High-Speed Intravascular Near-infrared Fluorescence-Ultrasound Imaging In Vivo.

Objective: The combination of near-infrared fluorescence (NIRF) with intravascular ultrasound (IVUS) has shown promising applications for imaging atherosclerosis in ex vivo human arteries and in vivo animal models. However, long acquisition times, rotational distortion causing inconsistent image quality and poor catheter durability have hampered clinical translation. Technical limitations have included motor drive unit (MDU) instability, and catheter designs with a single-layer drive shaft and long rigid length of the distal tip.

The Impact of Target Vessel Diameter on the Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry.

Background: The impact of target vessel diameter on outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.

Aim: To compare the impact of target vessel diameter on CTO PCI outcomes.

Methods: We examined the association of vessel diameter with clinical, angiographic characteristics, and procedural outcomes of CTO-PCI in a large multicenter registry.

Recent Pathophysiological Insights Are Advancing the Treatment of Venous Thromboembolism.

Venous thromboembolism, defined as deep vein thrombosis and pulmonary embolism, is the third leading cause of cardiovascular deaths globally. Long-term complications of unresolved venous thrombi include post-thrombotic syndrome in the legs and chronic thromboembolic pulmonary hypertension. As the venous thrombus ages, the acute, fibrin, and red blood cell-rich composition changes to a chronic cellular, fibrotic mass that does not respond to presently available therapeutic approaches.

Revisiting the Open Vein Hypothesis to Reduce the Postthrombotic Syndrome: Implications for Multidisciplinary Care and Research: A Scientific Statement From the American Heart Association.

The "open vein hypothesis" postulates that early thrombus clearance and restoration of venous blood flow may prevent postthrombotic syndrome after proximal deep vein thrombosis. Since its proposal several decades ago, new insights from basic and clinical studies have motivated a re-evaluation and refinement of this hypothesis. According to data from these studies, susceptibility to postthrombotic syndrome occurs as a result of differences in genetic composition, thrombophilic conditions, predilection to inflammation and fibrosis, endogenous fibrinolytic capability, timing of symptom presentation and treatment initiation, and efficacy of antithrombotic therapy.

Chronic Total Occlusion Percutaneous Coronary Intervention: Present and Future.

Chronic total occlusion percutaneous coronary intervention has evolved into a subspecialty of interventional cardiology. Using a variety of antegrade and retrograde techniques, experienced operators currently achieve success rates of 85% to 90%, with an incidence of major periprocedural complications of ≈2% to 3%. Several developments in equipment (new microcatheters and guidewires, novel reentry devices), imaging (computed tomography angiography guidance, intravascular imaging for reentry), techniques (intraocclusion contrast injection, advanced subintimal tracking and reentry), and artificial intelligence (automated computed tomography image analysis and prediction of the likelihood of crossing success with various techniques) could further improve outcomes.

Obstructive sleep apnea syndrome in chronic total occlusion percutaneous coronary intervention; insights from the PROGRESS-CTO registry.

Objective: To examine the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients with obstructive sleep apnea syndrome (OSAS).

Methods: We compared the procedural characteristics and outcomes of CTO PCIs in patients with and without OSAS in a multicenter registry.

Results: Of 7403 patients who underwent 7408 CTO PCIs between 2012 and 2024 at 47 centers, 942 (13%) had OSAS.

Vascular Access-Site Complications in Chronic Total Occlusion Percutaneous Coronary Intervention.

Background: Vascular access-site complications (VASC) can occur during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Methods: We compared the baseline and procedural characteristics, and outcomes of patients with versus without VASC in a large multicenter CTO PCI registry. VASC was defined as any of the following: small hematoma (hematoma < 5 cm), large hematoma (hematoma ≥ 5 cm), arteriovenous fistula, pseudoaneurysm and acute arterial closure.

Traditional Versus Dual Lumen Microcatheter-Assisted Parallel Wiring in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry.

Background: The effectiveness and safety of traditional versus dual lumen microcatheter (DLMC)-assisted parallel wiring in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.

Aims: To compare traditional versus dual lumen microcatheter (DLMC)-assisted parallel wiring.

Methods: We compared the clinical and angiographic characteristics and outcomes of traditional versus DLMC-assisted parallel wiring after failed antegrade wiring (AW) in a large, multicenter CTO PCI registry.

Management of Coronary Stent Underexpansion.

Coronary stent underexpansion is an important problem and limitation of percutaneous coronary intervention, adversely affecting both short- and long-term patient outcomes. Stent underexpansion occurs when a stent fails to expand adequately compared with the adjacent reference segment, resulting in inadequate luminal gain. Multiple studies suggest that stent underexpansion is associated with increased risks of in-stent restenosis, stent thrombosis, and myocardial infarction, resulting in recurrent symptoms, readmissions, repeat interventions, and increased mortality.

Use of the Ostial Flash balloon in aorto-ostial chronic total occlusion percutaneous coronary intervention.

Background: The use of the Ostial Flash balloon (Ostial Corporation) has received limited study in aorto-ostial chronic total occlusion (CTO) percutaneous coronary artery intervention (PCI).

Methods: The authors evaluated the outcomes of Ostial Flash balloon use in a large CTO-PCI registry (PROGRESS-CTO, NCT02061436).

Results: The Ostial Flash balloon was used in 54 of 907 aorto-ostial CTO PCIs in 905 patients (6.

Multiple Biomarkers to Predict Major Adverse Cardiovascular Events in Patients With Coronary Chronic Total Occlusions.

There are limited tools available to predict the long-term prognosis of persons with coronary chronic total occlusions (CTO). A previously described blood biomarker panel to predict cardiovascular (CV) events was evaluated in patients with CTO. From 1,251 patients in the CASABLANCA study, 241 participants with a CTO were followed for an average of 4 years for occurrence of major adverse CV events (MACE, CV death, nonfatal myocardial infarction or stroke) and CV death/heart failure (HF) hospitalization.

Association of Proximal Vessel Tortuosity with Technical Success and Clinical Outcomes: Analysis From the Progress-CTO Registry.

Background: Proximal vessel tortuosity can hinder wiring and equipment delivery during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Aims: We sought to examine the association of proximal vessel tortuosity with the short and long-term outcomes of patients undergoing CTO PCI.

Methods: We examined the association of proximal vessel tortuosity with clinical outcomes in patients who underwent CTO PCI at 50 US and non-US centers between 2012 and 2024.

Validation of the coronary artery specific chronic total occlusion percutaneous coronary intervention angiographic difficulty scores in the PROGRESS-CTO registry.

Background: The J-CTO investigators recently developed angiographic difficulty scores for each of the three major coronary arteries in patients undergoing first-attempt chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in de novo occlusions.

Methods: We examined the performance of the individual J-CTO scores in a large multicenter registry.

Results: The CTO lesion location was as follows: right coronary artery (RCA) 3,805 (54%), left anterior descending artery (LAD) 2,303 (33%), and left circumflex (LCX) 935 (13%).

Intravascular Lithotripsy Versus Rotational Atherectomy in Coronary Chronic Total Occlusions: Analysis from the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention Registry.

There are limited comparative data on the use of plaque modification devices during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We compared intravascular lithotripsy (IVL) with rotational atherectomy (RA) for lesion preparation in patients who underwent CTO PCI across 50 US and non-US centers from 2019 to 2024. Of 15,690 patients who underwent CTO PCI during the study period, 436 (2.

Emerging Hybrid Intracoronary Imaging Technologies and Their Applications in Clinical Practice and Research.

Intravascular ultrasound and optical coherence tomography are used with increasing frequency for the care of coronary patients and in research studies. These imaging tools can identify culprit lesions in acute coronary syndromes, assess coronary stenosis severity, guide percutaneous coronary intervention (PCI), and detect vulnerable plaques and patients. However, they have significant limitations that have stimulated the development of multimodality intracoronary imaging catheters, which provide improvements in assessing vessel wall pathology and guiding PCI.

Targeting Fibrinolytic Inhibition for Venous Thromboembolism Treatment: Overview of an Emerging Therapeutic Approach.

Venous thrombosis and pulmonary embolism (venous thromboembolism) are important causes of morbidity and mortality worldwide. In patients with venous thromboembolism, thrombi obstruct blood vessels and resist physiological dissolution (fibrinolysis), which can be life threatening and cause chronic complications. Plasminogen activator therapy, which was developed >50 years ago, is effective in dissolving thrombi but has unacceptable bleeding risks.

Intravascular ICG-enhanced NIRF-IVUS imaging to assess progressive atherosclerotic lesions in excised human coronary arteries.

Indocyanine green (ICG)-enhanced intravascular near-infrared fluorescence (NIRF) imaging enhances the information obtained with intravascular ultrasound (IVUS) by visualizing pathobiological characteristics of atherosclerotic plaques. To advance our understanding of this hybrid method, we aimed to assess the potential of NIRF-IVUS to identify different stages of atheroma progression by characterizing ICG uptake in human pathological specimens. After excision, 15 human coronary specimens from 13 adult patients were ICG-perfused and imaged with NIRF-IVUS.

ST-elevation myocardial infarction from septic embolism secondary to prosthetic aortic valve endocarditis: a case report.

Background: ST-elevation myocardial infarction (STEMI) is a cardiac emergency that requires prompt diagnosis and treatment. We describe a challenging and complex case of managing acute STEMI in a patient with severe anaemia, deranged clotting profile, and infective prodrome.

Case Summary: A 54-year-old Caucasian gentleman was referred by his general practitioner as an emergency after presenting with acute onset of chest pain.

Retrospective Multicenter Analysis of Intravascular Lithotripsy Use During Calcified Left Main Coronary Artery Percutaneous Coronary Interventions.

Background: Intravascular lithotripsy (IVL) safely and effectively modifies calcified coronary lesions during percutaneous coronary interventions (PCI). Data regarding its utility in modifying calcified left main coronary artery (LMCA) disease are limited. This study aimed to evaluate short-term outcomes of IVL-assisted LMCA PCI.