Cardiovascular Intervention and Therapeutics最新文献

Comparative evidence on treatment strategies for calcified coronary lesions (CCL) remains scarce, with few head-to-head trials and limited data on clinical outcomes. We conducted a frequentist network meta-analysis of randomized controlled trials (RCTs) comparing excimer laser (ELCA), lithotripsy (IVL), modified balloons (MBA), orbital atherectomy (OA), rotational atherectomy (RA), and RA plus cutting balloons (RA plus CBA) against a conventional strategy (CS). The primary endpoints were severe adverse events (SAE: death, coronary perforation, or slow-flow/no-reflow) and minimum stent area (MSA), while secondary endpoints included major adverse cardiovascular events (MACE) and target lesion revascularization (TLR). Fourteen RCTs including 3,671 patients were analyzed. Atherectomy-based strategies carried a higher risk of SAE versus CS, driven by slow-flow/no-reflow phenomenon. All strategies except OA and ELCA significantly increased MSA compared with CS, with the largest effect observed for RA plus CBA (MD 0.93 mm²; 95% CI 0.48-1.38). None of the strategies reduced MACE or TLR versus CS, although RA plus CBA ranked highest for both endpoints. IVL improved MSA (MD 0.59 mm²; 95% CI 0.14-1.03) without increasing SAE and ranked favorably for MACE and TLR, with the highest probability of lower mortality. Stand-alone MBA remained low-ranked for TLR, and sensitivity analysis confirmed its inferior MSA performance versus IVL. In summary, upfront plaque-modification improved MSA compared with a conventional strategy, although this gain did not translate into significant reductions in MACE or TLR, likely reflecting the limited number of events. RA plus CBA had the highest likelihood of lower MACE and TLR despite higher procedural risk, whereas IVL provided the most favorable balance between safety and efficacy.

In patients supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO), concomitant percutaneous procedures are often limited by difficulty obtaining vascular access. Although prior case reports have described using the ECMO arterial cannula as an access site, the hemodynamic implications are unknown. This in-vitro study examined the effect of direct catheter sheath insertion through the VA-ECMO arterial cannula on circuit hemodynamics. An ECMO circuit was constructed in a water-based bench model with arterial cannula size of 13.5, 15, and 16.5 Fr. We measured flow and pressure changes with the direct Seldinger insertion of 4, 5, 6, and 7 Fr sheaths and catheter into the arterial ECMO cannula, simulating concomitant catheter-based interventions. We demonstrated that sheath insertion consistently reduced circuit flow in a size-dependent manner, requiring higher pump speeds to maintain comparable flow. At the maximum pump speed (3000 rpm), the largest cannula (16.5 Fr) maintained flow rates > 3.0 L/min across all sheath sizes tested, whereas the 15 Fr cannula achieved this only with 4-6 Fr sheaths and the 13.5 Fr cannula only with a 4 Fr sheath. Our findings suggest that certain combinations of ECMO cannula and sheath sizes can preserve adequate perfusion, supporting the feasibility of this simple, reproducible technique under carefully selected conditions. This study provides the first evaluation of flow dynamics for this procedure in a standardized setting. Further studies are warranted to confirm our findings.

This systematic review and meta-analysis evaluate Acute Kidney Injury (AKI) differences between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) and how surgical risk stratification and diagnostic criteria influence outcomes. Following the PRISMA guidelines, we included both non-randomized studies and randomized clinical trials that reported AKI criteria and patients' surgical risk in patients with aortic stenosis by searching PubMed, Scopus, and Web of Science until late September. We executed a random-effects model in Review Manager to pool effect estimates of AKI incidence or the need for dialysis as an odds ratio (OR) and I² heterogeneity, and we utilized R for meta-regression to address any heterogeneity with subgroup analysis for surgical risk, AKI criteria, and study design. We used the Newcastle Ottawa Scale (NOS) and the Cochrane Risk of Bias Tool (RoB-1) for risk of bias assessment and GRADE for certainty assessment. Involving 17 studies and a total of 13,777 patients, we found that the AKI incidence was significantly lower in TAVR compared to SAVR (OR = 0.36; 95% CI: [0.30, 0.44], I² = 55%, P = 0.003), along with the need for dialysis (OR = 0.35; 95% CI: [0.19, 0.63], I² = 0%, P = 0.92). The study also found that intermediate and low-risk patients had more favorable outcomes. However, the retrospective study design and VARC-2 criteria were associated with unfavorable outcomes. TAVR effectively reduced the risk of AKI in all surgical risk categories and the need for dialysis compared to SAVR in patients with AS.

Percutaneous coronary intervention (PCI) after transcatheter aortic valve replacement (TAVR) is technically challenging because of the presence of the transcatheter heart valve (THV), which complicates coronary artery engagement. Owing to their flexibility, diagnostic catheters (DCs) facilitate coronary access, but require subsequent exchange to guiding catheters (GCs) for PCI. The feasibility of using an extension wire (EW) to facilitate DC-to-GC exchange in this context remains unexplored. A retrospective analysis was conducted at our institution, examining 11 PCI cases performed after TAVR between January 6, 2020, and June 1, 2024, in which an EW was employed to transition from a DC to a GC. Clinical, angiographic, and procedural data were reviewed. Procedural success was defined as a successful DC-to-GC exchange and completion of PCI. DC-to-GC exchange using an EW was successfully achieved in all 11 cases (100%). Revascularization was achieved in 10/11 cases (91%). The lesions were uniformly classified as American College of Cardiology/American Heart Association Type B2/C. The GCs included Judkins-type in 7/11 cases (64%) and backup-type in 4/11 cases (36%). The THV types included SAPIEN in 6/11 cases (55%), Evolut in 3/11 cases (27%), and Navitor in 2/11 cases (18%). A 6Fr GC was utilized in 10/11 cases (91%), and rotational atherectomy was performed in 1/11 cases (9%). The use of an EW to facilitate the transition from DC to GC in PCI after TAVR resulted in high procedural success, providing a feasible approach for addressing complex lesions and optimizing procedural outcomes.