Intravascular Ultrasound Findings Associated With Hydrodynamic Contrast Recanalization (HDR) of Coronary Chronic Total Occlusions.

Background: Hydrodynamic contrast recanalization (HDR) is a novel technique to facilitate wire crossing during chronic total occlusion (CTO) percutaneous coronary interventions (PCI). The mechanisms underlying HDR have not been fully described.

Aims: To investigate the impact of HDR on plaque morphology and wire tracking during CTO PCI using intravascular ultrasound (IVUS) imaging.

Clinical, procedural, and follow-up outcomes of percutaneous coronary intervention-related stroke: insight from the PROGRESS-COMPLICATIONS registry.

Background: Stroke is an infrequent but potentially severe complication of percutaneous coronary intervention (PCI).

Methods: The authors describe the clinical features, angiographic characteristics, and procedural and follow-up outcomes of PCI-related stroke in the PROGRESS-COMPLICATIONS registry.

Results: Of 22 503 patients who underwent PCI at 2 tertiary care centers between 2016 and 2023, 157 (0.

Functional Assessment of Intravascular Lithotripsy for Stent Underexpansion.

Background: Stent underexpansion from severe calcification leads to adverse outcomes. While intravascular lithotripsy (IVL) is effective pre-stenting, its role in treating stent underexpansion remains unclear.

Methods: We conducted a multicenter, retrospective study of patients undergoing percutaneous coronary intervention (PCI) with IVL from January 2019 to 2025.

Coronary Computed Tomography Angiography to Guide Percutaneous Coronary Intervention: Expert Opinion from a SCAI/SCCT Roundtable.

Coronary computed tomography angiography (CCTA) has emerged as an important tool for planning percutaneous coronary intervention (PCI). While it has traditionally been employed for diagnostic purposes, increasing evidence and real-world experience suggest that CCTA can be used for the preprocedural planning of PCI and can inform patient triage, shared decision making, case complexity, and resource use. This approach mirrors how computed tomography angiography is routinely used to plan structural interventions.

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.

Snare-Assisted LAceration of Subintimal Hematoma (SLASH): A Novel Technique for Side Branch Preservation in Bifurcation Chronic Total Occlusion Percutaneous Coronary Intervention.

Background: Side branch compromise due to extraplaque hematoma often complicates chronic total occlusion (CTO) percutaneous coronary intervention (PCI) involving a bifurcation at the distal cap.

Aims: To evaluate the feasibility and short-term outcomes of Snare-Assisted LAceration of Subintimal Hematoma (SLASH), a novel technique designed to mitigate this problem.

Methods: SLASH involves retrograde true lumen wiring across the distal bifurcation into a distal side branch, followed by successful antegrade dissection/re-entry into the same branch.

Coronary computed tomography angiography to guide percutaneous coronary intervention: Expert opinion from a SCAI/SCCT roundtable.

Coronary computed tomography angiography (CCTA) has emerged as an important tool for planning percutaneous coronary intervention (PCI). While it has traditionally been employed for diagnostic purposes, increasing evidence and real-world experience suggest that CCTA can be used for the pre-procedural planning of PCI and inform patient triage, shared decision-making, case complexity, and resource use. This approach mirrors how computed tomography angiography is routinely used to plan structural interventions.

Artificial intelligence for chronic total occlusion percutaneous coronary interventions.

Artificial intelligence (AI) has become pivotal in advancing medical care, particularly in interventional cardiology. Recent AI developments have proven effective in guiding advanced procedures and complex decisions. The authors review the latest AI-based innovations in the diagnosis of chronic total occlusions (CTO) and in determining the probability of success of CTO percutaneous coronary intervention (PCI).

Dissection Techniques in Chronic Total Occlusion Percutaneous Coronary Intervention.

Background: There is limited data on dissection strategies in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Aims: To study the differences in the baseline characteristics and procedural outcomes of antegrade CTO PCIs that used dissection strategies.

Methods: We performed a comparative analysis of antegrade dissection and re-entry CTO PCIs from the PROGRESS-CTO registry from 50 centers (2012-2024).

Impact of systematic intravascular imaging on the outcomes of complex and higher-risk percutaneous coronary intervention.

Background: Intravascular imaging (IVI) improves the outcomes of percutaneous coronary intervention (PCI). However, the benefit of a systematic approach versus an already higher usage rate remains unclear. This study investigates the short-term impact of systematic IVI utilization during PCI in a complex higher-risk interventional PCI (CHIP-PCI) center.

Impact of social determinants of health in patients undergoing percutaneous coronary intervention.

Background: Social determinants of health (SDOH) influence the outcomes of patients undergoing cardiovascular procedures. The area deprivation index (ADI) is a multidimensional tool designed to evaluate SDOH at the census block level, which has received limited study in cardiology. This study evaluated the impact of the ADI on short-term clinical outcomes after percutaneous coronary intervention (PCI).

Predicting Mortality and Periprocedural Adverse Events in Patients Undergoing Complex and Higher Risk Percutaneous Coronary Intervention.

Background: The estimation of periprocedural risk in patients undergoing complex and higher risk percutaneous coronary intervention (CHIP-PCI) is challenging. In this study we aimed to compare the performance of 3 different risk-scoring systems---National Cardiovascular Data Registry (NCDR) CathPCI, British Cardiovascular Intervention Society (BCIS)-CHIP, and Blue Cross Blue Shield of Michigan Cardiovascular Consortium 2 (BMC2)---in predicting mortality and major adverse cardiac and cerebrovascular events (MACCEs) in a population of patients undergoing CHIP-PCI at a specialized centre.

Methods: The primary endpoints of this study were in-hospital mortality and MACCE.

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.

How to Improve Radiation Protection in Interventional Cardiology Procedures.

The use of ionizing radiation during cardiac catheterization procedures poses risks to patients and medical staff, both directly and indirectly through orthopedic injuries caused by lead aprons. In this review, we summarize recent advances in radiation protection in the cardiac catheterization laboratory and discuss the effectiveness of traditional and novel radiation protection strategies and equipment.

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.

Risk of acute kidney injury after percutaneous coronary intervention with plaque modification.

Background: The use of plaque modification techniques during percutaneous coronary interventions (PCI) has increased. However, these procedures are linked to higher contrast volume and hypotensive episodes, which are risk factors for acute kidney injury (AKI). This study examined the effects of various plaque modification techniques on AKI after PCI.

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.