coronary Intervention: Retrospective Outcomes Study 在impella辅助的高风险经皮冠状动脉介入治疗中，大孔股动脉闭合的MANTA与Perclose：回顾性结果研究

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-12-01 DOI: 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

引用次数: 0

Revisiting Bioresorbable Scaffolds in Light of the SCAAR Study 从SCAAR研究的角度重新审视生物可吸收支架

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-12-01 DOI: 10.1016/j.jscai.2025.104050

Tirayut Veerasathian MD, Schawanya K. Rattanapitoon MD, Nav La MD, PhD, Nathkapach K. Rattanapitoon PhD

引用次数: 0

Innovative Double-Covered Stent Connection With Suture Thread for Transcatheter Sinus Venosus Atrial Septal Defect Closure: Case Report 经导管静脉窦房间隔缺损缝线双覆盖支架连接1例报告

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-12-01 DOI: 10.1016/j.jscai.2025.104020

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

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.

房间隔缺损（ASD）是成人常见的先天性心脏病。我们提出一个病例成功经导管关闭1.5厘米静脉窦ASD在34岁的男性用力呼吸困难。采用一种创新技术，将两个43毫米XXL覆盖CVS Optimus支架缝合在一起，以增强支持，并通过颈静脉和股静脉输送。与传统方法相比，这种双支架方法具有优势，减少了手术风险和恢复时间。然而，对于复杂的解剖变异，手术干预仍然是首选。本病例强调了一种新型经导管技术对静脉窦ASD闭合的有效性。

引用次数: 0

Case Report of Melody Valve Placement to Treat Neoaortic Valve Stenosis in an Adult With Fontan Circulation 旋律瓣置入术治疗成人Fontan循环新主动脉瓣狭窄1例报告

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-12-01 DOI: 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.

Melody瓣膜（美敦力）通常用于右心室到肺动脉导管功能不全或生物假体肺瓣膜的患者的肺瓣膜置换术。很少有报道将其用于主动脉位置，其中只有1例报道将其用于左心发育不全综合征患者。我们描述了一位31岁的左心发育不全综合征患者，他有严重的新主动脉瓣狭窄和中度反流，经皮在新主动脉瓣位置置放瓣膜成功治疗。

引用次数: 0

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