Search Results (134)

Background/Objectives: COPD is a chronic, progressive, heterogeneous disease. While volume-reducing procedures are available for advanced emphysema-predominant COPD, options remain limited for chronic bronchitis-predominant COPD. Broncho Muco Cleaner Balloon (BMCB) dilation therapy is a method that aims to provide clinical and functional benefit by causing damage to the goblet cells in the bronchial system. This study evaluated the safety and effects of this method on exacerbations, dyspnea and exercise capacity in chronic bronchitis-predominant COPD. Methods: In this prospective interventional study, a total of 35 patients with stage II–IV chronic bronchitis-predominant COPD underwent BMCB therapy. The results of 25 patients who completed the 12-month-follow-up period were analyzed. Dyspnea was assessed using the modified Medical Research Council (mMRC) scale, pulmonary function with spirometry, exercise capacity with the 6 min walk test (6MWT), and quality of life with the St. George’s Respiratory Questionnaire (SGRQ). Results: At the 12-month follow-up, there were significant improvements in mMRC scores (p < 0.001), moderate/severe exacerbations (p = 0.022), and in the symptom, activity, impact, and total scores of the SGRQ (all p < 0.05). However, no significant changes were observed in FEV₁ (p = 0.291) or 6MWT distance (p = 0.420). No procedure-related mortality occurred during the study period. In one patient, bradycardia was observed during the procedure, but it did not cause hemodynamic instability. Conclusions: Based on the results of this study, BMCB dilation therapy in patients with chronic bronchitis-predominant COPD appears to be safe. It reduces the perceived severity of dyspnea, decreases the number of moderate/severe exacerbations, and improves quality of life, without causing significant changes in pulmonary function or exercise capacity. Full article

Introduction: The Melody transcatheter pulmonary valve (TPV) was the first percutaneous bioprosthetic valve approved for transcatheter pulmonary valve implantation (TPVI). We report our single-centre experience with Melody TPV implantation in patients with congenital heart disease (CHD). Methods: This retrospective observational single-centre study included all patients evaluated in the catheterization laboratory for Melody TPV implantation. Early outcomes included procedural failure, life-threatening adverse events, and mortality. Long-term outcomes assessed during follow-up included infective endocarditis, transcatheter reintervention, and surgical reintervention. Results: Between 2015 and 2025, 50 consecutive patients were evaluated for TPVI with the Melody TPV at our institution. In four patients (8%), the procedure was aborted because of coronary artery compression detected during balloon interrogation of the right ventricular outflow tract (RVOT). One patient (2%) died of septic shock following acute pulmonary oedema in the immediate post-procedural period. The remaining 45 patients (90%) underwent successful Melody TPV implantation and were discharged from hospital. In six patients, the Melody TPV was implanted off-label: in the tricuspid position (n = 2) and in small conduits (<16 mm) (n = 4). Mean follow-up duration was 5.8 ± 3.6 years. One patient was lost to follow-up. Among the remaining 44 patients, seven (15.9%; 2.7% per patient-year) developed infective endocarditis, seven (15.9%; 2.7% per patient-year) underwent transcatheter reintervention (six balloon dilatations of the Melody valve and one valve-in-valve implantation), and four (9.1%; 1.5% per patient-year) required surgical replacement of the Melody TPV. Conclusions: Transcatheter implantation of the Melody TPV is an effective treatment for RVOT dysfunction. At mid-term follow-up, the majority of implanted Melody valves demonstrated satisfactory function, and only a minority of patients required surgical valve replacement. Full article

Background: An aorto-right ventricular fistula (ARVF) secondary to membranous septum rupture is an exceptionally rare complication after surgical aortic valve replacement (SAVR). While sutureless prostheses such as the Perceval valve have gained wide acceptance due to reduced cross-clamp times and procedural simplification, the reported adverse events predominantly include conduction disturbances and paravalvular leaks. Structural septal disruption remains sparsely described. We report a case of an early ARVF after Perceval implantation and review the pathophysiological and procedural mechanisms implicated in septal injury following sutureless and transcatheter aortic valve interventions. Case Description: A 66-year-old woman with severe bicuspid aortic valve stenosis underwent SAVR via a median sternotomy using a Perceval XL prosthesis after meticulous annular decalcification and sizing. Immediate intraoperative transesophageal echocardiography (TEE) confirmed optimal seating without any paravalvular regurgitation. Within 24 h, the patient developed a complete atrioventricular block followed by cardiogenic shock. A repeat TEE revealed a large ARVF with significant left-to-right shunt. Emergent re-exploration identified a membranous septum tear. The Perceval prosthesis was explanted, the defect was closed with a reinforced patch repair, and a 27 mm Inspiris Resilia bioprosthesis was implanted. Peripheral veno-arterial ECMO support was required temporarily. The patient recovered and remained free of prosthetic dysfunction at the two-year follow-up. Discussion: Membranous septum rupture after AVR has an estimated incidence of 0.4–1.5% in TAVR cohorts but is virtually unreported with Perceval valves. The mechanisms are thought to be chronic radial stress from oversized or malpositioned prostheses. Case reports with TAVR devices emphasize oversizing as a risk factor. Predictive factors for septal injury in sutureless AVR mirror those for conduction disturbances: valve oversizing, shallow infra-annular septal length, heavy calcification, and prior valve surgery. Preventive measures, such as strict sizing protocols, the avoidance of balloon dilation, and optimized implantation depth, have reduced conduction complications and may mitigate septal trauma. The treatment choice, whether percutaneous or surgical closure, depends on hemodynamic stability, defect size and anatomy, and operative risk. Conclusions: Early ARVF after Perceval implantation is exceedingly rare but potentially catastrophic. Strict adherence to sizing principles, awareness of septal anatomy, and prompt management, percutaneous in selected stable cases or surgical in acute large defects, are essential to optimize outcomes in sutureless AVR. Full article

Background and Objectives: Bladder neck stenosis (BNS) and vesicourethral anastomotic stenosis (VUAS) are challenging complications following prostate surgery and radiation therapy, with recurrence rates reaching 30–60% after conventional endoscopic management. The Optilume^® paclitaxel drug-coated balloon (DCB) has emerged as a novel minimally invasive treatment combining mechanical dilation with local anti-fibrotic drug delivery. This narrative review synthesizes current evidence on Optilume DCB specifically for BNS and VUAS. Materials and Methods: A comprehensive literature search identified eight relevant publications (2024–2026), including randomized controlled trials, prospective and retrospective cohort studies, and case series addressing Optilume DCB for posterior urethral stenoses. Results: Across the reviewed studies, freedom from reintervention for BNS ranged from 77.5% to 100% at 12 months, while VUAS outcomes were more variable (40–81%). A comparative study of 141 patients demonstrated significantly improved recurrence-free survival with DCB versus standard endoscopic treatment (HR 0.40, p = 0.021). Radiation-induced posterior urethral stenosis showed 81.1% freedom from repeat intervention. Complications were predominantly minor (Clavien-Dindo grade I), with no de novo incontinence attributable to the device. Conclusions: Optilume DCB represents a promising minimally invasive option for BNS and VUAS, particularly in patients with recurrent disease or those unsuitable for reconstructive surgery. BNS appears to respond more favorably than VUAS, likely reflecting distinct pathophysiological mechanisms. Prior radiation therapy remains a negative prognostic factor. Prospective randomized trials with longer follow-up are needed to define the role of DCB in posterior urethral stenosis management. Full article

Background and objectives: Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become an established treatment for failed surgical bioprostheses in patients at high surgical risk. However, procedures performed in degenerated stentless aortic valves remain particularly challenging because of the absence of a radiopaque frame, variable surgical implantation techniques, and a potentially increased risk of coronary obstruction. Evidence in this specific setting is limited. We conducted a systematic review of the literature to identify studies reporting ViV TAVI in degenerated stentless surgical bioprostheses. Materials and methods: Case reports and case series were included when patient-level or clearly identifiable data were available. Baseline characteristics, anatomical features, procedural strategies, and clinical outcomes were extracted and analyzed using a descriptive approach. A total of 54 studies were included, encompassing 294 ViV TAVI procedures performed in failed stentless aortic valves. Results: The mean patient age was 73.9 years, and the average STS-PROM score was 13.45%, reflecting a high-risk population. The most frequently treated prosthesis was the Medtronic Freestyle valve, and the predominant mechanism of failure was regurgitation. Transfemoral access represented the most common approach, while balloon-expandable and self-expanding transcatheter valves were used with similar frequency. Coronary protection strategies were adopted in a minority of procedures, whereas adjunctive procedural techniques such as pre- or post-dilation were relatively common. Device-related complications were mainly driven by coronary obstruction, while cardiac complications included myocardial infarction and unplanned coronary intervention. Overall, VARC-3 device success was achieved in the majority of procedures, with acceptable short-term mortality despite the complexity of the treated population. Conclusions: ViV TAVR in degenerated stentless bioprostheses appears feasible and generally effective but remains associated with specific procedural challenges, particularly related to coronary obstruction risk. Careful anatomical assessment and tailored procedural planning are essential, and larger contemporary studies are needed to better define optimal management strategies in this complex setting. Full article

Background/Objectives: Transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve (BAV) remains associated with higher rates of residual paravalvular leak (PVL), which confers a two-fold increase in mortality. Despite procedural optimization including balloon post-dilatation, a subset of patients exhibit residual ≥moderate PVL. Pre-procedural identification of these patients could guide procedural planning. Methods: We retrospectively analyzed 402 BAV patients who underwent TAVI with self-expanding valves and balloon post-dilatation between January 2016 and June 2024. A multi-modal deep learning model (Model B) was developed, integrating a 3D ResNet encoder for computed tomography (CT) imaging features with a multilayer perceptron (MLP) for clinical variables, fused via a cross-attention mechanism. Its performance was compared against a conventional model (Model A) combining clinical variables with manually derived CT measurements. Both models were evaluated on identical test folds using 5-fold stratified cross-validation. Results: Of 402 patients, 36 (9.0%) had residual ≥moderate PVL, associated with significantly larger aortic root dimensions at all anatomical levels and greater aortic valve calcification volume (median 887.6 vs. 559.2 mm³; p = 0.004). Model A achieved a mean AUC of 0.694 (95% CI: 0.596–0.792). Model B achieved a mean AUC of 0.822 (95% CI: 0.680–0.964), with a specificity of 0.971, accuracy of 0.881, and PPV of 0.860, while sensitivity was 0.429, reflecting the limited number of outcome events in this cohort. Conclusions: A multi-modal deep learning model integrating expert-segmented CT imaging with clinical variables demonstrated significantly improved discrimination over the conventional approach in this internal cohort for predicting residual PVL in BAV-TAVI, supporting the integration of segmentation-guided deep learning into pre-procedural TAVI planning. However, given the modest number of outcome events, external validation is required to confirm the generalizability of these findings. Full article

Introduction: Acquired ureteral stricture is an uncommon but clinically relevant complication, mainly associated with long-standing urolithiasis, chronic inflammatory processes, and repeated endourological procedures. Case presentation: We present the case of a 48-year-old woman with left distal ureteral stricture secondary to urolithiasis and repeated endourological procedures, with a complicated clinical course and progressive renal functional impairment. Despite stepwise management including balloon dilations, endoscopic incision, prolonged urinary diversion, and ultimately ureteral reimplantation with a psoas hitch, the patient developed restenosis of the ureteral neomeatus. Due to persistent obstruction, endoscopic dilation with a paclitaxel-coated balloon (Optilume^®) was performed. Subsequent imaging demonstrated partial improvement in ureteral drainage and relative functional improvement of the left kidney. Conclusion: This case highlights the potential complementary role of drug-coated balloons in complex and refractory benign ureteral strictures, although the currently available evidence remains limited. Full article

Pediatric subglottic stenosis (SGS) remains a significant cause of upper airway obstruction in infants and children, most commonly resulting from prolonged endotracheal intubation. Although open airway reconstruction procedures such as laryngotracheal reconstruction (LTR) and partial cricotracheal resection (PCTR) provide definitive treatment for severe disease, their invasiveness and the burden of postoperative management have prompted increasing interest in less invasive approaches. Endoscopic balloon dilation has emerged as an effective therapeutic option, particularly for early-stage, short-segment, and soft acquired stenosis. This review summarizes the pathophysiology, clinical presentation, and severity assessment of pediatric SGS, and discusses the evolution of surgical management with particular emphasis on the role of balloon dilation. Technical aspects—including balloon sizing, adjunctive radial incision, dilation protocols, and local pharmacologic therapies—are outlined. Endoscopic balloon dilation is most effective in carefully selected patients, particularly those with early-stage and less severe stenosis. While it can significantly reduce the need for open airway reconstruction, recurrence remains a key limitation, necessitating careful patient selection and long-term follow-up. This article represents a narrative review of the current literature combined with the authors’ clinical experience. Full article

Objectives: Strictures are a major complication of Crohn’s disease (CD) affecting up to 20% of patients at diagnosis. Endoscopic balloon dilation (EBD) is the first-line endoscopic approach; however, it entails complications and a need for reintervention. Endoscopic stricturotomy (ESt) and stricturoplasty (ESTx) are promising alternatives. This review aims to provide an up-to-date and comprehensive assessment of their efficacy and safety in CD-associated strictures. Methods: A literature search was performed until August 2025. Primary outcomes were clinical and technical success. Secondary outcomes included adverse events, additional endoscopic or surgical treatments, medication escalation, emergency department visits and hospitalization following intervention. A minimum of four studies were required for meta-analysis, and pooled estimates were calculated using random-effects meta-analysis. Study quality was assessed using CASP checklist. Results: Fifteen studies including 1050 IBD patients (470 CD) were included. Strictures were short (0.9–2.4 cm) and some had prior EBD (7.8–57.1%) or surgery (3.6–91%). Technical success of ESt ranged from 88% to 100% and clinical success from 50% to 96%. The bleeding rate was up to 11.8%, but perforation rate was mostly <2%. The need for additional intervention, endoscopic (18.2–66.6%) or surgical (0–18.2%), varied considerably. Additionally, ESTx’s technical success ranged from 91.7% to 100% whereas clinical success ranged from 71.4% to 91%, with bleeding ranging from 5.2% to 8.8% and perforation from 0% to 3.4%. Similarly, the need for additional endoscopic procedures (7.1–57.1%) and surgery (9.5–25%) varied considerably. Conclusions: ESt and ESTx are safe and effective for managing CD-related strictures, particularly when short, straight, accessible, fibrotic, anastomotic, or refractory to EBD. Full article

This study establishes a numerical model for the implantation of drug-coated balloons (DCBs) in blood vessels, in order to quantify drug (paclitaxel) transfer and diffusion within stenotic vessels and provide a reference for clinical surgical plans. Objective: To study the change in paclitaxel concentration over time in the blood vessel after the implantation of a DCB in vessels with different degrees of stenosis, and thereby determine the optimal balloon dilation time. Method: Using finite element modeling and numerical simulation techniques, a model was established to study the rules of paclitaxel concentration change over time in vessels with different degrees of stenosis. Results: Based on the simulation prediction, the longer the balloon dilation time during implantation, the more paclitaxel enters the vessel wall. After the balloon is withdrawn, the paclitaxel gradually diffuses evenly throughout the vessel, and the paclitaxel concentration gradually decreases over time. Conclusion: Under the simulation conditions, the optimal balloon dilation times for vessels with stenosis rates of 10%, 30%, and 50% should be 20 s, 60 s, and 80 s, corresponding effective duration of 6 weeks, 6 weeks and 4 weeks, respectively. Full article

Tracheostomal stenosis is a troublesome and distressing complication in laryngectomy. There are numerous techniques that describe dilatation of tracheostoma which are mostly performed under general anesthesia with the intermittent apnea technique. We report an alternative dilatation method using a Foley catheter for laryngectomee with stomal stenosis. One case was performed under high-frequency jet ventilation and the other case was carried out with a conventional anesthesia machine. The Foley catheter is used as a conduit for ventilation and the balloon on the Foley catheter was used as a dilatator. Full article

Excimer Laser Coronary Atherectomy (ELCA) has re-emerged as a valuable adjunctive modality in percutaneous coronary intervention (PCI), particularly in the context of increasingly complex coronary anatomy and rising procedural expectations. By delivering pulsed ultraviolet energy at 308 nm through flexible fiber-optic catheters, ELCA enables precise photochemical, photothermal, and photomechanical ablation of atherosclerotic, fibrotic, calcified, and thrombotic tissue while minimizing thermal injury to surrounding structures. Recent technical refinements, simplified catheter designs, and improved safety profiles have enhanced its feasibility and utility across a range of challenging lesion subsets. This review summarizes the fundamental principles underlying excimer laser–tissue interaction, discusses available equipment and key procedural considerations, and examines the expanding clinical evidence supporting ELCA in contemporary practice. Data from observational studies and multicenter registries suggest that ELCA may enhance device crossability, restore coronary flow, and reduce distal embolization in thrombus-rich lesions, particularly during primary PCI. In device-uncrossable lesions, ELCA facilitates plaque modification and improves procedural success, including in chronic total occlusions. Furthermore, ELCA—especially when performed with simultaneous contrast injection—has demonstrated efficacy in treating stent underexpansion refractory to high-pressure balloon dilation, improving minimal stent area and enabling optimal post-dilatation. As lesion complexity continues to increase, ELCA is gaining recognition as an important tool within the interventional armamentarium. While generally safe in experienced hands, ELCA carries a risk of procedural complications that must be carefully considered. Ongoing investigations are expected to further define its optimal use and reinforce its relevance in modern interventional cardiology. Full article

Background: Pancreatic cancer (PC) has a very poor 5-year survival and prognosis. Even when CT or MRI shows no metastasis, staging laparoscopy(SL) still detects tiny peritoneal deposits in 20–30% of patients, making them ineligible for surgery. SL is invasive, requiring general anesthesia and substantial resources. Endoscopic ultrasound (EUS) allows the observation of the bile ducts, pancreas, and abdominal cavity, and EUS-guided fine-needle aspiration (EUS-FNA) is essential for pathological diagnosis. Reports on using EUS to perform peritoneal lavage cytology are currently not available. We hypothesized that combining EUS-FNA with peritoneal lavage (EUS-lavage technique; EUS-LT) could enhance staging accuracy and avoid unnecessary surgical procedures. Methods: Ten in vivo porcine models underwent EUS-LT. Using a 19G FNA needle, 800 mL saline was instilled into the intraperitoneal cavity and then recovered. Two refinements were introduced sequentially: an ENBD catheter with additional side holes and, subsequently, a side-hole introducer (EndoSheather) that eliminated balloon dilation. The primary endpoint was procedural success. Secondary endpoints included safety, complications, recovered volume, duration of endoscopic procedure, and time required to instill 800 mL. Nonparametric tests compared outcomes across iterations. Results: Ten-model porcine in vivo model series were included, and all procedures were successful. No device malfunctions or unanticipated technical failures; one minor mucosal injury during saline injection resolved after re-puncture. The average procedure time was 31.1 min. Stepwise refinements shortened procedure and infusion times and increased recovered volume. Recovered volume approached the instilled amount in later cases, indicating efficient performance. Conclusions: In this ten-model in vivo series, EUS-LT demonstrated technical feasibility and short-term safety. Full article

Background: Optimal endovascular strategy for lower limb peripheral artery disease (PAD) remains debated, particularly regarding 1-year restenosis. Aim: To evaluate the association between drug-coated balloon (DCB)-based angioplasty and 1-year restenosis compared with stent-based and plain balloon strategies in a real-world PAD cohort. Methods: We performed a single-center retrospective analysis of 283 consecutive patients (mean age 67.5 ± 11.2 years, 79% male) undergoing lower limb angioplasty between 2010 and 2023. Patients were treated with one of five strategies: direct stent, pre-dilatation + stent, stent + post-dilatation, DCB ± bailout stent, or plain old balloon angioplasty (POBA). Restenosis at 12 months (≥50% diameter reduction on Doppler, CT angiography, or angiography) was the primary endpoint. Kaplan-Meier curves and multivariable Cox regression adjusted for clinical and lesion characteristics were used. The prespecified main comparison was DCB ± stent versus non-DCB strategies. Results: Overall, 1-year restenosis occurred in 81 patients (28.7%). Restenosis rates were 15.4% with DCB ± stent versus 34.2%, 29.8%, 31.5%, and 38.1% with direct stent, pre-dilatation + stent, stent + post-dilatation, and POBA, respectively (p = 0.004). In adjusted analysis, DCB ± stent was associated with a lower hazard of restenosis compared with direct stent (HR 0.52; 95% CI 0.31–0.87), whereas POBA was associated with a higher hazard versus DCB ± stent (HR 1.89; 95% CI 1.01–3.53). Periprocedural complication rates were low and similar across groups (overall 6.3%). Conclusions: In this real-world PAD cohort, DCB-based angioplasty was independently associated with lower 1-year restenosis compared with stent-based and plain balloon strategies, without an excess of procedural complications. Given the observational design and lesion-driven strategy selection, these findings should be interpreted as hypothesis-generating but support broader use of DCB in appropriately selected lesions. Full article

Background/Objectives: Reconstruction of membranous urethral strictures poses significant surgical challenges, including risks of urinary incontinence and erectile dysfunction. Optilume drug-coated balloon dilation (DCBD) is a minimally invasive treatment for short, recurrent bulbar urethral strictures, but its application in strictures involving the sphincteric urethra remains controversial. This study aims to evaluate the safety, efficacy, and impact on continence of DCBD in membranous urethral strictures involving the male sphincter. Methods: A retrospective analysis was conducted on 53 consecutive patients with urethral strictures involving the sphincteric urethra, treated with Optilume DCBD between June 2021 and June 2025 at a tertiary center. After preoperative imaging, dilation to 20 Fr, then DCBD (30 Fr, 10 bar, 10 min) were performed. We assessed anatomical success (≥18 Fr as per cystoscopy/calibration), freedom from re-intervention, and continence status. Patients with neurological conditions or urinary infections were excluded. Results: The cohort included 35 membranous urethral strictures and 18 vesicourethral anastomosis stenoses that extended into the sphincter. The median follow-up was 13.3 months. At last follow-up, 66.6% and 65.6% of patients in both groups were free from recurrence and re-intervention with satisfactory voiding. No de novo incontinence was observed; two patients with prior post-prostatectomy incontinence remained incontinent. The median age was 68 years; median prior interventions were 2.5, and median stricture length was 3 cm. Conclusions: Optilume DCBD appears to be a safe and effective option for membranous urethral strictures involving the sphincter, without inducing de novo incontinence. Although not a replacement for reconstruction, it offers a minimally invasive alternative for selected patients. Full article