Pub Date : 2025-12-01DOI: 10.1016/j.jscai.2025.103944
Enrique Soltero Mariscal MD , Alexander Slotwiner MD , Boutros Karam MD , Dimitrios Bliagos MD , Louai Razzouk MD, MPH , Binita Shah MD, MS , Sripal Bangalore MD, MHA , Sunil V. Rao MD , Atul Sharma MD
Background
Stenting of bifurcation and non–aorto-ostial coronary lesions presents significant challenges due to geographic miss and restenosis. Drug-coated balloons (DCBs) offer an attractive alternative to drug-eluting stents in the treatment of these lesions.
Methods
We conducted a systematic review of studies published from 2001 to 2024 comparing DCBs with plain old balloon angioplasty and/or drug-eluting stents (DES) in de novo coronary bifurcation lesions and non–aorto-ostial (NAO) lesions. A meta-analysis was performed with target lesion failure (TLF) as the selected outcome, defined as a composite of target lesion revascularization, target vessel myocardial infarction, or cardiovascular death.
Results
Eleven studies (4 randomized controlled trials and 7 observational) comprising 2443 patients were included. The median follow-up was 12 months. A random-effects model was applied to account for differences in study design and population despite a low heterogeneity among the studies (I2 < 25%). The pooled risk ratio (RR) for TLF was 0.52 (95% CI, 0.40-0.68; P < .0001). Subgroup analysis for randomized controlled trials, coronary bifurcation lesions, NAO lesions, and DES comparator revealed RRs of 0.55 (95% CI, 0.36-0.83; P = .0043), 0.51 (95% CI, 0.38-0.70; P < .0001), 0.54 (95% CI, 0.31-0.95; P = .034), and 0.53 (95% CI, 0.36-0.79; P = .0015), respectively.
Conclusions
In our meta-analysis, DCBs were associated with a lower rate of TLF compared with plain old balloon angioplasty and DES. These findings suggest that DCBs could be preferred for the treatment of bifurcation and NAO lesions.
背景：分叉和非主动脉口冠状动脉病变的支架植入术由于地理位置的遗漏和再狭窄而面临重大挑战。药物包被球囊（DCBs）为治疗这些病变提供了一种有吸引力的替代药物洗脱支架。方法：我们对2001年至2024年发表的研究进行了系统回顾，比较DCBs与普通旧球囊血管成形术和/或药物洗脱支架（DES）在新发冠状动脉分叉病变和非主动脉-口（NAO）病变中的应用。一项荟萃分析以靶病变失败（TLF）作为选择的结果，定义为靶病变血运重建、靶血管心肌梗死或心血管死亡的组合。结果纳入4项随机对照试验和7项观察性研究，共2443例患者。中位随访时间为12个月。应用随机效应模型来解释研究设计和人群的差异，尽管研究之间的异质性较低（I2 < 25%）。TLF的合并风险比（RR）为0.52 （95% CI, 0.40-0.68; P < 0.0001）。随机对照试验、冠状动脉分叉病变、NAO病变和DES比较物的亚组分析显示，相对危险度分别为0.55 （95% CI, 0.36-0.83; P = 0.0043）、0.51 （95% CI, 0.38-0.70; P < 0.0001）、0.54 （95% CI, 0.31-0.95; P = 0.034）和0.53 （95% CI, 0.36-0.79; P = 0.0015）。结论在我们的荟萃分析中，与普通球囊成形术和DES相比，DCBs与TLF发生率较低相关。这些发现表明DCBs可首选用于治疗分叉和NAO病变。
{"title":"Drug-Coated Balloons for De Novo Non–aorto-ostial and Coronary Bifurcation Lesions: A Systematic Review and Meta-analysis","authors":"Enrique Soltero Mariscal MD , Alexander Slotwiner MD , Boutros Karam MD , Dimitrios Bliagos MD , Louai Razzouk MD, MPH , Binita Shah MD, MS , Sripal Bangalore MD, MHA , Sunil V. Rao MD , Atul Sharma MD","doi":"10.1016/j.jscai.2025.103944","DOIUrl":"10.1016/j.jscai.2025.103944","url":null,"abstract":"<div><h3>Background</h3><div>Stenting of bifurcation and non–aorto-ostial coronary lesions presents significant challenges due to geographic miss and restenosis. Drug-coated balloons (DCBs) offer an attractive alternative to drug-eluting stents in the treatment of these lesions.</div></div><div><h3>Methods</h3><div>We conducted a systematic review of studies published from 2001 to 2024 comparing DCBs with plain old balloon angioplasty and/or drug-eluting stents (DES) in de novo coronary bifurcation lesions and non–aorto-ostial (NAO) lesions. A meta-analysis was performed with target lesion failure (TLF) as the selected outcome, defined as a composite of target lesion revascularization, target vessel myocardial infarction, or cardiovascular death.</div></div><div><h3>Results</h3><div>Eleven studies (4 randomized controlled trials and 7 observational) comprising 2443 patients were included. The median follow-up was 12 months. A random-effects model was applied to account for differences in study design and population despite a low heterogeneity among the studies (<em>I</em><sup>2</sup> < 25%). The pooled risk ratio (RR) for TLF was 0.52 (95% CI, 0.40-0.68; <em>P</em> < .0001). Subgroup analysis for randomized controlled trials, coronary bifurcation lesions, NAO lesions, and DES comparator revealed RRs of 0.55 (95% CI, 0.36-0.83; <em>P</em> = .0043), 0.51 (95% CI, 0.38-0.70; <em>P</em> < .0001), 0.54 (95% CI, 0.31-0.95; <em>P</em> = .034), and 0.53 (95% CI, 0.36-0.79; <em>P</em> = .0015), respectively.</div></div><div><h3>Conclusions</h3><div>In our meta-analysis, DCBs were associated with a lower rate of TLF compared with plain old balloon angioplasty and DES. These findings suggest that DCBs could be preferred for the treatment of bifurcation and NAO lesions.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 12","pages":"Article 103944"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145754177","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/S2772-9303(25)01595-9
{"title":"Cover","authors":"","doi":"10.1016/S2772-9303(25)01595-9","DOIUrl":"10.1016/S2772-9303(25)01595-9","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 12","pages":"Article 104149"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145754169","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.2025.104016
Megan Coylewright MD, MPH
{"title":"Coming of Age: Facing Growing Pains in Structural Heart Interventions With Innovative Imaging Solutions","authors":"Megan Coylewright MD, MPH","doi":"10.1016/j.jscai.2025.104016","DOIUrl":"10.1016/j.jscai.2025.104016","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 12","pages":"Article 104016"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145753810","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.2025.103922
Fatima Ali MBBS , Laila Akbar Ladak PhD , Asra Usmani MD , Mahnoor Javaid MBBS , Taha Anwar BA , Babar Sultan Hasan MBBS
Background
In Pakistan, where health care resources for congenital heart disease (CHD) are expanding, this study aimed to assess the health-related quality of life (HRQoL), challenges, and experiences of patients with CHD after cardiac catheterization. Using a mixed-methods approach, quantitative arm compared the HRQoL of patients with CHD with that of age-matched siblings identified predictors of low HRQoL scores, and qualitative arm explored patient’s perceptions of quality of life, the challenges, and their experiences.
Methods
In this prospective, cross-sectional study conducted at The Aga Khan University Hospital, quantitative data were collected via pediatric quality-of-life questionnaires from 120 case–control pairs, while qualitative insights were gathered through semistructured interviews. Data analysis used descriptive stats, paired t tests, and content analysis for HRQoL themes.
Results
A total of 320 interviews were analyzed, including 120 patients with CHD, 120 age-matched siblings, and 80 parents. Quantitative data revealed high scores with no significant HRQoL differences between patients with CHD and controls. Minor differences were observed in physical and emotional domains, and higher-risk patients showed few concerns in cardiac-related HRQoL. Predictors such as age at diagnosis and Procedural Risk in Congenital Cardiac Catheterization (PREDIC3T) category were associated with low HRQoL scores. Qualitative thematic analysis highlighted the importance of physical and mental well-being, the impact of financial stability, and the need for empathetic communication from health care providers.
Conclusions
This study found high HRQoL scores in patients with CHD after cardiac catheterization, with significant associations of low scores to late age at diagnosis and PREDIC3T categories. Despite these positive outcomes, challenges like access to care and national support highlight the need for systemic improvements.
{"title":"Health-Related Quality of Life, Challenges, and Experiences of Patients With Congenital Heart Disease After Cardiac Catheterization: A Mixed-Methods Study","authors":"Fatima Ali MBBS , Laila Akbar Ladak PhD , Asra Usmani MD , Mahnoor Javaid MBBS , Taha Anwar BA , Babar Sultan Hasan MBBS","doi":"10.1016/j.jscai.2025.103922","DOIUrl":"10.1016/j.jscai.2025.103922","url":null,"abstract":"<div><h3>Background</h3><div>In Pakistan, where health care resources for congenital heart disease (CHD) are expanding, this study aimed to assess the health-related quality of life (HRQoL), challenges, and experiences of patients with CHD after cardiac catheterization. Using a mixed-methods approach, quantitative arm compared the HRQoL of patients with CHD with that of age-matched siblings identified predictors of low HRQoL scores, and qualitative arm explored patient’s perceptions of quality of life, the challenges, and their experiences.</div></div><div><h3>Methods</h3><div>In this prospective, cross-sectional study conducted at The Aga Khan University Hospital, quantitative data were collected via pediatric quality-of-life questionnaires from 120 case–control pairs, while qualitative insights were gathered through semistructured interviews. Data analysis used descriptive stats, paired <em>t</em> tests, and content analysis for HRQoL themes.</div></div><div><h3>Results</h3><div>A total of 320 interviews were analyzed, including 120 patients with CHD, 120 age-matched siblings, and 80 parents. Quantitative data revealed high scores with no significant HRQoL differences between patients with CHD and controls. Minor differences were observed in physical and emotional domains, and higher-risk patients showed few concerns in cardiac-related HRQoL. Predictors such as age at diagnosis and Procedural Risk in Congenital Cardiac Catheterization (PREDIC<sup>3</sup>T) category were associated with low HRQoL scores. Qualitative thematic analysis highlighted the importance of physical and mental well-being, the impact of financial stability, and the need for empathetic communication from health care providers.</div></div><div><h3>Conclusions</h3><div>This study found high HRQoL scores in patients with CHD after cardiac catheterization, with significant associations of low scores to late age at diagnosis and PREDIC<sup>3</sup>T categories. Despite these positive outcomes, challenges like access to care and national support highlight the need for systemic improvements.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 12","pages":"Article 103922"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145754222","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 : 2025-11-01DOI: 10.1016/j.jscai.2025.104001
Rick H.J.A. Volleberg MD , Doosup Shin MD , Richard A. Shlofmitz MD , Aziz Maksoud MD , Bassem Chehab MD , Kanitha Phalakornkule PhD , Jana Buccola MS , Nutte Tarn Teraphongphom PhD , Ajay Gopinath PhD , Ashley Netravali MS , Ziad A. Ali MD, DPhil , Allen Jeremias MD, MSc
Background
Physiological indices and intracoronary imaging provide additional and complementary information to coronary angiography, which may enhance procedural decision making during percutaneous coronary intervention (PCI). This study aimed to evaluate the impact of fractional flow reserve (FFR) and optical coherence tomography (OCT) on revascularization decision making and PCI strategy compared with angiography guidance alone.
Methods
In this secondary analysis from the prospective, observational FUSION (Validation of OCT-Based Functional Diagnosis of Coronary Stenosis) study, the impact of angiography, OCT, and FFR on procedural decision making was evaluated by comparing the intended treatment strategy after each step to the actual treatment strategy, which was left to the operator’s discretion and was guided by the totality of diagnostic testing.
Results
Among 224 patients (mean age, 67.4 ± 9.2 years; 30.8% women), 116 (51.8%) underwent coronary revascularization, while it was deferred in 108 (48.2%). Compared with the actual treatment strategy, the rate of intended revascularization was significantly higher when guided by angiography (62.5% vs 51.8%; P = .002) or OCT (66.5% vs 51.8%; P < .001), but similar when guided by FFR (53.6% vs 51.8%; P = .34). Among lesions undergoing PCI with available strategy information (n = 83), the intended stent size differed from the actual implanted stent size in 59.0% of cases based on angiography, compared with 12.1% of cases based on OCT findings (P < .001).
Conclusions
Fractional flow reserve and OCT provide distinct yet complementary information that significantly impacts decision making during PCI. Specifically, FFR informs revascularization decision making, while OCT plays a crucial role in device sizing. Combining anatomical, morphological, and physiological variables in a single modality may enhance decision making and reduce resource utilization.
生理指标和冠状动脉内成像为冠状动脉造影提供了额外和补充的信息，可以增强经皮冠状动脉介入治疗（PCI）的手术决策。本研究旨在评估分数血流储备（FFR）和光学相干断层扫描（OCT）对血运重建决策和PCI策略的影响，并与单独的血管造影指导进行比较。方法在这项前瞻性、观察性FUSION（基于OCT的冠状动脉狭窄功能诊断验证）研究的二次分析中，通过比较每个步骤后的预期治疗策略和实际治疗策略，评估血管造影、OCT和FFR对程序决策的影响，实际治疗策略由操作者自行决定，并以诊断测试的总体指导。结果224例患者（平均年龄67.4±9.2岁，女性30.8%），116例（51.8%）行冠状动脉血运重建术，108例（48.2%）延期行。与实际治疗策略相比，血管造影（62.5% vs 51.8%, P = 0.002）或OCT （66.5% vs 51.8%, P = 0.001）指导下的预期血运重建率显著高于实际治疗策略（53.6% vs 51.8%, P = 0.34）， FFR指导下的预期血运重建率与实际治疗策略相似（P = 0.34）。在有可用策略信息的PCI病变中（n = 83），基于血管造影的病例中，59.0%的预期支架尺寸与实际植入支架尺寸不同，而基于OCT发现的病例中，这一比例为12.1% （P < .001）。结论血流储备分数和OCT提供了不同但互补的信息，显著影响PCI的决策。具体来说，FFR为血运重建决策提供信息，而OCT在器械尺寸中起着至关重要的作用。将解剖、形态和生理变量结合在一起，可以提高决策能力，减少资源利用率。
{"title":"Combining Optical Coherence Tomography and Fractional Flow Reserve for Decision Making in Percutaneous Coronary Intervention: Insights From the FUSION Study","authors":"Rick H.J.A. Volleberg MD , Doosup Shin MD , Richard A. Shlofmitz MD , Aziz Maksoud MD , Bassem Chehab MD , Kanitha Phalakornkule PhD , Jana Buccola MS , Nutte Tarn Teraphongphom PhD , Ajay Gopinath PhD , Ashley Netravali MS , Ziad A. Ali MD, DPhil , Allen Jeremias MD, MSc","doi":"10.1016/j.jscai.2025.104001","DOIUrl":"10.1016/j.jscai.2025.104001","url":null,"abstract":"<div><h3>Background</h3><div>Physiological indices and intracoronary imaging provide additional and complementary information to coronary angiography, which may enhance procedural decision making during percutaneous coronary intervention (PCI). This study aimed to evaluate the impact of fractional flow reserve (FFR) and optical coherence tomography (OCT) on revascularization decision making and PCI strategy compared with angiography guidance alone.</div></div><div><h3>Methods</h3><div>In this secondary analysis from the prospective, observational FUSION (Validation of OCT-Based Functional Diagnosis of Coronary Stenosis) study, the impact of angiography, OCT, and FFR on procedural decision making was evaluated by comparing the intended treatment strategy after each step to the actual treatment strategy, which was left to the operator’s discretion and was guided by the totality of diagnostic testing.</div></div><div><h3>Results</h3><div>Among 224 patients (mean age, 67.4 ± 9.2 years; 30.8% women), 116 (51.8%) underwent coronary revascularization, while it was deferred in 108 (48.2%). Compared with the actual treatment strategy, the rate of intended revascularization was significantly higher when guided by angiography (62.5% vs 51.8%; <em>P</em> = .002) or OCT (66.5% vs 51.8%; <em>P</em> < .001), but similar when guided by FFR (53.6% vs 51.8%; <em>P</em> = .34). Among lesions undergoing PCI with available strategy information (n = 83), the intended stent size differed from the actual implanted stent size in 59.0% of cases based on angiography, compared with 12.1% of cases based on OCT findings (<em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>Fractional flow reserve and OCT provide distinct yet complementary information that significantly impacts decision making during PCI. Specifically, FFR informs revascularization decision making, while OCT plays a crucial role in device sizing. Combining anatomical, morphological, and physiological variables in a single modality may enhance decision making and reduce resource utilization.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 11","pages":"Article 104001"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145533026","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}
Percutaneous coronary intervention (PCI) for true bifurcation lesions remains a significant challenge. PCI with drug-eluting stents presents challenges associated with metallic stents, such as branch occlusion, stent layers, and procedural complexity in bifurcation PCI. In contrast, stentless PCI using a drug-coated balloon (DCB) eliminates stent-related complexities. However, the outcomes of this approach remain unclear. This study aimed to evaluate the 1-year clinical outcomes of stentless PCI using DCB for de novo true bifurcation lesions.
Methods
This multicenter retrospective study enrolled patients with coronary artery disease who underwent PCI for de novo true bifurcation lesions using DCB without stent placement between January 2019 and March 2022. A total of 35 patients with lesions were analyzed.
Results
Among the analyzed lesions, 45.7% were classified as Medina 1,1,1, and 48.5% exhibited moderate or greater calcification. Debulking devices were employed in 65.7% of cases. The 1-year Kaplan-Meier estimate of freedom from target vessel failure was 87.3% (95% CI, 69.4-95.1), whereas the estimate for target vessel revascularization was 92.6% (95% CI, 73.5-98.1). No side branch flow disturbance related to DCB use was observed. The minimal lumen diameter and percent diameter stenosis of the main target vessel improved following the PCI procedure and remained stable for a mean duration of 11.2 ± 7.5 months without compromising the side branch.
Conclusions
Stentless PCI using DCB for de novo true bifurcation lesions demonstrated acceptable 1-year clinical outcomes.
{"title":"One-Year Clinical Outcomes of Stentless Percutaneous Coronary Intervention Using Drug-Coated Balloon for True Bifurcation Lesions","authors":"Yuki Tanaka MD , Yoichi Nozaki MD , Shunsuke Kitani MD , Yasuhiro Kato MD , Motoko Tokunaga MD , Naoki Inoue MD , Masaru Yamaki MD , Yasumi Igarashi MD, PhD","doi":"10.1016/j.jscai.2025.103941","DOIUrl":"10.1016/j.jscai.2025.103941","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous coronary intervention (PCI) for true bifurcation lesions remains a significant challenge. PCI with drug-eluting stents presents challenges associated with metallic stents, such as branch occlusion, stent layers, and procedural complexity in bifurcation PCI. In contrast, stentless PCI using a drug-coated balloon (DCB) eliminates stent-related complexities. However, the outcomes of this approach remain unclear. This study aimed to evaluate the 1-year clinical outcomes of stentless PCI using DCB for de novo true bifurcation lesions.</div></div><div><h3>Methods</h3><div>This multicenter retrospective study enrolled patients with coronary artery disease who underwent PCI for de novo true bifurcation lesions using DCB without stent placement between January 2019 and March 2022. A total of 35 patients with lesions were analyzed.</div></div><div><h3>Results</h3><div>Among the analyzed lesions, 45.7% were classified as Medina 1,1,1, and 48.5% exhibited moderate or greater calcification. Debulking devices were employed in 65.7% of cases. The 1-year Kaplan-Meier estimate of freedom from target vessel failure was 87.3% (95% CI, 69.4-95.1), whereas the estimate for target vessel revascularization was 92.6% (95% CI, 73.5-98.1). No side branch flow disturbance related to DCB use was observed. The minimal lumen diameter and percent diameter stenosis of the main target vessel improved following the PCI procedure and remained stable for a mean duration of 11.2 ± 7.5 months without compromising the side branch.</div></div><div><h3>Conclusions</h3><div>Stentless PCI using DCB for de novo true bifurcation lesions demonstrated acceptable 1-year clinical outcomes.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 11","pages":"Article 103941"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532993","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 : 2025-11-01DOI: 10.1016/j.jscai.2025.103936
Robert F. Wilson MD , Paul Steege BS , Ashley Tao PhD , Daniel Gomez-Cardona PhD , John P. Gainor BSBME, MBA , Robert F. Riley MD , Jacob Kamen PhD
Background
Scatter radiation (SR) exposure to personnel performing fluoroscopy-guided procedures is significant and complex. With the development of next-generation shielding systems, it is essential to establish a standardized method of measuring SR for clinically relevant scenarios.
Methods
A fixed C-arm x-ray unit was used to image the chest of an anthropomorphic phantom. SR was assessed using solid-state survey meters positioned at 6 positions where personnel typically stand during procedures. SR was measured from 20 to 200 cm from the floor at each position, in 5 commonly used radiographic projections. The radiation dose from the primary beam was measured below the table and at the image detector.
Results
Of the primary x-ray beam, 96% was absorbed or scattered by the phantom. SR dose rates were markedly higher in positions around the head of the x-ray table (average x-ray dose rate at the 3 positions near the head 4.1 ± 0.6 fold the 3 positions away from the head, P < .01). X-ray angulation markedly increased SR dose compared to the anterior-posterior projection. The right anterior oblique and caudal views generated more SR than the left anterior oblique and cranial angulations (P < .01). SR intensity to the head, body, and leg regions varied significantly between positions around the table.
Conclusions
Scatter radiation distribution around the x-ray table is highly dependent on the radiographic projection, with disproportionately high radiation dose levels around the head of the x-ray table and below it. This standardized method for measuring SR systematically may facilitate the assessment of enhanced radiation protection systems.
{"title":"Phantom-Based Evaluation of Scatter Radiation at Clinically Relevant Positions in Fluoroscopy-Guided Cardiac Procedures","authors":"Robert F. Wilson MD , Paul Steege BS , Ashley Tao PhD , Daniel Gomez-Cardona PhD , John P. Gainor BSBME, MBA , Robert F. Riley MD , Jacob Kamen PhD","doi":"10.1016/j.jscai.2025.103936","DOIUrl":"10.1016/j.jscai.2025.103936","url":null,"abstract":"<div><h3>Background</h3><div>Scatter radiation (SR) exposure to personnel performing fluoroscopy-guided procedures is significant and complex. With the development of next-generation shielding systems, it is essential to establish a standardized method of measuring SR for clinically relevant scenarios.</div></div><div><h3>Methods</h3><div>A fixed C-arm x-ray unit was used to image the chest of an anthropomorphic phantom. SR was assessed using solid-state survey meters positioned at 6 positions where personnel typically stand during procedures. SR was measured from 20 to 200 cm from the floor at each position, in 5 commonly used radiographic projections. The radiation dose from the primary beam was measured below the table and at the image detector.</div></div><div><h3>Results</h3><div>Of the primary x-ray beam, 96% was absorbed or scattered by the phantom. SR dose rates were markedly higher in positions around the head of the x-ray table (average x-ray dose rate at the 3 positions near the head 4.1 ± 0.6 fold the 3 positions away from the head, <em>P</em> < .01). X-ray angulation markedly increased SR dose compared to the anterior-posterior projection. The right anterior oblique and caudal views generated more SR than the left anterior oblique and cranial angulations (<em>P</em> < .01). SR intensity to the head, body, and leg regions varied significantly between positions around the table.</div></div><div><h3>Conclusions</h3><div>Scatter radiation distribution around the x-ray table is highly dependent on the radiographic projection, with disproportionately high radiation dose levels around the head of the x-ray table and below it. This standardized method for measuring SR systematically may facilitate the assessment of enhanced radiation protection systems.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 11","pages":"Article 103936"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532994","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 : 2025-11-01DOI: 10.1016/S2772-9303(25)01547-9
{"title":"Cover","authors":"","doi":"10.1016/S2772-9303(25)01547-9","DOIUrl":"10.1016/S2772-9303(25)01547-9","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 11","pages":"Article 104101"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145533016","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 : 2025-11-01DOI: 10.1016/j.jscai.2025.103937
Yuval Barak-Corren MD, MSc , Matthew Daemer BS , Mudit Gupta MD, PhD , Kyle Sunderland MSc , Andras Lasso PhD , Analise Sulentic BS , Trevor R. Williams MD , Silvani Amin BS , Alana Cianciulli BS , Michael L. O’Byrne MD, MSCE , Matthew A. Jolley MD
Background
Transcatheter cardiac interventions in congenital heart disease require a precise understanding of 3-dimensional (3D) anatomical structures represented through projectional angiograms. However, intraprocedural optimization of angiograms is limited by the need to reduce exposure to radiation and nephrogenic contrast. Preprocedural optimization using 3D images has the potential to improve patient outcomes and trainee education. We sought to simulate fluoroscopic projections from 3D computed tomography images within an integrated procedural planning framework with the goal of informing training and the planning of complex interventions.
Methods
We developed the Virtual Cath Lab simulator in SlicerHeart to generate fluoroscopic projections from cross-sectional 3D images contextualized in a realistic biplane C-arm model. Segmented images were used to simulate angiograms. Simulated projections were compared to actual angiograms obtained in the catheterization laboratory to assess realism and accuracy.
Results
The Virtual Cath Lab allowed realistic movement of a C-arm model in synchrony with the generation of realistic fluoroscopic projections. Seventeen subjects were modeled (10 ductus arteriosus stents, 4 transcatheter pulmonary valve replacement, 1 tetralogy of Fallot with major aortopulmonary collateral arteries, 1 aortopulmonary fistula, and 1 reverse Potts shunt). The simulator successfully generated fluoroscopic projections of each subject, rapidly producing clear and anatomically accurate images, suitable for procedural planning in all cases.
Conclusions
We report the development and application of an open-source, freely available, biplane fluoroscopy simulator based on computed tomography images. Integrated visualization of complex vascular anatomy prior to catheterization may facilitate optimization of fluoroscopic angles and procedural decision-making while also supporting education. Further studies are needed to demonstrate the clinical and educational benefits.
{"title":"Virtual Cath Lab: Versatile Open-Source Simulator for Education and Procedural Planning in Congenital Heart Interventions","authors":"Yuval Barak-Corren MD, MSc , Matthew Daemer BS , Mudit Gupta MD, PhD , Kyle Sunderland MSc , Andras Lasso PhD , Analise Sulentic BS , Trevor R. Williams MD , Silvani Amin BS , Alana Cianciulli BS , Michael L. O’Byrne MD, MSCE , Matthew A. Jolley MD","doi":"10.1016/j.jscai.2025.103937","DOIUrl":"10.1016/j.jscai.2025.103937","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter cardiac interventions in congenital heart disease require a precise understanding of 3-dimensional (3D) anatomical structures represented through projectional angiograms. However, intraprocedural optimization of angiograms is limited by the need to reduce exposure to radiation and nephrogenic contrast. Preprocedural optimization using 3D images has the potential to improve patient outcomes and trainee education. We sought to simulate fluoroscopic projections from 3D computed tomography images within an integrated procedural planning framework with the goal of informing training and the planning of complex interventions.</div></div><div><h3>Methods</h3><div>We developed the Virtual Cath Lab simulator in SlicerHeart to generate fluoroscopic projections from cross-sectional 3D images contextualized in a realistic biplane C-arm model. Segmented images were used to simulate angiograms. Simulated projections were compared to actual angiograms obtained in the catheterization laboratory to assess realism and accuracy.</div></div><div><h3>Results</h3><div>The Virtual Cath Lab allowed realistic movement of a C-arm model in synchrony with the generation of realistic fluoroscopic projections. Seventeen subjects were modeled (10 ductus arteriosus stents, 4 transcatheter pulmonary valve replacement, 1 tetralogy of Fallot with major aortopulmonary collateral arteries, 1 aortopulmonary fistula, and 1 reverse Potts shunt). The simulator successfully generated fluoroscopic projections of each subject, rapidly producing clear and anatomically accurate images, suitable for procedural planning in all cases.</div></div><div><h3>Conclusions</h3><div>We report the development and application of an open-source, freely available, biplane fluoroscopy simulator based on computed tomography images. Integrated visualization of complex vascular anatomy prior to catheterization may facilitate optimization of fluoroscopic angles and procedural decision-making while also supporting education. Further studies are needed to demonstrate the clinical and educational benefits.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 11","pages":"Article 103937"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145533023","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 : 2025-11-01DOI: 10.1016/j.jscai.2025.103927
Fatimah A. Alkhunaizi MD, MS , Yonatan Mehlman MD , Maya Guglin MD , Daniel Burkhoff MD, PhD , Michael I. Brener MD, MS
Background
The mortality rate of cardiogenic shock complicating acute myocardial infarction (AMI-CS) remains high and underscores an unmet clinical need for more effective therapeutic strategies in this space. Reducing myocardial O2 consumption (MVO2) improves myocardial O2 supply–demand balance, even in the presence of ongoing ischemia, and limits infarct size.
Methods
Using a comprehensive cardiovascular simulation, we aimed to examine the impact of mechanical unloading with a percutaneous left ventricular assist device (pVAD) combined with heart rate and contractility reduction, also referred to as pharmacologic chronotropic and inotropic unloading (mechano-ino-chronotropic unloading [MIC]), on MVO2 and hemodynamic parameters in a model of AMI-CS.
Results
We found that MIC unloading is more effective at reducing MVO2 than mechanical unloading alone, without adverse hemodynamic effects when adequate mechanical unloading is utilized. Furthermore, we show that the degree of mechanical unloading achieved by pVAD is enhanced at lower heart rates due to longer periods of outflow from the left ventricle during diastole; that is, pVAD and lower heart rate are synergistic with regards to unloading.
Conclusions
Overall, these findings suggest that MIC unloading may be more effective than mechanical unloading in reducing infarct size in AMI-CS, potentially leading to greater short-term and long-term left ventricular recovery. Future clinical investigations of this therapeutic approach are encouraged.
{"title":"Mechano-Ino-Chronotropic Unloading in Cardiogenic Shock Due to Acute Myocardial Infarction—Hemodynamic Insights From Simulation Modeling","authors":"Fatimah A. Alkhunaizi MD, MS , Yonatan Mehlman MD , Maya Guglin MD , Daniel Burkhoff MD, PhD , Michael I. Brener MD, MS","doi":"10.1016/j.jscai.2025.103927","DOIUrl":"10.1016/j.jscai.2025.103927","url":null,"abstract":"<div><h3>Background</h3><div>The mortality rate of cardiogenic shock complicating acute myocardial infarction (AMI-CS) remains high and underscores an unmet clinical need for more effective therapeutic strategies in this space. Reducing myocardial O<sub>2</sub> consumption (MVO<sub>2</sub>) improves myocardial O<sub>2</sub> supply–demand balance, even in the presence of ongoing ischemia, and limits infarct size.</div></div><div><h3>Methods</h3><div>Using a comprehensive cardiovascular simulation, we aimed to examine the impact of mechanical unloading with a percutaneous left ventricular assist device (pVAD) combined with heart rate and contractility reduction, also referred to as pharmacologic chronotropic and inotropic unloading (mechano-ino-chronotropic unloading [MIC]), on MVO<sub>2</sub> and hemodynamic parameters in a model of AMI-CS.</div></div><div><h3>Results</h3><div>We found that MIC unloading is more effective at reducing MVO<sub>2</sub> than mechanical unloading alone, without adverse hemodynamic effects when adequate mechanical unloading is utilized. Furthermore, we show that the degree of mechanical unloading achieved by pVAD is enhanced at lower heart rates due to longer periods of outflow from the left ventricle during diastole; that is, pVAD and lower heart rate are synergistic with regards to unloading.</div></div><div><h3>Conclusions</h3><div>Overall, these findings suggest that MIC unloading may be more effective than mechanical unloading in reducing infarct size in AMI-CS, potentially leading to greater short-term and long-term left ventricular recovery. Future clinical investigations of this therapeutic approach are encouraged.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 11","pages":"Article 103927"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145533025","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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