Pub Date : 2025-10-01DOI: 10.1016/j.jscai.2025.103873
Lyndon C. Box MD, FSCAI , Mark H. Hoyer MD, FSCAI , Sergio Bartakian MD, FSCAI , Sarosh P. Batlivala MD, MSCI, FSCAI , James C. Blankenship MD, MHCM, MSCAI , Joaquin E. Cigarroa MD, MSCAI , Gurumurthy Hiremath MD, FSCAI , Satyan Lakshminrusimha MD , Jeremy M. Ringewald MD, FSCAI , Curtis Rooney JD , Nicole J. Sutton MD, FSCAI , Monica Wright DPA, MHA, CPC, CPMA, CPCO , Frank F. Ing MD, MSCAI
Congenital heart disease (CHD) patients needing interventional cardiology procedures require highly skilled physicians to deliver resource-intensive care. The current United States health care system presents multiple economic barriers. This includes payments from Medicaid, procedure values, physician compensation, and device development. In combination, these factors contribute to worse outcomes for CHD patients. Society for Cardiovascular Angiography & Interventions is committed to removing these barriers for improved patient outcomes. This will require a coordinated effort with advocacy and education to change the current process and develop new approaches to delivering interventional cardiology care for CHD patients.
{"title":"Economic Barriers to Interventional Cardiology Care for Adults and Children With Congenital Heart Disease and Potential Policy Solutions: A SCAI Policy Statement","authors":"Lyndon C. Box MD, FSCAI , Mark H. Hoyer MD, FSCAI , Sergio Bartakian MD, FSCAI , Sarosh P. Batlivala MD, MSCI, FSCAI , James C. Blankenship MD, MHCM, MSCAI , Joaquin E. Cigarroa MD, MSCAI , Gurumurthy Hiremath MD, FSCAI , Satyan Lakshminrusimha MD , Jeremy M. Ringewald MD, FSCAI , Curtis Rooney JD , Nicole J. Sutton MD, FSCAI , Monica Wright DPA, MHA, CPC, CPMA, CPCO , Frank F. Ing MD, MSCAI","doi":"10.1016/j.jscai.2025.103873","DOIUrl":"10.1016/j.jscai.2025.103873","url":null,"abstract":"<div><div>Congenital heart disease (CHD) patients needing interventional cardiology procedures require highly skilled physicians to deliver resource-intensive care. The current United States health care system presents multiple economic barriers. This includes payments from Medicaid, procedure values, physician compensation, and device development. In combination, these factors contribute to worse outcomes for CHD patients. Society for Cardiovascular Angiography & Interventions is committed to removing these barriers for improved patient outcomes. This will require a coordinated effort with advocacy and education to change the current process and develop new approaches to delivering interventional cardiology care for CHD patients.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103873"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340558","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 : 2025-10-01DOI: 10.1016/j.jscai.2025.103999
Dennis W. Kim MD, PhD
{"title":"Different Hearts, Different Standards","authors":"Dennis W. Kim MD, PhD","doi":"10.1016/j.jscai.2025.103999","DOIUrl":"10.1016/j.jscai.2025.103999","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103999"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340559","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 : 2025-10-01DOI: 10.1016/j.jscai.2025.103926
Abduljabar Adi MD , Ramsis Ramsis MD , Emily Rodriguez DO , Daniel Miklin MD , Jack Jnani MD , Allan Lin MD , Atul D. Bali MD , Sandrine Lebrun MD , Arber Kodra MD , Matthew Griffin MD , Matthew Pierce MD , Miguel Alvarez Villela MD
Background
Early revascularization improves survival in patients with ST-elevation myocardial infarction–related cardiogenic shock (STEMI-CS). However, lower rates of invasive management are seen in states with public reporting of outcomes for percutaneous coronary intervention and coronary artery bypass grafting surgery. The reasons for this remain speculative. We aim to report contemporary treatment patterns and examine the reasons for deferral of invasive management in patients with STEMI-CS in a New York cohort.
Methods
All patients with STEMI-CS in the Northwell-Shock Registry, a retrospective study of cardiogenic shock across 11 hospitals in New York, treated between January 2016 and August 2022, were included. Clinical variables and outcomes were compared between patients managed invasively and conservatively. Reasons for deferral of invasive management were collected manually from clinical documentation. Multivariable logistic regression was performed to examine the factors associated with a conservative management strategy.
Results
Invasive management was performed in 87% of patients, revascularization with percutaneous coronary intervention in 63% and coronary artery bypass grafting surgery in 8%. Hospital mortality was 27% for patients managed invasively and 81% for those managed conservatively. The most cited reasons for deferring invasive management were unclear neurologic status (35%), patient or family preference (29%), and complicating medical conditions (25%). Meanwhile, the factors independently associated with conservative management were older age, higher creatinine, cardiac arrest, and higher Society for Cardiovascular Angiography & Interventions (SCAI) stages.
Conclusions
Although rates of invasive management were high in this contemporary cohort of STEMI-CS patients in New York, risk aversion seems to still play a role in the deferral of invasive management in many patients.
{"title":"Contemporary Management of ST-Elevation Myocardial Infarction–Related Cardiogenic Shock in New York: A Multicenter Registry","authors":"Abduljabar Adi MD , Ramsis Ramsis MD , Emily Rodriguez DO , Daniel Miklin MD , Jack Jnani MD , Allan Lin MD , Atul D. Bali MD , Sandrine Lebrun MD , Arber Kodra MD , Matthew Griffin MD , Matthew Pierce MD , Miguel Alvarez Villela MD","doi":"10.1016/j.jscai.2025.103926","DOIUrl":"10.1016/j.jscai.2025.103926","url":null,"abstract":"<div><h3>Background</h3><div>Early revascularization improves survival in patients with ST-elevation myocardial infarction–related cardiogenic shock (STEMI-CS). However, lower rates of invasive management are seen in states with public reporting of outcomes for percutaneous coronary intervention and coronary artery bypass grafting surgery. The reasons for this remain speculative. We aim to report contemporary treatment patterns and examine the reasons for deferral of invasive management in patients with STEMI-CS in a New York cohort.</div></div><div><h3>Methods</h3><div>All patients with STEMI-CS in the Northwell-Shock Registry, a retrospective study of cardiogenic shock across 11 hospitals in New York, treated between January 2016 and August 2022, were included. Clinical variables and outcomes were compared between patients managed invasively and conservatively. Reasons for deferral of invasive management were collected manually from clinical documentation. Multivariable logistic regression was performed to examine the factors associated with a conservative management strategy.</div></div><div><h3>Results</h3><div>Invasive management was performed in 87% of patients, revascularization with percutaneous coronary intervention in 63% and coronary artery bypass grafting surgery in 8%. Hospital mortality was 27% for patients managed invasively and 81% for those managed conservatively. The most cited reasons for deferring invasive management were unclear neurologic status (35%), patient or family preference (29%), and complicating medical conditions (25%). Meanwhile, the factors independently associated with conservative management were older age, higher creatinine, cardiac arrest, and higher Society for Cardiovascular Angiography & Interventions (SCAI) stages.</div></div><div><h3>Conclusions</h3><div>Although rates of invasive management were high in this contemporary cohort of STEMI-CS patients in New York, risk aversion seems to still play a role in the deferral of invasive management in many patients.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103926"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340571","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 : 2025-10-01DOI: 10.1016/j.jscai.2025.103789
Mustafa Mohammed DO , Waleed Al-Darzi MD , Ahmad Jabri MD , Laith Alhuneafat MD , Ahmed Kazem DO , Pedro Engel Gonzalez MD , Tiberio Frisoli MD , Khaldoon Alaswad MD , Mir Babar Basir DO , Mohammad Alqarqaz MD , Brian O’Neill MD , James Lee MD , William W. O’Neill MD , Pedro Villablanca MD
Background
Transcaval access (TCA) may enable percutaneous mechanical circulatory support (MCS) with reduced risk of vascular complications in cardiogenic shock patients needing mechanical support.
Methods
This single-center retrospective study included patients who underwent TCA placement of an Impella 5.0 (Abiomed) from June 2015 to March 2023. Data on demographic characteristics, clinical, procedural variables, and in-hospital outcomes were collected.
Results
Seventy-two patients (mean age, 58.2 years; 66.7% men) were included. Twenty-eight patients had nonischemic cardiomyopathy and 43 had ischemic cardiomyopathy, with a baseline left ventricular ejection fraction of 23.5% ± 14.2%. Most patients (90.3%) were in categories C to E of the Society for Cardiovascular Angiography & Interventions (SCAI) classification for cardiogenic shock. TCA and MCS delivery were successful in all cases. Forty-two patients survived to explant device and TCA sheath, with successful explant in 36 using nitinol occluders; 7 needed a covered stent due to underlying right ventricular dysfunction to avoid right ventricular failure. Overall, in-hospital survival was 44.4%, with 43.8% in the nonischemic group and 56.2% in the ischemic group. Bleeding Academic Research Consortium (BARC) bleeding >1 occurred in 13.9%. No vascular complications from the access site were observed. During hospitalization, 16.7% had ventricular tachycardia/ventricular fibrillation and 5.6% had pulseless electrical activity postimplantation. Acute kidney injury requiring hemodialysis occurred in 15.3%, and 4.2% had a stroke. The average length of stay was 19.9 days (IQR, 3-28.25).
Conclusions
Transcaval access for Impella 5.0 is safe and feasible in experienced hands for patients needing advanced MCS due to inadequate peripheral arterial access or insufficient support from conventional devices.
{"title":"Safety and Feasibility of Transcaval Access for the Delivery of Impella Microaxial Flow Pump","authors":"Mustafa Mohammed DO , Waleed Al-Darzi MD , Ahmad Jabri MD , Laith Alhuneafat MD , Ahmed Kazem DO , Pedro Engel Gonzalez MD , Tiberio Frisoli MD , Khaldoon Alaswad MD , Mir Babar Basir DO , Mohammad Alqarqaz MD , Brian O’Neill MD , James Lee MD , William W. O’Neill MD , Pedro Villablanca MD","doi":"10.1016/j.jscai.2025.103789","DOIUrl":"10.1016/j.jscai.2025.103789","url":null,"abstract":"<div><h3>Background</h3><div>Transcaval access (TCA) may enable percutaneous mechanical circulatory support (MCS) with reduced risk of vascular complications in cardiogenic shock patients needing mechanical support.</div></div><div><h3>Methods</h3><div>This single-center retrospective study included patients who underwent TCA placement of an Impella 5.0 (Abiomed) from June 2015 to March 2023. Data on demographic characteristics, clinical, procedural variables, and in-hospital outcomes were collected.</div></div><div><h3>Results</h3><div>Seventy-two patients (mean age, 58.2 years; 66.7% men) were included. Twenty-eight patients had nonischemic cardiomyopathy and 43 had ischemic cardiomyopathy, with a baseline left ventricular ejection fraction of 23.5% ± 14.2%. Most patients (90.3%) were in categories C to E of the Society for Cardiovascular Angiography & Interventions (SCAI) classification for cardiogenic shock. TCA and MCS delivery were successful in all cases. Forty-two patients survived to explant device and TCA sheath, with successful explant in 36 using nitinol occluders; 7 needed a covered stent due to underlying right ventricular dysfunction to avoid right ventricular failure. Overall, in-hospital survival was 44.4%, with 43.8% in the nonischemic group and 56.2% in the ischemic group. Bleeding Academic Research Consortium (BARC) bleeding >1 occurred in 13.9%. No vascular complications from the access site were observed. During hospitalization, 16.7% had ventricular tachycardia/ventricular fibrillation and 5.6% had pulseless electrical activity postimplantation. Acute kidney injury requiring hemodialysis occurred in 15.3%, and 4.2% had a stroke. The average length of stay was 19.9 days (IQR, 3-28.25).</div></div><div><h3>Conclusions</h3><div>Transcaval access for Impella 5.0 is safe and feasible in experienced hands for patients needing advanced MCS due to inadequate peripheral arterial access or insufficient support from conventional devices.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103789"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340494","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 : 2025-10-01DOI: 10.1016/j.jscai.2025.103879
Sachin Joseph MD , Pablo Rengifo-Moreno MD
A clot in transit is a venous thrombus lodged in the right heart en route to the pulmonary arteries. When a clot in transit lodges in a patent foramen ovale, it becomes an impending paradoxical embolism (IPDE), a rare, life-threatening condition with a 30-day mortality of 18.4%. Management options—surgical extraction, anticoagulation, or thrombolysis—lack consensus. We present the case of a 53-year-old man with a saddle pulmonary embolism, in whom postthrombectomy transthoracic echocardiogram revealed an IPDE. This case illustrates aspiration thrombectomy of the IPDE with the FlowTriever device (Inari Medical) with cerebral protection (SENTINEL, Boston Scientific), offering an alternative to thrombolysis and surgery.
运输中的血块是一种静脉血栓，它位于右心脏，在通往肺动脉的途中。当运输中的血块停留在未闭卵圆孔内时，它就会成为一种即将发生的矛盾栓塞（IPDE），这是一种罕见的、危及生命的疾病，30天死亡率为18.4%。治疗选择-手术摘除、抗凝或溶栓-缺乏共识。我们提出一个53岁的男子鞍状肺栓塞的情况下，在他的血栓切除术后经胸超声心动图显示IPDE。本病例说明了使用flowtriver装置（Inari Medical）对IPDE进行吸入性取栓，并具有脑保护功能（SENTINEL, Boston Scientific），为溶栓和手术提供了另一种选择。
{"title":"Percutaneous Thrombectomy of Clot in Transit Lodged in the Patent Foramen Ovale Using the FlowTriever Device: Case Report","authors":"Sachin Joseph MD , Pablo Rengifo-Moreno MD","doi":"10.1016/j.jscai.2025.103879","DOIUrl":"10.1016/j.jscai.2025.103879","url":null,"abstract":"<div><div>A clot in transit is a venous thrombus lodged in the right heart en route to the pulmonary arteries. When a clot in transit lodges in a patent foramen ovale, it becomes an impending paradoxical embolism (IPDE), a rare, life-threatening condition with a 30-day mortality of 18.4%. Management options—surgical extraction, anticoagulation, or thrombolysis—lack consensus. We present the case of a 53-year-old man with a saddle pulmonary embolism, in whom postthrombectomy transthoracic echocardiogram revealed an IPDE. This case illustrates aspiration thrombectomy of the IPDE with the FlowTriever device (Inari Medical) with cerebral protection (SENTINEL, Boston Scientific), offering an alternative to thrombolysis and surgery.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103879"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340497","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 : 2025-10-01DOI: 10.1016/j.jscai.2025.103817
Jadon Rajagopal , Rishab Jayanthi BS , James P. Stewart MD , Raul R. Blanco MD , William M. Brown MD , James R. Kauten MD , Mark R. Helmers MD , Vinod H. Thourani MD , Pradeep K. Yadav MD
{"title":"Transcatheter Aortic Valve Replacement in Patient With Extensive Aortic Dissection: Role of “Balloon Flossing”","authors":"Jadon Rajagopal , Rishab Jayanthi BS , James P. Stewart MD , Raul R. Blanco MD , William M. Brown MD , James R. Kauten MD , Mark R. Helmers MD , Vinod H. Thourani MD , Pradeep K. Yadav MD","doi":"10.1016/j.jscai.2025.103817","DOIUrl":"10.1016/j.jscai.2025.103817","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103817"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340557","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 : 2025-10-01DOI: 10.1016/j.jscai.2025.103877
Gal Sella MD , Chloe Kharsa MD, MSc , Mangesh Kritya MD , Devin Olek MS, DABR , Bin S. Teh MD , Muhammad Faraz Anwaar MD , Joseph Elias MD , Elia El Hajj MD , Albert E. Raizner MD , Andrew Farach MD , Neal S. Kleiman MD , Alpesh Shah MD
Background
In-stent restenosis (ISR) remains a significant challenge in coronary intervention, particularly among patients with chronic kidney disease (CKD) who exhibit altered inflammatory responses and accelerated vascular calcification. Vascular brachytherapy has reemerged as a potential treatment modality for recurrent ISR. This study evaluates the clinical outcomes of vascular brachytherapy for ISR in patients with and without CKD.
Methods
We conducted a retrospective analysis of 227 patients (54 in CKD and 173 in non-CKD groups) who underwent vascular brachytherapy for coronary ISR between June 2016 and January 2024 at the Houston Methodist Hospital. Patients were stratified based on the presence of CKD, defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m2 for at least 3 months. The primary end point was target lesion revascularization (TLR). Secondary end points included major adverse cardiovascular events, its components and all-cause mortality at 1 year.
Results
Baseline demographic characteristics and procedural characteristics were similar between groups, except for a significantly higher prevalence of diabetes in the CKD group (83.3% vs 57.8%; P = .001). At 1-year follow-up, major adverse cardiovascular events (MACE) rates were significantly higher in patients with CKD than those in patients without CKD (63.0% vs 32.9%; P = .0003), primarily driven by higher TLR rates (31.5% vs 17.9%; P = .038). Bleeding complications occurred exclusively in the CKD group (5.6% vs 0%; P = .013). In multivariable analysis, male sex was associated with a significantly lower risk of TLR in patients with CKD (hazard ratio, 0.15; 95% CI, 0.04-0.64; P = .010).
Conclusions
Despite similar procedural characteristics, patients with CKD experience significantly higher rates of adverse events following vascular brachytherapy for ISR than those without CKD patients. The nearly doubled rate of MACE and higher TLR rates suggest that the inflammatory milieu associated with CKD may overcome the antiproliferative effects of radiation therapy. These findings highlight the need for refined interventional strategies and comprehensive cardiovascular risk management in this high-risk population with MACE.
背景：支架内再狭窄（ISR）仍然是冠状动脉介入治疗的一个重大挑战，特别是在慢性肾脏疾病（CKD）患者中，他们表现出改变的炎症反应和加速的血管钙化。血管近距离放射治疗已重新成为复发性ISR的潜在治疗方式。本研究评估了血管近距离放射治疗伴有和不伴有CKD的ISR患者的临床结果。方法：我们对2016年6月至2024年1月在休斯顿卫理公会医院接受血管近距离治疗冠状动脉ISR的227例患者（54例CKD组，173例非CKD组）进行了回顾性分析。根据CKD的存在对患者进行分层，定义为肾小球滤过率估计为60 mL/min/1.73 m2，持续至少3个月。主要终点为靶病变血运重建术（TLR）。次要终点包括主要不良心血管事件、其组成部分和1年时的全因死亡率。结果两组之间的基线人口学特征和手术特征相似，除了CKD组的糖尿病患病率明显更高（83.3% vs 57.8%; P = 0.001）。在1年的随访中，CKD患者的主要不良心血管事件（MACE）发生率显著高于非CKD患者（63.0% vs 32.9%; P = 0.0003），主要是由于TLR发生率较高（31.5% vs 17.9%; P = 0.038）。出血并发症仅发生在CKD组（5.6% vs 0%; P = 0.013）。在多变量分析中，男性与CKD患者TLR风险显著降低相关（风险比为0.15；95% CI为0.04-0.64;P = 0.010）。结论：尽管有相似的手术特点，CKD患者在血管近距离治疗ISR后的不良事件发生率明显高于无CKD患者。近一倍的MACE率和更高的TLR率表明，与CKD相关的炎症环境可能克服了放射治疗的抗增殖作用。这些发现强调了在MACE高危人群中需要完善的介入策略和全面的心血管风险管理。
{"title":"Intravascular Brachytherapy for In-Stent Restenosis in Patients With Chronic Kidney Disease","authors":"Gal Sella MD , Chloe Kharsa MD, MSc , Mangesh Kritya MD , Devin Olek MS, DABR , Bin S. Teh MD , Muhammad Faraz Anwaar MD , Joseph Elias MD , Elia El Hajj MD , Albert E. Raizner MD , Andrew Farach MD , Neal S. Kleiman MD , Alpesh Shah MD","doi":"10.1016/j.jscai.2025.103877","DOIUrl":"10.1016/j.jscai.2025.103877","url":null,"abstract":"<div><h3>Background</h3><div>In-stent restenosis (ISR) remains a significant challenge in coronary intervention, particularly among patients with chronic kidney disease (CKD) who exhibit altered inflammatory responses and accelerated vascular calcification. Vascular brachytherapy has reemerged as a potential treatment modality for recurrent ISR. This study evaluates the clinical outcomes of vascular brachytherapy for ISR in patients with and without CKD.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 227 patients (54 in CKD and 173 in non-CKD groups) who underwent vascular brachytherapy for coronary ISR between June 2016 and January 2024 at the Houston Methodist Hospital. Patients were stratified based on the presence of CKD, defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m<sup>2</sup> for at least 3 months. The primary end point was target lesion revascularization (TLR). Secondary end points included major adverse cardiovascular events, its components and all-cause mortality at 1 year.</div></div><div><h3>Results</h3><div>Baseline demographic characteristics and procedural characteristics were similar between groups, except for a significantly higher prevalence of diabetes in the CKD group (83.3% vs 57.8%; <em>P</em> = .001). At 1-year follow-up, major adverse cardiovascular events (MACE) rates were significantly higher in patients with CKD than those in patients without CKD (63.0% vs 32.9%; <em>P</em> = .0003), primarily driven by higher TLR rates (31.5% vs 17.9%; <em>P</em> = .038). Bleeding complications occurred exclusively in the CKD group (5.6% vs 0%; <em>P</em> = .013). In multivariable analysis, male sex was associated with a significantly lower risk of TLR in patients with CKD (hazard ratio, 0.15; 95% CI, 0.04-0.64; <em>P</em> = .010).</div></div><div><h3>Conclusions</h3><div>Despite similar procedural characteristics, patients with CKD experience significantly higher rates of adverse events following vascular brachytherapy for ISR than those without CKD patients. The nearly doubled rate of MACE and higher TLR rates suggest that the inflammatory milieu associated with CKD may overcome the antiproliferative effects of radiation therapy. These findings highlight the need for refined interventional strategies and comprehensive cardiovascular risk management in this high-risk population with MACE.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103877"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340576","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}
Combination of bicuspid aortic valve and coarctation of aorta (CoA) is common. With the widespread use of transcatheter aortic valve replacement (TAVR), cases associated with either untreated or treated CoA forms an important subset and pose specific challenges. We discuss a case of a patient with previously stented coarctation presenting with degenerated aortic bioprosthesis considered for TAVR due to porcelain aorta. The CoA stent was significantly underexpanded, which was balloon dilated, followed by TAVR with a self-expandable valve. We discuss the factors determining sequence of management, choice of CoA management, access and valve choice for TAVR in this subset.
{"title":"Transcatheter Valve-in-Valve Aortic Valve Replacement in Stented Coarctation With Restenosis: A Case Report","authors":"Pramod Sagar MD, DM , Aashish Chopra MD, DM , Kothandam Sivakumar MD, DM , Mullasari Sankardas Ajit MD, DM","doi":"10.1016/j.jscai.2025.103921","DOIUrl":"10.1016/j.jscai.2025.103921","url":null,"abstract":"<div><div>Combination of bicuspid aortic valve and coarctation of aorta (CoA) is common. With the widespread use of transcatheter aortic valve replacement (TAVR), cases associated with either untreated or treated CoA forms an important subset and pose specific challenges. We discuss a case of a patient with previously stented coarctation presenting with degenerated aortic bioprosthesis considered for TAVR due to porcelain aorta. The CoA stent was significantly underexpanded, which was balloon dilated, followed by TAVR with a self-expandable valve. We discuss the factors determining sequence of management, choice of CoA management, access and valve choice for TAVR in this subset.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103921"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340556","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 : 2025-10-01DOI: 10.1016/j.jscai.2025.103859
Batla Falah MD, MPH , Behnam N. Tehrani MD , Julia B. Thompson MS , Yousuf Shah MD , Yiran Zhang MS , Tayyab Shah MD , Michael J. Schonning MS, MBS , Arsalan Abu-Much MD , David J. Cohen MD, MSc , Björn Redfors MD, PhD , Deepak Acharya MD, MSPH , Samer M. Garas MD, MBA , Suzanne J. Baron MD, MSc , Mir B. Basir DO , Aditya S. Bharadwaj MD , Cindy L. Grines MD , Alejandro Lemor MD, MS , Alexander G. Truesdell MD , William W. O’Neill MD , Wayne B. Batchelor MD, MHS, MBA
Background
Impella-supported high-risk percutaneous coronary intervention (HRPCI) is an alternative for patients ineligible for coronary artery bypass grafting (CABG). However, limited data exist on patient characteristics, reasons for surgical turndown, and patient outcomes. This study aimed to characterize the baseline characteristics and short-term and intermediate-term outcomes of patients evaluated for CABG in the PROTECT III study.
Methods
Patients enrolled in the PROTECT III study (NCT04136392), who underwent Impella-supported HRPCI, with an evaluable chart who were assessed by a cardiothoracic surgeon (CTS) for CABG were studied. Reasons for surgical turndown were derived from medical records. Baseline characteristics and major adverse cardiovascular and cerebrovascular events (composite of all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization) at 30 and 90 days and all-cause mortality at 1 year were assessed. Observed to expected 30-day mortality ratios were calculated using the Society of Thoracic Surgeons (STS) risk score.
Results
Of 791 patients evaluated for CABG, 680 (86.0%) were turned down by a CTS, and 111 (14.0%) declined surgery. The most common reasons for surgical turndown were comorbidities (40%) and anatomical factors (25%). Compared with patients who declined surgery, patients turned down (deemed ineligible) by CTS had higher rates of major adverse cardiovascular and cerebrovascular event at 30 days (9.2% vs 4.6%; P = .12) and 90 days (14.1% vs 4.6%; P = .02). The observed to expected mortality ratio, based on the STS risk score, was 1.43 (95% CI, 1.08-1.83).
Conclusions
Impella-supported HRPCI is a viable alternative for high-risk patients deemed ineligible for CABG. Patients turned down by a CTS had worse clinical outcomes than those who declined surgery. The underestimation of 30-day mortality by the STS risk score suggests the need for improved risk prediction models in this high-risk cohort.
背景：dimpella支持的高风险经皮冠状动脉介入治疗（HRPCI）是不适合冠状动脉旁路移植术（CABG）患者的替代选择。然而，关于患者特征、手术拒绝的原因和患者预后的数据有限。本研究旨在描述在PROTECT III研究中评估CABG的患者的基线特征和短期和中期结果。方法纳入PROTECT III研究（NCT04136392）的患者，他们接受了impella支持的HRPCI，并采用可评估的图表，由心胸外科医生（CTS）评估CABG。手术拒绝的原因来源于医疗记录。评估30天和90天的基线特征和主要不良心脑血管事件（全因死亡、心肌梗死、卒中/短暂性脑缺血发作和重复血运重建术）以及1年的全因死亡率。使用胸外科学会（Society of Thoracic Surgeons， STS）风险评分计算观察到的至预期的30天死亡率。结果791例CABG评估患者中，680例（86.0%）拒绝CTS， 111例（14.0%）拒绝手术。最常见的手术拒绝原因是合并症（40%）和解剖学因素（25%）。与拒绝手术的患者相比，拒绝（被认为不合格）CTS的患者在30天（9.2% vs 4.6%; P = .12）和90天（14.1% vs 4.6%; P = .02）的主要不良心脑血管事件发生率更高。基于STS风险评分的观察死亡率与预期死亡率之比为1.43 （95% CI, 1.08-1.83）。结论simpella支持的HRPCI对于不适合CABG的高危患者是一种可行的替代方案。被CTS拒绝的患者的临床结果比拒绝手术的患者更差。STS风险评分对30天死亡率的低估表明需要改进这一高危队列的风险预测模型。
{"title":"Short-Term Outcomes of Impella-Supported High-Risk Percutaneous Coronary Intervention in Surgically Ineligible Patients: Insights From PROTECT III","authors":"Batla Falah MD, MPH , Behnam N. Tehrani MD , Julia B. Thompson MS , Yousuf Shah MD , Yiran Zhang MS , Tayyab Shah MD , Michael J. Schonning MS, MBS , Arsalan Abu-Much MD , David J. Cohen MD, MSc , Björn Redfors MD, PhD , Deepak Acharya MD, MSPH , Samer M. Garas MD, MBA , Suzanne J. Baron MD, MSc , Mir B. Basir DO , Aditya S. Bharadwaj MD , Cindy L. Grines MD , Alejandro Lemor MD, MS , Alexander G. Truesdell MD , William W. O’Neill MD , Wayne B. Batchelor MD, MHS, MBA","doi":"10.1016/j.jscai.2025.103859","DOIUrl":"10.1016/j.jscai.2025.103859","url":null,"abstract":"<div><h3>Background</h3><div>Impella-supported high-risk percutaneous coronary intervention (HRPCI) is an alternative for patients ineligible for coronary artery bypass grafting (CABG). However, limited data exist on patient characteristics, reasons for surgical turndown, and patient outcomes. This study aimed to characterize the baseline characteristics and short-term and intermediate-term outcomes of patients evaluated for CABG in the PROTECT III study.</div></div><div><h3>Methods</h3><div>Patients enrolled in the PROTECT III study (NCT04136392), who underwent Impella-supported HRPCI, with an evaluable chart who were assessed by a cardiothoracic surgeon (CTS) for CABG were studied. Reasons for surgical turndown were derived from medical records. Baseline characteristics and major adverse cardiovascular and cerebrovascular events (composite of all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization) at 30 and 90 days and all-cause mortality at 1 year were assessed. Observed to expected 30-day mortality ratios were calculated using the Society of Thoracic Surgeons (STS) risk score.</div></div><div><h3>Results</h3><div>Of 791 patients evaluated for CABG, 680 (86.0%) were turned down by a CTS, and 111 (14.0%) declined surgery. The most common reasons for surgical turndown were comorbidities (40%) and anatomical factors (25%). Compared with patients who declined surgery, patients turned down (deemed ineligible) by CTS had higher rates of major adverse cardiovascular and cerebrovascular event at 30 days (9.2% vs 4.6%; <em>P</em> = .12) and 90 days (14.1% vs 4.6%; <em>P</em> = .02). The observed to expected mortality ratio, based on the STS risk score, was 1.43 (95% CI, 1.08-1.83).</div></div><div><h3>Conclusions</h3><div>Impella-supported HRPCI is a viable alternative for high-risk patients deemed ineligible for CABG. Patients turned down by a CTS had worse clinical outcomes than those who declined surgery. The underestimation of 30-day mortality by the STS risk score suggests the need for improved risk prediction models in this high-risk cohort.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103859"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340570","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 : 2025-10-01DOI: 10.1016/j.jscai.2025.103855
Grant W. Reed MD, MSc , Ankur Kalra MD, MSc , Fawzi Zghyer MD
{"title":"Transcaval Access for Impella Placement: A Viable Alternative in Appropriate Patients","authors":"Grant W. Reed MD, MSc , Ankur Kalra MD, MSc , Fawzi Zghyer MD","doi":"10.1016/j.jscai.2025.103855","DOIUrl":"10.1016/j.jscai.2025.103855","url":null,"abstract":"","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 10","pages":"Article 103855"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340495","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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