Distal Versus Conventional Transradial Artery Access for Coronary Catheterization in Patients With STEMI (DR-STEMI): Rationale and Design of an International, Multicenter, Randomized Trial.

Rationale: Transradial access (TRA) constitutes the cornerstone for cardiac catheterization and is recommended by the multiple recent guidelines, irrespective of clinical presentation. The existing literature has evaluated distal transradial access (dTRA), as a feasible and safe approach in patients with chronic and acute coronary syndrome, excluding although patients presenting with ST- elevation myocardial infraction (STEMI).

Primary Hypothesis: The current randomized clinical trial compares dTRA versus conventional TRA access in patients with STEMI undergoing coronary angiography and interventions regarding peri- and post-procedural characteristics.

Incidence and Predictors of Persistent Left Atrial Appendage Patency and its Subtypes after Percutaneous Closure: a Pre-Specified Analysis of the SWISS-APERO Trial.

Aims: Left atrial appendage (LAA) patency after percutaneous closure is associated with higher thromboembolic risk, especially when detected at later time points after procedure. We aim to investigate the incidence and predictors of persistent LAA patency and its different subtypes at cardiac computed tomography angiography (CCTA) during the first year after LAA closure (LAAC).

Methods: In the SWISS APERO trial, patients undergoing LAAC were randomly assigned (1:1) to Amulet or Watchman/FLX across 8 European centers and received CCTA follow-up at 45 days and 13 months.

Management of device embolisation during left atrial appendage closure.

Percutaneous left atrial appendage closure (LAAC) is increasingly used as a valuable intervention to prevent cardioembolic stroke among patients with atrial fibrillation who are poor candidates for long-term anticoagulation. The safety of the procedure has significantly improved over time; nevertheless, device embolisation remains a severe complication that still occurs in around 0.1% of cases.

Impact of diabetes on three-year outcome after coronary stenting in patients with polyvascular atherosclerotic disease - a secondary analysis of the randomized TWENTE trials.

Background: The presence of polyvascular atherosclerotic disease is associated with a high-risk of adverse events following percutaneous coronary intervention (PCI). As the extent to which the presence of diabetes further increases this elevated risk is unclear, based on current literature, we sought to assess the long-term outcome after PCI in patients with polyvascular disease, comparing those with and without diabetes.

Methods: The current study population consists of patients with known polyvascular disease, identified from a pooled patient-level database of 4 PCI trials in all-comers treated with new-generation drug-eluting stents; no exclusion criteria were set.

3-Year Clinical Outcomes Comparing the Amulet vs Watchman FLX for Left Atrial Appendage Closure in Patients With Atrial Fibrillation: Results From the SWISS-APERO Randomized Clinical Trial.

Background: No study thus far has compared Amulet with Watchman FLX for clinical outcomes beyond 1 year after percutaneous left atrial appendage closure (LAAC).

Objectives: The goal of this study was to compare Amulet and Watchman FLX in terms of 3-year clinical outcomes.

Methods: In the investigator-initiated SWISS-APERO (Comparison of Amplatzer Amulet and Watchman Device in Patients Undergoing Left Atrial Appendage Closure) trial, patients with atrial fibrillation and high bleeding risk undergoing LAAC were randomly assigned (1:1) to receive Amulet or Watchman/FLX across 8 centers.

A new implanter classification system for left atrial appendage closure from the European Left Atrial Appendage Closure Club (ELAACC).

This manuscript proposes a novel implanter classification system for left atrial appendage (LAA) closure, aimed at overcoming the limitations of current anatomical classifications. By integrating essential anatomical and functional details, this new classification system strives to provide a comprehensive framework that is both user-friendly and effective in distinguishing between complex and standard LAA anatomies, facilitating a common language among implanters and imagers, and predicting procedural risks.

Percutaneous Left Atrial Appendage Closure: Supporting Evidence, Limitations and Future Directions.

Percutaneous Left Atrial Appendage Occlusion (LAAO) has emerged as a promising intervention for stroke prevention in patients with atrial fibrillation who are contraindicated for long-term anticoagulation therapy. Despite its growing adoption, a comprehensive review of the LAAO procedure is essential to consolidate the supporting evidence, identify limitations, and outline future directions. This review aims to evaluate the efficacy and safety of LAAO, drawing on clinical trials and real-world studies to provide a balanced perspective.

Elderly patients treated with Onyx versus Orsiro drug-eluting coronary stents in a randomized clinical trial with long-term follow-up.

Background: Percutaneous coronary intervention (PCI) with new-generation drug-eluting stents is increasingly performed in elderly patients, who generally have more comorbidities and more technically challenging target lesions. Nevertheless, there is a paucity of reported data on the long-term safety and efficacy of PCI with contemporary stents in elderly all-comers.

Methods: This prespecified secondary analysis of a large-scale randomized clinical trial (BIONYX; clinicaltrials.

Contemporary European practice in left atrial appendage closure: results from a survey focusing on planning, techniques and post-implantation management.

Objectives: The purpose of this European survey was to describe current preprocedural planning, procedure techniques and post-implantation management of left atrial appendage closure (LAAC).

Design: Prospective survey regarding current practice for LAAC between March and August 2023.

Setting: 357 participating European LAAC centres in 14 countries.

Impact of Anthropometric Measures on Distal vs Conventional Radial Access for Percutaneous Coronary Procedures.

Background: Results from the Distal vs Conventional Radial Access (DISCO RADIAL) trial confirmed distal radial access (DRA) as a valid alternative to conventional transradial access, with equally low rates of radial artery occlusion (RAO), yet higher crossovers but shorter hemostasis.

Objectives: The purpose of the study was to investigate whether patient anthropometric measures influence the effect of randomized access on key secondary outcomes.

Methods: DISCO RADIAL was an international, multicenter, randomized controlled trial in which patients with indications for percutaneous coronary procedure using a 6-F Slender sheath were randomized to DRA (n = 650) or transradial access (n = 657) implementing best practices to reduce RAO.

Benefit of Systematic "Jailed Wire" Technique for Bifurcation Provisional Stenting. A CABRIOLET Substudy.

Background: Jailed wire (JW) in the side branch (SB) is recommended during coronary bifurcation provisional stenting, but there is uncertainty about the real benefit. Our objective was to evaluate the benefit of a JW technique in the Coronary Artery Bifurcation Revascularization Without kIssing ballOon infLation by rEpoT (CABRIOLET) registry.

Methods: In CABRIOLET, which included 500 patients, we compared the primary composite end point of a poor final SB angiographic result (of Thrombolysis in Myocardial Infarction (TIMI) flow < III, dissection grade > B, thrombosis, residual stenosis > 70%, or additional SB stenting) whether JW was performed or not.

Clinical outcome after bleeding events following coronary stenting in patients with and without comorbid peripheral arterial disease.

Patients undergoing percutaneous coronary intervention (PCI) may experience bleeding events. Bleeding risk is increased in patients with comorbid peripheral arterial disease (PADs). To evaluate whether PCI patients with PADs have worse outcome after bleeding, we assessed pooled patient-level data of 5,989 randomized all-comer trial participants and identified those who had a bleeding (BIO-RESORT:NCT01674803, BIONYX:NCT02508714).

Impact of intensive versus nonintensive antithrombotic treatment on device-related thrombus after left atrial appendage closure.

Introduction And Objectives: The optimal antithrombotic therapy (AT) after left atrial appendage closure (LAAC) is debated. We assessed the impact of intensive vs nonintensive AT on the incidence of device-related thrombus (DRT) based on whether the device implantation was classified as optimal or suboptimal.

Methods: This study included patients who underwent successful LAAC in 9 centers.

Distal radial artery palpability and successful arterial access for coronary angiography: A post-hoc analysis from two randomized trials.

Background: Distal radial artery access (DRA) has been emerged as an alternative for conventional transradial arterial access. While palpation of radial artery is mandatory prior coronary angiography, it remains unknown the clinical impact of palpation in DRA success. Aim of our study is to explore whether the palpability of distal radial artery is linked with higher rates of successful arterial access.

Ultrasound-guided versus fluoroscopy-guided large-bore femoral access in PCI of complex coronary lesions: the international, multicentre, randomised ULTRACOLOR Trial.

Background: Transfemoral access is often used when large-bore guide catheters are required for percutaneous coronary intervention (PCI) of complex coronary lesions, especially when large-bore transradial access is contraindicated. Whether the risk of access site complications for these procedures may be reduced by ultrasound-guided puncture is unclear.

Aims: We aimed to show the superiority of ultrasound-guided femoral puncture compared to fluoroscopy-guided access in large-bore complex PCI with regard to access site-related Bleeding Academic Research Consortium 2, 3 or 5 bleeding and/or vascular complications requiring intervention during hospitalisation.