Catheterization and Cardiovascular Interventions最新文献

Drug-coated balloons (DCB) have emerged as a promising stentless strategy in percutaneous coronary intervention, but their role in ST-elevation myocardial infarction (STEMI) involving large de novo coronary arteries remains uncertain. This systematic review and meta-analysis evaluated the clinical and angiographic outcomes of DCB compared with drug-eluting stents (DES) in STEMI patients with large bservational cohorts. The primary outcomes were target lesion revascularization (TLR), major adverse cardiac events (MACE), myocardial infde novo coronary lesions (≥ 2.5 mm). A comprehensive search of PubMed, Scopus, and Web of Science was performed up to July 1, 2025, including randomized controlled trials, non-randomized trials, and oarction (MI), and cardiac and all-cause death; angiographic endpoints included minimal lumen diameter (MLD) post-PCI and at follow-up, and late lumen loss (LLL). Four studies comprising 1428 patients were included. There were no significant differences between DCB and DES in TLR (RR = 1.16, 95% CI: 0.62–2.17, p = 0.65), MACE (RR = 1.59, 95% CI: 0.64–3.97, p = 0.32), cardiac death (RR = 1.07, 95% CI: 0.55–2.09, p = 0.84), or MI (RR = 1.20, 95% CI: 0.77–1.87, p = 0.42). Post-PCI MLD was significantly higher with DES (MD = –0.29 mm, 95% CI: –0.39 to –0.20, p < 0.00001), whereas follow-up MLD did not differ significantly between groups (MD = –0.26 mm, 95% CI: –0.62 to 0.11, p = 0.17). LLL was comparable (MD = 0.02 mm, 95% CI: –0.08 to 0.11, p = 0.73). These findings suggest that DCB represents a safe and effective alternative to DES in STEMI patients with large de novo coronary artery lesions.

Coronary perforation (CP) is an uncommon but serious complication of orbital atherectomy (OA). Optical coherence tomography (OCT) evidence of catheter “tenting” against the healthy vessel wall may indicate unsatisfactory guidewire bias and elevated perforation risk during OA. We describe OCT findings of a case with OA-related CP.

Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) is a technically demanding procedure where successful guidewire navigation is critical. While intravascular ultrasound (IVUS) provides essential anatomical detail, its utility is often limited by the cognitive challenge of correlating the 2D IVUS image with the 3D angiographic view. A failure in this co-registration can lead to procedural failure. To address this challenge, we detail the “Be-The-Wire” cognitive model, a simple, six-step mnemonic-based method for achieving intuitive 3D IVUS-angiographic co-registration. The technique requires the operator to adopt the perspective of being the IVUS-carrying wire, with their head positioned on the proximal side of the coronary artery. Key steps include optimizing the angiographic view for gear separation, deducing the C-arm's viewing angle, mapping this angle to a clock-face position on the IVUS display, and physically rotating the screen to align it with the vessel's trajectory. The “Be-The-Wire” cognitive model provides a simple yet profound method to improve guidewire control by facilitating intuitive co-registration without requiring complex software. Mastering this technique is a valuable step which may potentially contribute to improving safety and success rates in complex CTO PCI.

Cholesterol crystal embolism (CCE) is a systemic thromboinflammatory disorder (the intertwined activation of inflammatory pathways and coagulation cascades) characterized by the embolization of cholesterol crystals (CCs) from atherosclerotic plaques into microvasculature, leading to multiorgan dysfunction. Despite its clinical significance, CCE remains underdiagnosed due to nonspecific presentations and diagnostic challenges. This review synthesizes current evidence on the central role of CC-induced neutrophil extracellular trap (NET) formation in driving endothelial injury, thrombosis, and gastrointestinal cancer progression with a specific focus on gastrointestinal malignancies. Mechanistically, CCs activate the TLR4/9-NLRP3 inflammasome cascade, triggering IL-1β release and PAD4-mediated histone citrullination, which culminate in NETosis. These NETs exacerbate vascular damage by promoting endothelial dysfunction, platelet adhesion, and immune evasion. In gastrointestinal cancer (e.g., colorectal, hepatocellular, pancreatic), CCs remodel the tumor microenvironment (TME) by inducing NET-driven immunosuppression, extracellular matrix degradation, and metastatic niche formation. The interplay between CCs, NETs, and inflammation creates a self-perpetuating cycle that worsens atherosclerosis, CCE, and tumor metastasis. Emerging therapeutic strategies targeting this cholesterol-NET-inflammation axis show promise. DNase I and heparin disrupt NET scaffolds, while PAD4 inhibitors (e.g., GSK484) block NET generation. Colchicine demonstrates dual anti-inflammatory and NETosis-inhibitory effects, and lipid-lowering agents (statins, PCSK9 inhibitors) mitigate CC burden. Nanotherapies, such as HDL-mimetic nanoparticles, offer targeted delivery to restore immune surveillance. This review highlights the need for personalized, biomarker-guided therapies to disrupt the pathogenic CC-NET axis proposing an integrated approach to mitigate CC-mediated damage in cardiovascular and gastrointestinal oncologic disease.

The diagnosis of acute aortic dissection (AAD) is challenging, particularly when it presents with features of acute myocardial infarction (AMI). We report the case of an 81-year-old male with multiple risk factors (refractory hypertension, low BMI, smoking history) who presented with persistent substernal crushing pain and elevated cardiac biomarkers, leading to an initial diagnosis of acute coronary syndrome (ACS). Coronary angiography revealed no obstructive disease but a hazy appearance in the left anterior descending artery. Subsequent intravascular ultrasound (IVUS) interrogation of the left main ostium identified a fibrous plaque with a widened hypoechoic space extending toward the aorta, highly suspicious for aortic dissection involvement. This was definitively confirmed by aortic computed tomography angiography (CTA), which visualized the dissection flap. Notably, the patient's d-dimer level was within normal limits, contravening typical expectations. This case underscores the critical role of IVUS in the diagnostic armamentarium for AAD mimicking AMI, especially when classic features are absent or other imaging modalities are equivocal or unavailable. It highlights the necessity of maintaining a high index of suspicion for this life-threatening condition to avoid inappropriate antithrombotic therapy and guide appropriate management.