Search Results (125)

Intracardiac echocardiography (ICE) is increasingly recognized as a valuable imaging modality in structural heart interventions, offering high-resolution, real-time visualization from within the cardiac chambers. Originally developed for electrophysiologic procedures, ICE has expanded its use across a broad spectrum of structural interventions, including atrial septal defect (ASD) and patent foramen ovale (PFO) closure, left atrial appendage occlusion (LAAO), transseptal puncture guidance, transcatheter edge-to-edge repair (TEER), balloon mitral valvuloplasty, and both mitral and tricuspid valve therapies. This review outlines the current role and technical principles of ICE, with an emphasis on catheter design, image acquisition protocols, and the emerging potential of 3D ICE. Comparisons with transesophageal echocardiography (TEE) and fluoroscopy are discussed, highlighting ICE’s ability to support minimally invasive, sedation-sparing procedures while maintaining procedural precision. We provide a focused analysis of ICE-guided applications in specific clinical scenarios, emphasizing its role in anatomical assessment, device navigation, and intra-procedural monitoring. Data from recent clinical studies and registries are reviewed to assess safety, feasibility, and outcomes. Practical considerations including operator learning curve, workflow integration, and limitations such as cost and field of view are also addressed. Lastly, we explore future directions including advanced 3D imaging, fusion imaging, artificial intelligence integration, and robotic catheter systems. 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

Drug-coated balloons (DCBs) have emerged as an alternative to drug-eluting stents (DESs) in percutaneous coronary intervention, delivering antiproliferative drugs without leaving a permanent implant. This review provides a comparative analysis of sirolimus-coated DCBs (DCB-S), paclitaxel-coated DCBs (DCB-P), and DESs across key scenarios: de novo coronary lesions in chronic coronary syndrome (CCS), acute coronary syndromes (ACS), and in-stent restenosis (ISR). We discuss late lumen loss (LLL), target lesion/vessel revascularization (TLR/TVR), vessel patency, and major adverse cardiac events (MACE) outcomes, along with current guidelines and emerging indications for DCB-S. We also examine pharmacological differences between sirolimus and paclitaxel (mechanisms of action, tissue uptake, and healing profiles), trial methodologies, and recent innovations in DCB technology. Across stable de novo lesions (especially small vessels and high bleeding-risk patients), multiple trials show DCB-P can achieve non-inferior clinical outcomes to DES. Early data suggest newer DCB-S may likewise match DES outcomes in broader populations. In ACS, DCB-only strategies have demonstrated feasibility and safety in carefully selected lesions without heavy thrombus, with randomized studies like REVELATION (STEMI) showing non-inferior fractional flow reserve and low revascularization rates compared to DES. For ISR, DCB-P is an established Class I treatment in both BMS-ISR and DES-ISR, yielding similar or lower TLR rates than repeat stenting. DCB-S are now being evaluated as an alternative in ISR, aiming to avoid additional stent layers. Contemporary guidelines endorse DCB use in ISR and small vessels, and experts anticipate expanding indications as evidence grows. Sirolimus and paclitaxel differ in antiproliferative mechanisms and pharmacokinetics—sirolimus (cytostatic, mTOR inhibition) may offer faster endothelial recovery, whereas paclitaxel’s high lipophilicity ensures sustained arterial wall retention. Technological advances (e.g., phospholipid micro-reservoirs for sirolimus) are enhancing drug transfer and addressing prior limitations. In summary, DCB-P and DCB-S now represent viable alternatives to DES in specific scenarios, especially where “leaving nothing behind” could reduce long-term complications. Ongoing large randomized trials, such as SELUTION DeNovo, currently available as conference-presented data, together with longer-term follow-up will further clarify the optimal niches for DCB-S versus DCB-P and DES. Full article

Since the initial use of transcatheter pulmonary valves (TPVs), various generations of balloon-expandable and self-expanding valves have become available to effectively treat dysfunctional right ventricular outflow tract (RVOT), providing a less invasive alternative to surgery. In this review, we summarize the most up-to-date TPVR outcomes and mechanisms of TPV dysfunction. Full article

Cryotherapy involves flash freezing of tissue and removing unwanted tissue. Mechanism of injury is causing cell membrane rupture by rapid multiple freeze–thaw cycles, while reserving tissue architecture and the collagen matrix. This promotes favorable wound healing. In recent years, it has gained increasing attention as a treatment option for upper gastrointestinal diseases (Barrett’s Esophagus and early cancer). Currently, two FDA-approved delivery methods are available in the GI tract: Cryoballoon and spray cryotherapy, which will be discussed. In this review, we also propose to examine the expanding role of cryotherapy in gastrointestinal practice, drawing from both clinical studies and illustrative vignettes. In addition, we will highlight its established role in eradicating Barrett’s with low and high-grade dysplasia and compare its outcomes and safety profile with radiofrequency ablation (RFA). We will also discuss the application and safety of spray cryotherapy in the palliation of malignant esophageal strictures when compared with Esophageal stent placement. Cryotherapy may have immunological potential, and it may shrink both primary and metastatic diseases. Ongoing research in this field of Cryo-immunology will be highlighted. Beyond esophageal neoplasia, cryotherapy is increasingly utilized in other upper gastrointestinal precancerous conditions. Through this synthesis, our goal is to provide a timely and comprehensive overview of advancements in cryotherapy and its potential to reshape novel therapeutic approaches in upper gastrointestinal cancers. Finally, we highlight the evolution of a novel platform using nitrous oxide delivered by a handheld device, a contact balloon, and a small replaceable cartridge. This approach may make delivery of cryogen application favorable and a first-line approach in the management of Barrett’s esophagus and early cancer. In addition, Cryoballoon therapy for dysphagia palliation for malignant esophageal strictures may become a preferred approach as more data evolves. Full article

Background/Objectives: The increasing use of endovascular procedures with common femoral artery (CFA) access has led to a rise in iatrogenic arterial injuries at this site. The most frequent injuries are pseudoaneurysms (PSA), retrograde dissections (RD), arteriovenous fistulas (AVF), and arterial perforations. Surgical repair is the standard treatment; however, the use of covered stents (CS) may represent a valid alternative, despite current instructions for use (IFU) not recommending CFA implantation. Methods: We conducted a single-center retrospective study on a prospectively maintained database. Patients undergoing transcatheter aortic valve repair (TAVR), endovascular aortic repair EVAR, diagnostic or therapeutic coronary angiography, or peripheral percutaneous transluminal angioplasty, who were subsequently treated for CFA injury with CS implantation between February 2015 and May 2024, were included. Endpoints were technical success (complete arterial repair), 30-day mortality, overall mortality, reintervention rates, and long-term stent patency. Results: A total of 41 patients were included: 10 (24.4%) PSA, 3 (7.3%) AVF, 27 (65.8%) perforations, and 2 (4.9%) RD. Of which 28 (68.3%) were treated with self-expandable CS and 13 (31.7%) with balloon-expandable CS. Additionally, 33 (80.5%) underwent urgent treatment. Technical success was achieved in 97.5%. Thirty-day mortality was 7.3%, with no procedure-related deaths. At a mean follow-up of 50.8 months (range 1–109), survival was 63.4%, with 100% stent patency and no procedure-related reinterventions. Conclusions: CS implantation for CFA iatrogenic injuries achieved high technical success and excellent long-term patency, representing a viable alternative to open repair. Further studies are needed to integrate CS use for CFA injuries into treatment algorithms and to update device IFUs accordingly. Full article

Mitral annular calcification makes conventional mitral valve surgery extremely challenging and has led to growing interest in less invasive alternatives such as transcatheter mitral valve replacement. Alongside percutaneous approaches, some centers have explored open transatrial implantation of transcatheter heart valves in patients with heavily calcified annuli. This systematic review examines the current evidence on this hybrid “valve-in-MAC” technique, tracing its clinical evolution, technological refinements, patient outcomes, and ongoing debates. Key themes emerging from the literature include the adaptation of existing balloon-expandable and mitral-specific devices to the complex anatomy of calcified mitral annuli, the open transatrial approach as a safer alternative to extensive surgical debridement, and advances in imaging and device design aimed at reducing left ventricular outflow tract obstruction and paravalvular leak. Persistent uncertainties remain, particularly regarding patient selection, long-term valve performance, and comparisons with conventional surgical repair or replacement. Although open transatrial implantation appears technically feasible and provides favorable hemodynamic results compared with fully percutaneous procedures, reported 30-day mortality remains high (approximately 19–27%). This reflects the advanced age, frailty, and multiple comorbidities typical of this patient group rather than procedural shortcomings. Current evidence is limited, with few comparative studies and little data on valve durability. Future work should prioritize multicenter prospective registries and well-designed comparative studies to better define the role of this emerging salvage strategy. Full article

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes in younger women without typical atherosclerotic risk factors. Its distinct pathophysiology and vessel fragility create unique challenges for revascularization. Conservative management is preferred when hemodynamics and coronary flow permit, but selected cases necessitate intervention, primarily percutaneous coronary intervention (PCI). Despite growing insights into SCAD pathomechanics—the “outside-in” and “inside-out” hypotheses—and the central role of intracoronary imaging (OCT/IVUS), optimal device strategies remain under-researched. The present review covers contemporary SCAD-PCI pitfalls and limitations, expanding to the mechanistic underpinnings and procedural applications of drug-coated balloons (DCB) and bioresorbable scaffolds (BRS) as “leave-nothing-behind” alternatives. Both approaches have advantages and drawbacks but are attractive in selected scenarios: DCB delivers antiproliferative therapy without permanent caging, and BRS provides temporary scaffolding (amenable to overlap when required) with the potential to restore biomechanics/vasomotion after resorption. Acknowledging that definitive evidence is lacking and current data are largely observational, the review finally sets future research priorities including head-to-head trials of different DCB types and evaluation of next-generation, thinner-strut, predictably resorbing BRS. The overarching question is whether—and how—these modalities can be integrated into standardized, imaging-guided interventional algorithms for SCAD. Full article

Objectives: This study sought to compare midterm outcomes of low-risk patients who underwent a surgical aortic valve replacement (SAVR) vs. balloon-expandable (BE) or self-expandable (SE) transcatheter aortic valve implantation (TAVI). Methods: Data on consecutive patients undergoing SAVR or transfemoral TAVI between 2017 and 2022 were collected. Patients were separated into three groups according to the type of prosthesis: a biological surgical prosthesis, BE prosthesis and SE prosthesis. The three groups were compared in terms of baseline characteristics, post-procedural outcomes and long-term survival. Results: A total of 542 patients were enrolled, and 221 received a surgical prothesis, 150 received a BE prosthesis and 171 received an SE prosthesis. TAVI patients were older and had a higher risk profile compared to surgical patients. Propensity score matching resulted in an excellent matching of nearly 80 patients in each group. In the matched cohort, SE prostheses were associated with a significantly higher incidence of stroke (SE group 6.3%, BE group 0, SAVR group 2.3%, p = 0.045), para-valvular leak (SE group 8.1%, BE group 2.4%, SAVR group 0, p = 0.017) and left bundle branch block (SE group 23.8%, BE group 18.2%, SAVR group 0%, p < 0.001). Regarding 5-year mortality, no significant differences were reported between the BE and SE TAVI (13.6% vs. 22.5%, p = 0.066). However, when comparing surgery versus TAVI, the SE prosthesis showed a significantly higher 5-year mortality (22.5% vs. 11.6%, p = 0.042). Instead, the BE prosthesis demonstrated its non-inferiority compared to the surgical prosthesis (13.6% vs. 11.6%, p = 0.249). Conclusions: The BE prosthesis should be considered the prosthesis of choice for patients with a long life expectancy requiring a transcatheter procedure. Full article

Objectives: The aim of this study is to evaluate the safety and efficacy of repeat transcatheter aortic valve implantation (redo-TAVI) in the polish population. Methods: In this multicentre nationwide registry (ClinicalTrials.gov identifier, NCT03361046), we provide characteristics, periprocedural variables and long-term outcomes of high-risk patients who underwent redo-TAVI. Results: The mean age among 32 individuals who underwent redo-TAVI was 75 ± 13 years, and 62.5% were male. The mean time from index TAVI to redo-TAVI was 4.7 ± 3.5 years, with failed procedures (up to 1 year) occurring in 7 (21.9%) and failed transcatheter heart valve (THV, beyond 1 year) in the remaining majority of the 25 (78.1%) patients. Computed tomography-based native bicuspid aortic anatomy was found frequently in 37.5% of cases (58.3% in failed procedures and 41.7% in failed THV). The mean failed THV size was large (27.7 ± 3 mm) and predominantly presenting with pure regurgitation (59.4%). In more than two-thirds (68.7%), balloon-expandable or self-expandable THV was the most common strategy of redo-TAVI. None or mild regurgitation was found in 90.6%, and the mean transvalvular gradient was 13.1 ± 5.5 mmHg, with only three cases with >20 mmHg of the residual gradient (9.4%). Peri-procedural and 30-day complications were low, and cardiovascular and all-cause mortality at 1 year was 9.4 and 15.6%, respectively. There was a relatively high incidence of non-procedural stroke after redo-TAVI (n = 5, 15.6%), with all cases observed after 30 days. Conclusions: Initial data of redo-TAVI in Poland suggest that the procedure is safe and characterized by favourable efficacy and low rates of short-term adverse outcomes. A high frequency of baseline native bicuspid anatomy and late stroke occurrence after the redo-procedure warrants further investigation in larger cohorts. Full article

Background: Peripheral Artery Disease (PAD) of the lower extremities is a prevalent manifestation of atherosclerotic disease, significantly affecting individuals aged 55–70, with a global incidence of 4–12%. Major risk factors include smoking, diabetes mellitus, hypertension, dyslipidemia, and chronic kidney disease, all contributing to endothelial damage and subsequent plaque progression. This retrospective study examines the outcomes of endovascular treatment for TASC C and D lesions, which are complex cases that have historically required surgical intervention. Methods: From June 2022 to September 2023, 48 patients were analyzed, with a mean age of 67.48 years; 37.5% were female. Statins were administered to 64.6% of patients, and 93.8% received antiplatelet therapy. Endovascular procedures included balloon angioplasty, stenting, and the use of drug-eluting balloons (DEB), employing varying access routes, primarily via percutaneous approaches. Results: The study revealed a 12-month primary patency rate of 75.8% and a secondary patency rate of 95.5%, highlighting the effectiveness of follow-up interventions. Complications occurred in 10.4% of cases, with a perioperative mortality rate of 0%. Notably, 29.2% of patients required amputation, reflecting the severity of PAD. Conclusions: The outcomes demonstrate that endovascular treatment may be a viable alternative for managing TASC C and D lesions, offering satisfactory clinical outcomes and an acceptable safety profile. Continuous monitoring and interdisciplinary evaluations are essential for optimizing patient care and minimizing complications. As endovascular technologies advance, their role in treating severe peripheral arterial disease is likely to expand. Full article

Background/Objectives: To report our single-centre experience with the first 100 patients who underwent transcatheter aortic valve replacement (TAVR) with the new balloon-expandable Myval system. We report 3-year outcomes in low- to high-risk TAVR patient populations. Methods: From November 2019 to July 2021, 100 consecutive patients underwent TAVR, and their outcomes were classified according to the Valve Academic Research Consortium 3 definitions. Device performance was assessed using transthoracic echocardiography. Data collection was approved by the local ethical committee. Results: Among the 100 patients, most were male (n = 63), the mean age was 74.7 years, the mean EuroSCORE II score was 4.8 ± 4.9, and the mean Society of Thoracic Surgeons score was 5.6 ± 3.9. All patients were followed up for three years or until death. The rates of all-cause mortality, cardiac mortality and stroke were 28%, 7% and 5%, respectively. After three years, residual moderate aortic regurgitation was detected in eight patients without severe grade, and bioprosthetic valve dysfunction was observed in 17: structural valve deterioration in 10 (only stage 2), non-structural valve deterioration in three (paravalvular leak in one, patient–prosthesis mismatch in two), and endocarditis in four. Definite transcatheter heart valve thrombosis (hypoattenuated leaflet thickening) was not observed. Bioprosthetic valve failure was detected in four patients (stage 1: 1, stage 2: 0, stage 3: 3). After three years of follow-up, survival analysis revealed no significant differences in all-cause mortality, cardiac mortality, or the composite endpoint (including cardiac mortality, stroke and valve-related dysfunction) between patients with bicuspid (BAV) and tricuspid (TAV) aortic valve morphology and across annulus sizes (small, intermediate and large). Conclusions: TAVR resulted in significant and sustained improvements in valve haemodynamics with low rates of valve dysfunction and adverse clinical outcomes over a three-year follow-up period. Valve morphology (BAV vs. TAV) and annulus size did not significantly impact survival, haemodynamic performance, or valve durability. These results support the expanded use of TAVR in diverse patient populations, although extended follow-up is essential to fully establish long-term durability. Full article

Background: Pre-existing atrial fibrillation (AF) is common among patients undergoing transcatheter aortic valve replacement (TAVR). However, evidence regarding its impact on the risk of permanent pacemaker (PPM) implantation and other conduction disturbances (CDs) after TAVR remains inconsistent. The aim of this study was to assess the effect of baseline heart rhythm on the risk of conduction abnormalities following TAVR. Methods: This study included patients with severe AS who underwent TAVR using either balloon-expandable (BEVs) or self-expanding valves (SEVs). The primary endpoint was the incidence of PPM implantation and new or worsening left bundle branch block (LBBB) after TAVR according to baseline rhythm (sinus rhythm vs. AF). Secondary endpoints were predictors of PPM implantation, LBBB, the occurrence of periprocedural stroke, and in-hospital mortality. Results: A total of 5195 TAVR patients were included: 3560 with baseline sinus rhythm and 1635 with baseline AF. PPM implantation was more frequent in patients with AF than in those with sinus rhythm (17% vs. 15%, p = 0.033), whereas new or worsening LBBB was less common (11% vs. 14%, p = 0.026). After adjustment with multivariable logistic regression, these associations were no longer statistically significant (PPM implantation: OR 1.156, 95% CI 0.969–1.379, p = 0.108; new or worsening LBBB: OR 0.826, 95% CI 0.676–1.010, p = 0.062). Independent peri-procedural predictors of PPM implantation included baseline first-degree AV block, pre-procedural RBBB, the use of self-expandable valves, implantation of larger valve sizes (≥23 mm), and the need for valve repositioning. Conclusions: In this large cohort, baseline AF was not associated with an increased risk of PPM implantation or new onset LBBB compared with sinus rhythm. These findings suggest that baseline rhythm alone should not be considered an independent predictor of PPM implantation or CDs following TAVR. Full article

Transcatheter aortic valve replacement (TAVR) has evolved over the last two decades into a cornerstone therapy for patients with severe symptomatic aortic stenosis. This therapy was initially reserved for those at high or prohibitive surgical risk but is now firmly established across all surgical risk categories. Its non-inferiority to surgical aortic valve replacement has been demonstrated even in low-risk populations, supporting the rapid worldwide expansion of its use. Nevertheless, despite procedural refinements and the advent of newer-generation prostheses, conduction disturbances leading to permanent pacemaker implantation (PPI) remain one of the most frequent and clinically relevant complications. Reported incidence ranges between 8% and 20% depending on prosthesis type, implantation technique, and baseline patient characteristics. Multiple clinical, anatomical, and procedural factors have been identified as strong predictors of post-TAVR conduction disturbances. Taken together, the integration of anatomical and clinical risk assessment, precise procedural planning, careful device selection, structured monitoring, and emerging therapeutic strategies constitutes a comprehensive, evidence-based approach to reduce the burden of conduction disturbances following TAVR. Such a multimodal framework has the potential not only to lower the incidence of permanent pacemaker implantation but also to improve safety, optimize healthcare resource utilization, and support the broader adoption of TAVR in increasingly younger and lower-risk patient populations. Full article

Background: Drug-coated balloons (DCBs) have transformed percutaneous coronary intervention (PCI) by delivering antiproliferative drugs without leaving a permanent scaffold. DCB is initially indicated for in-stent restenosis (ISR) and now has expanded indication for treating small vessel disease and bifurcation lesions. However, there is a heterogeneity in the patient and lesion selection, lesion preparation techniques, and the optimal duration of dual antiplatelet therapy after DCB angioplasty. The Cardiovascular Intervention Association of Thailand (CIAT) developed a consensus statement on DCB use in coronary interventions. Methods: The CIAT expert panel systematically reviewed randomized controlled trials, meta-analyses, and real-world studies evaluating DCB therapy. Procedural strategies, imaging guidance, physiologic assessment, and antiplatelet therapy protocols were appraised. The recommendations were developed and put to an online vote. Consensus was defined when the recommendation reached 80% of votes in support of “agree” or “neutral”. Results: Clinical evidence demonstrates that DCBs achieve comparable outcomes to drug-eluting stents (DESs) in selected lesions while enabling shorter durations of dual antiplatelet therapy (DAPT), particularly beneficial for high-bleeding-risk patients. Optimal outcomes require meticulous lesion preparation, appropriate balloon sizing, and controlled vessel dissection. Intravascular imaging and physiologic assessment further refine procedural precision, while hybrid strategies combining DCBs and DESs address complex lesions and multivessel disease. The final document presents 15 consensus statements addressing indications, procedural techniques, imaging and physiologic guidance, and antiplatelet therapy recommendations. Conclusions: DCB angioplasty can be an alternative or complement to therapeutic options to DESs across multiple clinical and anatomical scenarios. The CIAT consensus provided structured recommendations to support DCB therapy in contemporary practice. Full article