Procedural and Clinical Outcomes After Orbital Atherectomy Versus Intravascular Lithotripsy in Patients With Calcified Nodules.

Background: Calcified nodules (CNs) remain a major challenge in percutaneous coronary intervention (PCI). We sought to compare procedural and clinical outcomes after orbital atherectomy (OA) versus intravascular lithotripsy (IVL)-facilitated PCI in patients with CNs.

Methods: We identified patients with optical coherence tomography (OCT)-defined CNs who underwent PCI with either OA or IVL between 2012 and 2022 and had both pre- and post-PCI OCT images available.

Paclitaxel-Coated Balloon for the Treatment of Multilayer In-Stent Restenosis: AGENT IDE Subgroup Analysis.

Background: Patients with coronary in-stent restenosis (ISR) within multiple layers of stent pose a specific clinical challenge because of higher rates of recurrent restenosis as well as a desire to avoid an additional layer of stent. Drug-coated balloons (DCBs) provide an alternative antiproliferative therapeutic option for multilayer ISR.

Objectives: We evaluated the efficacy and safety of a low-dose paclitaxel-coated vs uncoated balloon among patients with multilayer or single-layer ISR in the AGENT IDE (A Clinical Trial to Assess the Agent Paclitaxel Coated PTCA Balloon Catheter for the Treatment of Subjects With In-Stent Restenosis) trial.

Outcomes among patients with coronary bifurcation lesions undergoing Impella-supported high-risk percutaneous coronary intervention.

Background: Coronary bifurcation lesions (CBL) are associated with lower procedural success, worse postprocedural outcomes, and greater unplanned repeat revascularization. We sought to better understand the impact of Impella support in patients undergoing percutaneous coronary intervention (PCI) of CBLs.

Methods: We used data from the cVAD PROTECT III study (NCT04136392), an FDA-audited, single-arm study of patients undergoing high-risk PCI with Impella support, to examine the outcomes of patients undergoing PCI of CBLs.

Stent-Edge Hinge Movement in a Calcified Lesion Is Associated With Increased Prevalence of a Calcified Nodule at Follow-Up.

Background: Coronary stenting alters vessel dynamics, displacing hinge movement closer to stent edges. We aimed to investigate whether calcified nodules (CNs) are more frequent at stent edges associated with calcium.

Methods: In vessels with previously implanted stents evaluated by optical coherence tomography, 4 different calcified lesions were studied: stent-edge calcified lesions with or without a CN, and unstented native calcified lesions with or without a CN.

Factors Associated With Chronic Stent Recoil and its Impact on Revascularization: A Serial Optical Coherence Tomography Study.

Background: Chronic stent recoil can vary according to both stent materials and designs.

Objectives: The authors sought to use serial optical coherence tomography (OCT) to investigate the incidence of chronic stent recoil and its impact on target lesion revascularization (TLR) in second- or newer-generation drug-eluting stent implantation.

Methods: Patients undergoing clinically indicated serial OCT studies (baseline and either at TLR or after more than 6-month follow-up) were studied.

Artificial Intelligence in Intravascular Imaging for Percutaneous Coronary Interventions: A New Era of Precision.

Intravascular imaging (IVI), including intravascular ultrasound and optical coherence tomography, play a crucial role in guiding percutaneous coronary intervention by providing detailed visualization of coronary anatomy and plaque morphology. Despite substantial evidence supporting IVI use, its adoption in clinical practice remains limited for multiple reasons including limited operator experience and a lack of confidence in image interpretation. The emergence of artificial intelligence presents a promising solution to these challenges by enhancing procedural efficiency and precision, thereby potentially increasing both IVI adoption and procedural optimization.

A Revised Optical Coherence Tomography-Derived Calcium Score to Predict Stent Underexpansion in Severely Calcified Lesions.

Background: Severe calcification is the morphology most strongly associated with stent underexpansion.

Objectives: The aim of this study was to revise an optical coherence tomography (OCT)-derived calcium score to predict stent underexpansion in severely calcified lesions (angle >270°) using a point-based system.

Methods: A retrospective observational study was conducted in which 250 de novo lesions undergoing OCT-guided stenting, with angiographically visible calcium and optical coherence tomographic maximum superficial calcium angle >270°, not subjected to atherectomy or specialty balloon treatment before stent implantation, were randomly divided into derivation (n = 167) and validation (n = 83) cohorts.

Ultra-Low-Contrast PCI: A Structured Approach to Reducing Dependence on Contrast Vessel Opacification in PCI.

Since its inception, percutaneous coronary intervention (PCI) has relied upon vessel opacification with iodinated contrast to plan, guide, and assess the results of the procedure. Yet revisiting this fundamental concept is important in contemporary PCI practice, especially in patients with high-risk clinical or anatomical profiles. In addition to decreasing the probability of acute kidney injury during PCI, limiting the volume of iodinated contrast allows the operator to perform more thorough interventions by relying on intracoronary imaging and physiology, ultimately contributing to more complete revascularization and improving the efficacy and durability of the intervention.

Evolving operator practices reduced patient radiation dose in interventional cardiology: Trends in a single center.

Background: This retrospective study addresses the role of operator and fluoroscopy equipment in reducing patient radiation exposure in the Cath lab.

Methods: Data from 99,400 procedures performed in our institution between 2007 and 2019 were reviewed. Dosimetric parameters included reference point air kerma (K), Kerma Area Product (P), fluoroscopic time, and contrast volume.

Coronary artery disease and percutaneous coronary intervention in patients with severe chronic kidney disease.

Coronary artery disease (CAD) is the leading cause of mortality among patients with chronic kidney disease (CKD), presenting unique challenges in diagnosis and management. Advanced CKD patients often present with atypical symptoms, and conventional diagnostic and interventional approaches carry risks, including contrast-induced nephropathy and the potential need for renal replacement therapy. These risks have led to the phenomenon of "renalism," where necessary procedures may be deferred due to concerns over renal injury.

Clinical outcomes among patients with mitral valve regurgitation undergoing Impella-supported high-risk PCI.

Background: Mitral valve regurgitation (MR) is associated with worse outcomes in patients undergoing percutaneous coronary intervention (PCI). We sought to evaluate outcomes of Impella-supported high-risk PCI (HRPCI) patients according to MR severity.

Methods: Patients from the PROTECT III study undergoing Impella-supported HRPCI were stratified into 4 groups according to MR severity: No or trace MR, mild MR, moderate MR, and severe MR.

Association of Preprocedural SYNTAX Score With Outcomes in Impella-Assisted High-Risk Percutaneous Coronary Intervention.

Background: Patients with complex coronary artery disease, as defined by high SYNTAX scores, undergoing percutaneous coronary intervention (PCI) have poorer outcomes when compared with patients with lower SYNTAX I scores. This study aimed to assess if mechanical circulatory support using Impella mitigates the effect of the SYNTAX I score on outcomes after high-risk percutaneous coronary intervention (HRPCI).

Methods: Using data from the PROTECT III study, patients undergoing Impella-assisted HRPCI between March 2017 and March 2020 were divided into 3 cohorts based on SYNTAX I score-low (≤22), intermediate (23-32), and high (≥33).

Paclitaxel-coated versus sirolimus-coated balloon angioplasty for coronary artery disease: A systematic review and meta-analysis.

Background: Although use of sirolimus-based analogs has shown superiority over paclitaxel in drug-eluting stents, the relative efficacy of these two agents released from drug-coated balloons (DCB) is unclear. The present meta-analysis is aimed to compare outcomes after percutaneous coronary intervention (PCI) with paclitaxel-coated balloons (PCB) versus sirolimus-coated balloons (SCB) for either in-stent restenosis or native de novo lesions.

Methods: The study outcomes were 1) target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, or target lesion revascularization, and 2) follow-up angiographic parameters including late lumen loss (LLL), diameter stenosis, and minimal lumen diameter (MLD).