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

英文中文

Transcatheter Versus Surgical Aortic Valve Replacement in Patients Aged 50 to 64 Years in the United States 经导管与手术主动脉瓣置换术在美国50 - 64岁患者中的应用

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-11-01 DOI: 10.1016/j.jscai.2025.103991

Mahmoud Ismayl MBBS , Hasaan Ahmed MD , Andrew M. Goldsweig MD, MS , Sivakumar Sudhakaran MD , Kent Bailey PhD , Juan Crestanello MD , Naveen Pereira MD , Mayra Guerrero MD

Background

Outcomes of transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) in patients aged 50-64 years have not been evaluated in randomized clinical trials. Despite the lack of randomized data, these patients are often treated with TAVR.

Methods

We queried the Nationwide Readmissions Database (2016-2021) to identify patients aged 50-64 years hospitalized for isolated aortic valve replacement (AVR). The contemporary use of TAVR and SAVR in patients aged 50-64 years was evaluated. In-hospital outcomes of TAVR vs SAVR were compared using propensity score matching. Readmissions were compared using the Cox proportional hazards regression model.

Results

Of 75,413 weighted hospitalizations for isolated AVR in patients aged 50-64 years, 22,695 (30.1%) included TAVR, and 52,718 (69.9%) included SAVR. From 2016Q1 to 2021Q4, the proportion of AVR performed using TAVR increased from 12.6% to 41.4% in patients aged 50-64 years (p_trend < .001). TAVR, compared with SAVR, was associated with lower in-hospital mortality (1.0% vs 2.0%; P < .001), stroke (1.4% vs 2.8%; P < .001), acute kidney injury (9.8% vs 17.4%; P < .001), and major bleeding (1.0% vs 1.4%, P = .04) and with higher permanent pacemaker placement (4.7% vs 3.4%; P < .001), vascular complications (3.5% vs 1.6%; P < .001), and 180-day all-cause readmissions (14.4% vs 9.0%; P < .001). Length of stay was shorter (2 vs 6 days; P < .001) and nonhome discharges were lower (17.1% vs 54.6%; P < .001) with TAVR than those with SAVR.

Conclusions

This nationwide observational analysis found that TAVR is increasingly performed among patients aged 50-64 years with lower in-hospital mortality and resource utilization but higher readmissions than SAVR.

在50-64岁的患者中，经导管主动脉瓣置换术（TAVR）与手术主动脉瓣置换术（SAVR）的结果尚未在随机临床试验中进行评估。尽管缺乏随机数据，但这些患者通常接受TAVR治疗。方法：我们查询了全国再入院数据库（2016-2021），以确定50-64岁住院的孤立主动脉瓣置换术（AVR）患者。评估当代50-64岁患者TAVR和SAVR的使用情况。使用倾向评分匹配比较TAVR和SAVR的住院结果。再入院率采用Cox比例风险回归模型进行比较。结果在50-64岁的75,413例孤立AVR加权住院患者中，22,695例（30.1%）包括TAVR， 52,718例（69.9%）包括SAVR。从2016Q1到2021Q4, 50-64岁患者中使用TAVR进行AVR的比例从12.6%上升到41.4% （ptrend < .001）。与SAVR相比，TAVR与较低的住院死亡率（1.0%比2.0%;P < .001）、卒中（1.4%比2.8%;P < .001）、急性肾损伤（9.8%比17.4%;P < .001）和大出血（1.0%比1.4%,P = .04）相关，并与较高的永久性起搏器放置（4.7%比3.4%;P < .001）、血管并发症（3.5%比1.6%;P < .001）和180天全因再入院率（14.4%比9.0%;P < .001）相关。TAVR患者的住院时间较SAVR患者短（2天vs 6天，P < 0.001），非家庭出院率较低（17.1% vs 54.6%, P < 0.001）。结论：这项全国性的观察性分析发现，与SAVR相比，50-64岁的患者越来越多地接受TAVR，住院死亡率和资源利用率较低，但再入院率较高。

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引用次数: 0

Alcohol Septal Ablation Before TAVR in Patients With Concomitant LVOT Obstruction and Severe Aortic Stenosis: A Single-Center Study 合并LVOT梗阻和严重主动脉瓣狭窄的患者在TAVR前进行酒精间隔消融：一项单中心研究

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-11-01 DOI: 10.1016/j.jscai.2025.104005

Gerardo V. Lo Russo MD , Mohamad A. Alkhouli MD , Mayra E. Guerrero MD , Charanjit S. Rihal MD , Mackram F. Eleid MD

引用次数: 0

Procedural Utility, Reliability, and Success of Endovascular Intervention for Peripheral Arterial Disease Utilizing Transradial Access 外周动脉疾病经桡动脉通路血管内介入治疗的程序实用性、可靠性和成功

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-11-01 DOI: 10.1016/j.jscai.2025.103992

Ahmad Khraisat MD, Zaid Abood MD, Mark W. Mewissen MD, Mohamed Osman MD, MPH, RCIS, Suhail Q. Allaqaband MD, Tanvir Bajwa MD, M. Fuad Jan MBBS (Hons), MD

Background

Transradial access (TRA) in coronary interventions is widely recognized for its reduced complication rates and improved patient outcomes. Its application in peripheral vascular interventions (PVI) is limited.

Methods

We retrospectively reviewed the electronic medical records of all patients who underwent PVI via TRA between November 2021 and November 2024 at a single center. The primary outcome was procedural success.

Results

A total of 137 patients (median age, 70 years; 51% men) with 213 lesions were included; smoking (94.2%) and hypertension (93.4%) were the most common comorbidities. Chronic total occlusions were present in 36.4% of cases. Access was predominantly obtained via the left radial artery (83.9%); the right radial artery was used in 7.2% of cases. Bilateral interventions were performed in 21.8% of cases. The success rate was 98.5%, with a 2.1% rate of periprocedural complications. TRA facilitated early ambulation (30-120 minutes) and a 96.5% same-day discharge rate.

Conclusions

TRA appears to be a viable alternative to femoral or brachial access for PVI, demonstrating reduced complication rates and enhanced patient outcomes and satisfaction in this series. A few tools are needed to perfect and facilitate this approach.

经桡动脉通路（TRA）在冠状动脉介入治疗中因其降低并发症发生率和改善患者预后而得到广泛认可。其在外周血管干预（PVI）中的应用有限。方法回顾性分析2021年11月至2024年11月在同一中心通过TRA行PVI的所有患者的电子病历。主要结果是手术成功。结果共纳入137例患者（中位年龄70岁，男性占51%），213个病变；吸烟（94.2%）和高血压（93.4%）是最常见的合并症。36.4%的病例存在慢性全闭塞。主要通过左桡动脉进入（83.9%）；7.2%的病例使用右桡动脉。21.8%的病例行双侧干预。手术成功率98.5%，围手术期并发症发生率2.1%。TRA促进了早期下床（30-120分钟）和96.5%的当日出院率。结论：在本系列研究中，stra似乎是PVI的可行替代方法，可以降低并发症发生率，提高患者的预后和满意度。需要一些工具来完善和促进这种方法。

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引用次数: 0

Published Evidence on Peripheral Atherectomy: A Meta-analysis and Systematic Literature Review of More Than 300 Original Investigations 已发表的外周动脉粥样硬化切除术的证据：300多个原始调查的荟萃分析和系统文献综述

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-11-01 DOI: 10.1016/j.jscai.2025.104009

Jeffrey G. Carr MD , Ralf Langhoff MD , Brian G. DeRubertis MD , Kristin L. Hood PhD , Prakash Krishnan MD , Vikram Puttaswamy MD , Thomas Zeller MD, PhD , Eric A. Secemsky MD, MSc

Background

Although atherectomy for peripheral interventions has been studied for over 35 years, recent criticisms suggest it lacks supportive evidence. This analysis provides a comprehensive overview of the quality and outcomes in the published atherectomy literature.

Methods

A systematic review of original research published in MEDLINE, Embase, and PubMed through November 2024 identified prospective and retrospective studies on atherectomy for infrainguinal peripheral artery interventions. Case studies and meta-analyses were included in the systematic review but excluded from the quantitative meta-analysis. Risk of bias was assessed using validated scales. Study design, device class, patient/lesion characteristics, provisional stenting, distal embolization, and 12-month outcomes (patency, major amputation, target lesion revascularization, and mortality) were captured.

Results

The systematic review included 322 published atherectomy papers (121 directional, 44 laser, 30 orbital, 72 rotational, 55 mixed atherectomy classes). Designs were meta-analyses in 3.7% (12 papers), randomized controlled trials in 5.9% (19 papers), prospective observational studies in 29.8% (96 papers), retrospective observational studies in 45.7% (147 papers), and case studies in 14.9% (48 papers). Adjunctive therapies were used in 91.5%, and 29.2% included a comparator arm. Among 190 papers included in the meta-analysis, the 12-month patency, target lesion revascularization, major amputation, and mortality rates were 75.4% (51 studies), 15.6% (67 studies), 1.7% (71 studies), and 2.8% (63 studies), respectively. The distal embolization rate was 2.2% (159 studies), and the provisional stenting rate was 9.3% (131 studies). Considerable heterogeneity was observed.

Conclusions

Extensive published literature exists for peripheral atherectomy, including high levels of evidence. Clinical outcomes were overall favorable with low rates of amputation, mortality, provisional stenting, and distal embolization. This intentionally broad review was associated with considerable heterogeneity and should be confirmed with appropriate comparative studies.

尽管动脉粥样硬化切除术用于外周干预的研究已经超过35年，但最近的批评表明它缺乏支持性证据。本分析提供了发表的动脉粥样硬化切除术文献的质量和结果的全面概述。方法对MEDLINE、Embase和PubMed上发表的原始研究进行系统回顾，确定了腹沟下外周动脉介入治疗的动脉粥样硬化切除术的前瞻性和回顾性研究。案例研究和荟萃分析被纳入系统评价，但被排除在定量荟萃分析之外。使用有效的量表评估偏倚风险。研究设计、器械类别、患者/病变特征、临时支架置入、远端栓塞和12个月的结果（通畅、主要截肢、靶病变血运重建和死亡率）被记录下来。结果系统回顾了322篇已发表的动脉粥样硬化切除术论文（121篇定向、44篇激光、30篇轨道、72篇旋转、55篇混合动脉粥样硬化切除术）。设计包括：荟萃分析占3.7%（12篇），随机对照试验占5.9%（19篇），前瞻性观察研究占29.8%（96篇），回顾性观察研究占45.7%（147篇），病例研究占14.9%（48篇）。91.5%的患者采用辅助治疗，29.2%的患者采用比较组。在纳入meta分析的190篇论文中，12个月通畅率、靶病变血运重建率、主要截肢率和死亡率分别为75.4%（51篇研究）、15.6%（67篇研究）、1.7%（71篇研究）和2.8%（63篇研究）。远端栓塞率为2.2%（159项），临时支架置入率为9.3%（131项）。观察到相当大的异质性。结论外周动脉粥样硬化切除术有大量已发表的文献，证据水平较高。临床结果总体上是有利的，截肢率低，死亡率低，临时支架置入率低，远端栓塞率低。这一有意广泛的综述与相当大的异质性有关，应该通过适当的比较研究来证实。

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引用次数: 0

Retrograde Crossing Facilitating Rotational Atherectomy for Recanalization of Uncrossable Near Aorto-Ostial Chronic Total Occlusion: Case Report 逆行交叉促进旋转动脉粥样硬化切除术治疗不能交叉的近主动脉口慢性全闭塞再通一例报告

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-11-01 DOI: 10.1016/j.jscai.2025.103942

Min-Ping Huang MD, Chun-Ting Shih MD, Hsiu-Yu Fang MD, Shu-Kai Hsueh MD, Chiung-Jen Wu MD

Calcified near aorto-ostial chronic total occlusions pose considerable procedural challenges because of their intricate anatomical configuration. This case concerns a 64-year-old uremic woman with a near-ostial chronic total occlusion of the right coronary artery. Following the failure of retrograde RG3 externalization because of an uncrossable lesion, a staged percutaneous coronary intervention was undertaken, employing rotational atherectomy with a RotaWire Extra Support wire (Boston Scientific) that capitalized on microfractures previously created by antegrade and retrograde 0.014-inch guidewires. This case underscores the strategic utilization of guide wire–induced microfractures to facilitate direct RotaWire advancement and illustrates a safe and effective approach for navigating anatomically complex coronary lesions.

近主动脉口钙化慢性全闭塞由于其复杂的解剖结构带来了相当大的手术挑战。本病例涉及一位64岁尿毒症妇女，右冠状动脉近口慢性全闭塞。由于无法交叉病变，逆行RG3外置失败后，采用分阶段经皮冠状动脉介入治疗，采用旋转动脉粥样硬化切除术，使用RotaWire Extra Support钢丝（波士顿科学公司），利用之前由顺行和逆行0.014英寸导丝造成的微骨折。该病例强调了导丝诱导微骨折的策略性应用，以促进RotaWire的直接推进，并说明了一种安全有效的方法来导航解剖复杂的冠状动脉病变。

引用次数: 0

Near-Infrared Spectroscopy Detects Lipid-Rich Plaque Preceding ST-Segment Elevation Myocardial Infarction 近红外光谱检测st段抬高型心肌梗死前的富脂斑块

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-11-01 DOI: 10.1016/j.jscai.2025.103990

Shazil Mahmood MD, Samia Mazumder MD, Ryan D. Madder MD

引用次数: 0

Impact of Age and Sex on Coronary Flow Reserve and Microvascular Function in Patients With Angina and Nonobstructive Coronary Arteries 年龄和性别对心绞痛和非阻塞性冠状动脉患者冠状动脉血流储备和微血管功能的影响

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-11-01 DOI: 10.1016/j.jscai.2025.103989

Spyridon Kostantinis MD , Gabriel Garcia Castro MD , Nida Latif MD , Natasha Cigarroa MD , Steffne J. Kunnirickal MD , Natalija Odanovic MD , Samit M. Shah MD, PhD

Background

Angina and nonobstructive coronary arteries is increasingly recognized, but the impact of age and sex on coronary microvascular function in this population has received limited study.

Methods

In 206 consecutive patients with angina and nonobstructive coronary arteries, invasive coronary function testing was performed including vasoreactivity testing with acetylcholine provocation, guidewire–based assessment of coronary flow reserve (CFR) with bolus thermodilution, and index of microcirculatory resistance (IMR). Multivariable regression models assessed associations of age and sex with coronary physiologic indices, and subgroup analyses were conducted to examine age-related trends in microvascular function separately in men and women.

Results

Mean age was 57.1 ± 11.2 years (range, 27-81 years), and 149 (72.3%) were women. Increasing age was associated with progressive decrease in CFR (β = −0.05; P = .001) and increase in hyperemic mean transit time (Tmn; β = 0.009; P < .001) and IMR (β = 0.63; P < .001). Baseline Tmn was similar among the 3 age groups. Women had lower IMR (24.5 ± 13.5 vs 30.2 ± 18.1; P = .038), and shorter baseline and hyperemic Tmn, but similar CFR (3.43 ± 1.59 vs 3.73 ± 1.94; P = .315) compared with men. In sex-stratified analysis, age was associated with higher IMR in women (β = 0.51; P < .001), but not in men (β = 0.29; P = .154). CFR declined significantly with increasing age in both sexes, with a stronger association in women (β = −0.04; P < .001) than in men (β = −0.06; P = .011).

Conclusions

Increasing age was associated with a decrease in coronary microvascular function and increase in microcirculatory resistance, which was pronounced in women but not in men. There was no association of baseline Tmn with age, suggesting that age-related impairment in CFR was primarily driven by reduced hyperemic flow.

背景：冠心病和非阻塞性冠状动脉越来越被人们所认识，但年龄和性别对这一人群冠状动脉微血管功能的影响的研究却很有限。方法对连续206例心绞痛和非阻塞性冠状动脉患者进行有创冠状动脉功能检测，包括乙酰胆碱激发血管反应性检测、热稀释导丝法冠状动脉血流储备（CFR）评估和微循环阻力指数（IMR）检测。多变量回归模型评估了年龄和性别与冠状动脉生理指标的关系，并进行了亚组分析，分别检查了男性和女性微血管功能的年龄相关趋势。结果平均年龄57.1±11.2岁（27 ~ 81岁），女性149例（72.3%）。随着年龄的增加，CFR （β = - 0.05, P = .001）和血凝平均转运时间（Tmn, β = 0.009, P < 001）和IMR （β = 0.63, P < 001）逐渐降低。3个年龄组的基线Tmn相似。与男性相比，女性IMR较低（24.5±13.5 vs 30.2±18.1;P = 0.038），基线和充血Tmn较短，但CFR相似（3.43±1.59 vs 3.73±1.94;P = 0.315）。在性别分层分析中，年龄与女性较高的IMR相关（β = 0.51; P < .001），但与男性无关（β = 0.29; P = .154）。CFR随年龄的增加而显著下降，其中女性的相关性较男性强（β = - 0.04; P < .001）（β = - 0.06; P = .011）。结论随着年龄的增长，冠状动脉微血管功能下降，微循环阻力增加，女性明显，男性不明显。基线Tmn与年龄没有关联，表明年龄相关的CFR损害主要是由充血流量减少引起的。

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引用次数: 0

The Age of Opportunity in Aortic Valve Interventions: Beyond Traditional Boundaries for Transcatheter Aortic Valve Replacement in Younger Patients 主动脉瓣介入治疗的机会年龄：超越经导管主动脉瓣置换术在年轻患者中的传统界限

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-11-01 DOI: 10.1016/j.jscai.2025.104014

Grant W. Reed MD, MSc, Evan Harmon MD

引用次数: 0

Designing and Implementing a Heart Team: Institutional Experiences Over the Past 10 Years 心脏团队的设计与实施：过去十年的机构经验

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-11-01 DOI: 10.1016/j.jscai.2025.103918

Mahrukh F. Akram MD , Andrea L. Burgess RN , Deeann Stickland RN , Charles L. Willekes MD , Richard F. McNamara MD , David A. McNamara MD, MPH

The heart team (HT) is a multidisciplinary team that performs a comprehensive review of patients with complex cardiac issues, collaborates on potential treatment options, and provides the patient with treatment recommendations. Despite strong guideline support and HT’s ubiquitous presence, data on how to operationally design, implement, and measure the success of an HT remain limited. This, in turn, has led to wide variability in how HT are instituted. This review examines the development and strategy toward operationalizing HT to help identify potential barriers to HT development and growth. The HT itself is the culmination of a complex care process with the goal of adopting an integrated, patient-centric HT approach to treatment decisions in the care of patients with complex coronary artery disease.

心脏小组（HT）是一个多学科团队，对患有复杂心脏问题的患者进行全面审查，就潜在的治疗方案进行合作，并为患者提供治疗建议。尽管有强有力的指南支持和高温疗法的普遍存在，但关于如何设计、实施和衡量高温疗法成功与否的数据仍然有限。这反过来又导致了高温疗法在制定方式上的广泛差异。本文综述了高温疗法的发展和实施策略，以帮助确定高温疗法发展和增长的潜在障碍。HT本身是一个复杂护理过程的高潮，其目标是在复杂冠状动脉疾病患者的护理中采用综合的、以患者为中心的HT方法进行治疗决策。

引用次数: 0

A Blueprint for Building a Renal Denervation Program 建立肾去神经支配计划的蓝图

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-11-01 DOI: 10.1016/j.jscai.2025.104008

Tayyab Shah MD , Catherine Vanchiere MD, MA , Maria Bonanni MSN, CRNP , Debbie L. Cohen MD , Jay Giri MD, MPH , Taisei Kobayashi MD , Brian Fulton MD

Renal denervation (RDN) has emerged as a promising adjunctive therapy for hypertension, particularly in patients with poor blood pressure control despite pharmacologic and lifestyle interventions. With the recent approval of 2 RDN systems by the US Food and Drug Administration, there is growing opportunity for interested interventional cardiologists to develop expertise in this rapidly evolving, unsaturated field. This review serves as a comprehensive guide to building an RDN program, covering team development, training requirements, workflow design, and economic considerations. Interventional cardiologists, particularly fellows-in-training and those at early career stages, are uniquely positioned to advance this emerging technology by leveraging their multidisciplinary training, technological fluency, and openness to innovation to shape the future of interventional hypertension care. This blueprint offers a practical roadmap to capitalize on the clinical and career opportunities that RDN presents.

肾去神经支配（RDN）已成为一种很有前景的高血压辅助治疗方法，特别是对血压控制不佳的患者，尽管有药物和生活方式干预。随着美国食品和药物管理局最近批准了2个RDN系统，有越来越多的机会感兴趣的介入心脏病学家在这个快速发展的，不饱和的领域发展专业知识。这篇综述作为构建RDN计划的全面指南，涵盖了团队发展、培训需求、工作流设计和经济考虑。介入性心脏病专家，特别是在培训中的研究员和处于早期职业阶段的人员，通过利用他们的多学科培训、技术的流畅性和对创新的开放性来塑造介入性高血压护理的未来，在推进这一新兴技术方面处于独特的地位。该蓝图提供了一个实用的路线图，以利用RDN提供的临床和职业机会。

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