BACKGROUND:The safety and efficacy of protamine reversal of heparin anticoagulation during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is unknown. To outline the indications for and outcomes of protamine administration during CTO PCI. METHODS:We conducted a multicenter registry of consecutive patients who underwent CTO PCI between January 2019 and March 2025 at five centers and received protamine. Patients were stratified into bailout (for perforation or access-site bleeding) and non-bailout cohorts. The primary endpoint was major adverse cardiovascular events (all-cause death, myocardial infarction, target vessel revascularization, and pericardiocentesis). Outcomes were reported descriptively by indication for protamine use, without formal comparative analysis. RESULTS:Among 2345 CTO PCI procedures, 672 patients (28.7%) received protamine, including 179 in the bailout cohort and 493 in the non-bailout cohort. The mean J-CTO score was 3.0 ± 1.3 in the bailout cohort and 2.6 ± 1.2 in the non-bailout cohort. Retrograde strategies were used in 31.8% of the bailout cohort and 19.3% of the non-bailout cohort. Overall, there were 126 coronary perforations observed (6.1%), of which 10 cases (0.5%) required pericardiocentesis. In-hospital major adverse cardiovascular events occurred in 20 patients (11.2%) in the bailout cohort and in 10 patients (2.0%) in the non-bailout cohort (reported descriptively without comparative inference). Across both cohorts, there were no reported cases of stent thrombosis or anaphylaxis. CONCLUSION:Protamine use during CTO PCI was variably applied across centers and was associated with acceptable in-hospital outcomes; however, the lack of a non-protamine comparison group limits any inference regarding safety.
BACKGROUND:Basal septal hypertrophy (BSH) is commonly encountered in elderly patients undergoing transcatheter aortic valve replacement (TAVR). However, its impact on periprocedural and procedural outcomes remains unclear. AIMS:The aim of this study was to evaluate the effect of BSH on periprocedural and postprocedural outcomes in patients undergoing TAVR. METHODS:This study included patients with severe aortic stenosis (AS) who underwent TAVR using either balloon-expandable (BEVs) or self-expanding valves (SEVs). The primary endpoint was to compare periprocedural interventions and procedural outcomes. Secondary endpoints included subgroup analyses by device generation (new vs. old), valve type (BEVs vs. SEVs), severity of septal hypertrophy, and across study periods. RESULTS:A total of 3261 TAVR patients were included: 1050 had a BSH ≥ 15 mm (HS+ group) and 2211 had a septal thickness < 15 mm (HS- group). Patients in the HS+ group had higher rates of post-dilatation (25% vs. 21%, p = 0.008), moderate or greater paravalvular leak (PVL) on angiography (2.4% vs. 0.8%, p < 0.001) and echocardiography (5% vs. 3.4%, p = 0.033), and permanent pacemaker (PPM) implantation (18% vs. 14%, p = 0.008). Conversely, HS- patients more often required valve repositioning and a second valve. In subgroup analyses stratified by device generation, the influence of BSH appeared broadly consistent across platforms. Additional Subgroup analysis showed particularly higher rates of post-dilatation, moderate or greater PVL, and PPM implantation in the SEV HS+ group, whereas mild septal thickening (12-15 mm) had no significant impact compared with marked hypertrophy (≥ 15 mm). CONCLUSION:In this large cohort of TAVR patients, BSH (≥ 15 mm) was associated with higher rates of post-dilatation, PVL, and PPM implantation, particularly among those receiving SEVs, while mild septal thickening had no significant impact.
Transcatheter mitral valve interventions have emerged as valuable alternatives to surgical repair in high-risk patients, including transcatheter closure of mitral valve perforations. However, there is little experience with percutaneous mitral valve interventions in pediatric patients or patients with congenital heart disease. We report a case of transcatheter closure of a residual mid-leaflet mitral valve cleft in a 19-year-old patient with moderate mitral regurgitation through two defects in the anterior leaflet of a repaired cleft mitral valve using a retrograde approach and a novel device, a Siege Vascular Plug (Merit Medical Systems Inc, UT, USA), with favorable results.
BACKGROUND:Acute myocardial infarction with cardiogenic shock (AMI-CS) remains highly fatal despite advances in revascularization and intensive care. The Impella, a micro-axial pump, offers a potential balance of hemodynamic support and minimal invasiveness. AIMS:This study examined its optimal configuration of low- versus high-capacity for effectiveness and safety. METHODS:We conducted a systematic review and pooled analysis of 20 studies, including three randomized controlled trials (RCTs) and 3896 AMI-CS patients, comparing high-capacity (Impella 5.0/5.5) versus low-capacity (Impella 2.5/CP) devices. The primary outcome was in-hospital or 30-day mortality, with secondary endpoints including mortality on support, ischemic and bleeding complications, acute kidney injury requiring renal replacement therapy (RRT), and hemolysis. RESULTS:Among the included patients, 2022 received low-capacity Impella, while 771 received high-capacity Impella. The high-capacity Impella group demonstrated lower in-hospital or 30-day mortality (41.4% vs. 45.4%; p = 0.045) and significantly reduced mortality on support (17.9% vs. 46.1%; p < 0.001). Major bleeding events (1.4% vs. 6.0%; p < 0.001) and ischemic complications (3.9% vs. 5.9%; p = 0.05) were also lower in the high-capacity group. However, transfusion requirements were higher in the high-capacity Impella cohort (52.1% vs. 23.1%; p < 0.001). There were no significant differences in stroke rates (4.3% vs. 4.3%; p = 1.0) or AKI requiring RRT (36.5% vs. 34.9%; p = 0.69). CONCLUSION:High-capacity Impella, when compared to low-capacity devices, may provide superior survival benefits and lower complication rates, particularly in reducing ischemic and major bleeding events, in AMI-CS patients. These findings support the early consideration of high-capacity Impella in treatment algorithms.
BACKGROUND:Percutaneous pulmonary valve implantation (PPVI) is an alternative to surgery for dysfunctional right ventricular outflow tracts (RVOTs). The VenusP-valve is a self-expanding transcatheter valve, available in diameters from 24 to 36 mm, and is designed for use in the larger RVOTs. AIMS:A retrospective review to evaluate the medium to long-term results of the VenusP-valve, focusing on patient outcomes and durability of the valve. METHODS:Between October 2013 and September 2018, 58 patients with severe pulmonary regurgitation (PR) underwent attempted PPVI with the VenusP-valve at Evelina London Children's Hospital, London, UK, and Pediatric Heart Center, Queen Sirikit National Institute of Child Health, Bangkok, Thailand. Data on patient characteristics, clinical and imaging outcomes, and follow-up status were collected retrospectively. RESULTS:During the studied period, 56 (96.6%) patients had a successful PPVI out of 58 attempted procedures. One attempt was unsuccessful, and one patient experienced valve migration, both requiring surgical intervention. There were no early or late deaths, and no patients developed valve stenosis or severe PR. Additionally, none of the patients experienced infective endocarditis or significant ventricular arrhythmias. Fluoroscopic evaluation at 6-12 months revealed wire frame fractures in 13 patients (23.2%), typically in the proximal flare of the valve; however, these fractures did not affect the valve function. Atrial arrhythmias occurred in two patients (3.5%), one of whom was managed medically and the other underwent successful ablation. The cohort of patients showed a significant decrease in PR on transthoracic echocardiography and a significant reduction in indexed right ventricular end-diastolic volumes and pulmonary regurgitant fraction by cardiac magnetic resonance imaging at between 6 and 12 months. These results were sustained on serial follow-up. CONCLUSION:VenusP-valve implantation is associated with excellent early and mid-term outcomes over a 5-10 year period, with no major complications related to valve function. However, longer-term follow-up is required to further assess its performance and longevity.
An impenetrable proximal cap complicates chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and is often an indication for the retrograde approach. When also the distal cap of the CTO is impenetrable, very few options remain to recanalize the vessel. We report a case of retrograde balloon-assisted subintimal entry (BASE), enabling successful CTO PCI in a case with impenetrable proximal and distal caps.
INTRODUCTION:Same-day discharge (SDD) following percutaneous coronary intervention (PCI) is a safe and efficient strategy, especially within dedicated care models like the Radial Lounge. While SDD is well established for standard elective PCI, evidence for its use in complex cases is limited. This sub-analysis evaluated the safety and feasibility of SDD in patients undergoing complex PCI within a structured SDD framework. AIMS:To assess the incidence of major adverse cardiac events (MACEs)-including in-hospital mortality, 30-day mortality, and 30-day readmission-in patients undergoing complex PCI with SDD, compared to non-complex PCI cases. METHODS:We retrospectively analyzed elective SDD PCI cases performed between 2015 and 2023 at a single center. Complex PCI was defined by anatomical and procedural criteria, including left main or proximal LAD interventions, saphenous vein grafts, chronic total occlusions, bifurcations, Syntax score > 33, and use of IVUS or Rotablator. Outcomes were compared between complex and non-complex PCI groups. The primary endpoint was 30-day MACE. RESULTS:Of 3725 elective SDD PCIs, 1671 were complex. No significant differences were observed in in-hospital mortality (0.23% vs. 0.19%), 30-day mortality (0% in both), or readmissions. Complex PCI patients had higher rates of diabetes, prior PCI, femoral access, and multivessel interventions. Radial access was more frequent in the non-complex group. The most common complexity criteria were proximal LAD and bifurcations. CONCLUSIONS:SDD is a feasible and safe approach for selected complex PCI cases when implemented within a structured care model, supporting broader adoption of SDD protocols to optimize resource utilization without compromising safety.
BACKGROUND:Percutaneous left atrial appendage occlusion (LAAO) has traditionally been performed under general anesthesia (GA) to maintain patient comfort and immobility, especially in the setting of transesophageal echocardiography. AIMS:We aimed to compare the safety and efficacy of conscious sedation (CS) compared to GA for LAAO, concurrent with the expansion of intracardiac echocardiography guidance. METHODS:A systematic search of the PubMed, Embase, Cochrane Central, and Scopus databases was conducted through December 2024 for studies comparing CS versus GA for LAAO. For outcomes of procedural complications and characteristics, random-effects models were used to calculate the mean difference (MD), odds ratio (OR), and risk ratio (RR) effect estimates with 95% confidence intervals (CIs). RESULTS:Four studies with 1540 patients undergoing LAAO were included (CS = 678, GA = 862). CS was associated with significantly shorter total procedural time [MD -11.95 min; 95% CI -19.52 to -2.78; p = 0.009] and a lower volume of contrast media [MD -31.90 mL; 95% CI -56.72 to -7.08; p = 0.01]. No significant differences were noted for total fluoroscopy time, total length of hospital stay, device success, all-cause mortality, cardiovascular mortality, stroke, device-related thrombus, and peri-device leak > 5 mm. CONCLUSION:Percutaneous LAAO using CS allows for faster procedures and lower contrast media volumes compared to GA without compromising device success and clinical outcomes. Randomized studies with longer follow-ups are necessary to understand the long-term outcomes of percutaneous LAAO using CS.
BACKGROUND:Data on commissural misalignment (CMA) during valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) for valve failure after surgical aortic valve replacement (SAVR) is scarce. AIMS:To study the impact of CMA on clinical and hemodynamic outcomes following ViV-TAVI for failed SAVR. METHODS:Data of patients who underwent ViV-TAVI for failed SAVR valves at two institutions (Heart Center Leipzig at Leipzig University, Leipzig, Germany; Cedars-Sinai Smidt Heart Institute, Los Angeles, USA) were retrospectively collected and compared regarding the existence of CMA. Outcomes of interest included Valve Academic Research Consortium (VARC)-3-based clinical endpoints, Computed Tomography-based hypoattenuated leaflet thickening (HALT), hemodynamic outcome, and mid-term all-cause mortality. RESULTS:Of the 687 patients who underwent ViV-TAVI, post-procedural CT of sufficient quality to measure commissural alignment was available in 180 patients (47.8% females, mean age 78.0 years). Self-expanding TAVI valves were used in 49.2% of the cases. CMA was found in 35 individuals (19.4%) and was associated with reduced VARC-3-based technical success (80% vs. 93%, p = 0.03), driven by increased rates of coronary obstruction (17.1% vs. 5.6%, p = 0.03). The incidence of HALT was 31.7%, without differences in patients with and without CMA. VARC-3-based device success was 62.9%, driven by an incidence of residual mean valve gradient (≥ 20 mmHg) of 35.4%, without differences between groups. Midterm survival after a mean of 747 days was 84.6% and comparable between groups. CONCLUSIONS:For patients undergoing ViV-TAVI for failed SAVR, technical success is reduced for cases of CMA due to higher odds of coronary obstruction, without differences in mid-term survival.
BACKGROUND:Dual antiplatelet therapy (DAPT), which combines aspirin with a P2Y12 receptor inhibitor, is considered the standard of care for patients who have had percutaneous coronary intervention (PCI). This study aimed to compare indobufen-based (DAPT) to aspirin-based (DAPT) after PCI. METHODS:This systematic review and meta-analysis analyzed randomized controlled trials (RCTs) and propensity-matched cohort studies comparing indobufen (DAPT) to standard aspirin (DAPT) after PCI. We searched four databases: PubMed, Scopus, Web of Science, and Cochrane through January 2025 and updated the search in September 2025. Dichotomous data were pooled as odds ratios with 95% CIs. RESULTS:Our search identified 403 records; only five studies were included in the analysis. Comparing major adverse cardiac and cerebrovascular events (MACCE) between the indobufen and aspirin groups, no difference was observed (OR 1.12, 95% CI: 0.87-1.46; p = 0.38). Bleeding BARC types 2, 3, 5 were compared between the two groups, showing fewer bleeding events in the indobufen group than in the aspirin group (OR: 0.47, 95% CI: 0.24-0.95; p = 0.03). CONCLUSION:Indobufen-based (DAPT) had a lower incidence of bleeding than aspirin-based (DAPT), with no difference between the two groups for MACCE, myocardial infarction, ischemic stroke, cardiovascular death, repeat vascularization, or stent thrombosis.
Coronary slow flow (SF) and no-reflow (NR) are clinically significant complications of percutaneous coronary intervention (PCI), particularly in ST-segment elevation myocardial infarction (STEMI) and saphenous vein graft (SVG) interventions. Angiographically defined as impaired myocardial perfusion despite restored epicardial patency, SF/NR results from microvascular dysfunction driven by distal embolization, ischemia-reperfusion injury, microvascular spasm, capillary plugging and emerging molecular mechanisms such as endothelial glycocalyx degradation and microRNA-mediated inflammatory pathways. These processes contribute to larger infarct size, maladaptive remodeling, and increased mortality. Advanced intracoronary imaging enables lesion-level risk stratification by identifying features such as lipid-rich cores, thin-cap fibroatheromas, positive remodeling, and thrombus. Image-guided strategies, incorporating deferred stenting, selective aspiration, and tailored lesion preparation, can mitigate distal embolization. Risk stratification models (e.g., PAMI score) and recognition of sex- and race-based disparities further refine procedural planning. Cost, accessibility, and emerging AI-driven automated plaque characterization tools are important considerations for wider implementation. Preventive measures emphasize systemic optimization, adequate anticoagulation, high-intensity statin pretreatment informed by precision dosing, dual antiplatelet therapy, and refined device techniques in thrombus-rich or calcified lesions. Management requires early recognition, systematic exclusion of mimics such as dissection or epicardial spasm, maintenance of anticoagulation, and rapid stepwise administration of intracoronary microvasculature dilators. Device-based delivery methods offer practical advantages but carry specific risks, including device entrapment or vessel trauma. Adjunctive therapies such as supersaturated oxygen may be considered in refractory cases. A structured, imaging-informed algorithm integrating preventive strategies, pharmacologic escalation, and device-assisted therapy may reduce SF/NR incidence and improve procedural and long-term outcomes. Future research should validate imaging-guided preventive strategies, standardized rescue protocols, and the role of AI-driven risk assessment in diverse patient populations.
BACKGROUND:Ulnar artery access may provide an alternative access route for chronic total occlusion percutaneous coronary intervention (CTO PCI), but data is limited. AIMS:To assess the utilization, patient characteristics, and in-hospital outcomes of ulnar artery access compared with radial access and non-ulnar access in patients undergoing CTO PCI. METHODS:We analyzed patients who underwent CTO PCI between 2012 and 2024 at 51 centers within the PROGRESS-CTO Registry. Patients were stratified by access: (1) no radial/ulnar, (2) radial without ulnar, and (3) ulnar. The primary endpoint was in-hospital major adverse cardiovascular events (MACE). Secondary endpoints included technical success. Multivariable logistic regression was used to identify independent predictors of outcomes. RESULTS:Among 18,826 patients, 8844 (47.0%) had no radial/ulnar access, 9835 (52.2%) radial without ulnar, and 147 (0.8%) ulnar. Ulnar patients were younger (62.5 ± 10.4 vs. 64.0 ± 10.4 radial and ulnar, 65.1 ± 10.5 no radial/ulnar, p < 0.001) and had higher prevalence of prior PCI (73.6% vs. 59.3% and 64.0%, p < 0.001) and peripheral arterial disease (23.9% vs. 12.1% and 15.1%, p < 0.001). Lesion complexity was lower with ulnar access (J-CTO 2.19 ± 1.27 vs. 2.32 ± 1.27 radial and 2.47 ± 1.21 no radial/ulnar, p < 0.001). In-hospital outcomes were similar: MACE (2.7% ulnar vs. 1.8% radial vs. 2.0% no radial/ulnar, p = 0.315), technical success (83.7% vs. 87.3% vs. 87.2%, p = 0.425), and access complications (0.7% vs. 0.7% vs. 1.2%, p = 0.001). Logistic regression showed no independent association between ulnar access and MACE, technical success, or access-site complications. CONCLUSION:In the largest series to date, ulnar access was used in 0.8% of CTO PCI with similar outcomes to radial and femoral access. Given its use in lower complexity cases, these findings are hypothesis-generating and warrant prospective evaluation.
BACKGROUND:Operability of patients with atrial septal defects (ASD) and pulmonary arterial hypertension (PAH) is guided by various hemodynamic parameters obtained after acute vasodilator testing (AVT). Fenestrated closure is suggested in gray-zone of operability as well as restrictive left ventricular (LV) physiology. On-table fenestrations made in the catheterization laboratory close on follow-up. Nitinol wire braid and fabric are modified in custom-fenestrated occluders to create a permanent 5-8 mm communication. AIMS:This retrospective analysis studied patient characteristics and hemodynamics of 33 patients with ASD and PAH or restrictive LV, closed with custom-fenestrated occluders. METHODS:Baseline shunt, vascular resistances, and pulmonary/aortic diastolic pressure ratio were measured and repeated after AVT and temporary balloon occlusion. Gray-zone patients satisfied at least one of the operability parameters. Change in symptoms and hemodynamics, and device patency were assessed on follow-up. RESULTS:Out of the 22 patients with PAH (median age 29.5 years, range 9-66 years) who underwent fenestrated device closure in the last 10 years, 13 had indexed pulmonary vascular resistance > 6 wood units.m2; 7 had a resistance ratio > 0.3, and 12 had a pulmonary/aortic diastolic pressure ratio > 0.4. 21 patients satisfied at least one operability parameter during AVT. In the only patient who did not satisfy any of the parameters, balloon occlusion reduced the PA mean pressure > 25%. During a median follow-up of 27 months (range 1-106 months), hemodynamics improved in all and fenestration was patent in all patients. Procedural success in 11 patients with restrictive LV (median age 57 years, range 39-69 years) was 91%. Fenestrated occluder was removed immediately in one patient with coronary artery and chronic kidney disease who did not tolerate closure. Patency was maintained on follow-up, and symptoms improved in all patients. CONCLUSIONS:Fenestrated occluders allowed ASD closure in gray-zone patients with PAH and borderline operability as well as restrictive LV physiology. Consistent symptom improvement and atrial decompression by their prolonged patency justified their utility.
Antegrade percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) remains technically challenging. HydroDynamic contrast Recanalization (HDR) is a novel technique involving low-pressure, low-volume intraplaque contrast injection immediately distal to the proximal cap, with the goal of modulating plaque architecture and facilitating a polymer-jacketed guidewire advancement toward the distal true lumen. Intravascular ultrasound (IVUS) is useful in two HDR-related scenarios: first, to resolve proximal cap ambiguity and guide precise puncture; second, in cases of unsuccessful true lumen crossing, to identify extraplaque guidewire position and assist re-entry into the true lumen. We report a case of proximal left anterior descending artery CTO treated using combined HDR and tip detection-antegrade dissection and re-entry (TD-ADR). Initial HDR produced patchy Type 1 staining, generally indicating intraplaque tracking. Second and third subsequent contrast injections again demonstrated Type 1 staining; however, true lumen crossing with polymer-jacketed wires (Sion Black and Gladius EX) was unsuccessful. IVUS confirmed subintimal wire position. To avoid stiff wire escalation and maintain control, we switched to IVUS-guided TD-ADR. Spatial alignment enabled re-entry into the distal true lumen with a Conquest Pro 12 Sharpened Tip wire. A drug-eluting stent was implanted with excellent angiographic results and no complications. This case illustrates the complementary roles of HDR and TD-ADR in antegrade CTO PCI. HDR promotes early plaque modification and facilitates wiring with minimal perforation risk, but does not ensure intraplaque tracking. IVUS-guided TD-ADR offers a safe bailout when true lumen crossing fails. A stepwise, imaging-guided approach integrating both techniques may improve procedural success.
Coronary calcifications reduce procedural success rates, increase the risk of complications, and worsen the outcomes of percutaneous coronary intervention (PCI). We report the case of a 74-year-old woman with multiple comorbidities who was admitted for chronic total occlusion (CTO) PCI of the right coronary artery (RCA). Coronary angiography revealed double CTO with severe calcifications and high anatomical complexity. After unsuccessful true lumen-to-true lumen crossing, an antegrade dissection and re-entry (ADR) strategy was successfully employed. Post-procedure angiography revealed an unusual “scattergun” appearance of the proximal RCA, a parallel extra-plaque lumen with implanted stents and an occluded true lumen, separated by calcified plaque. Clinical and angiographic outcomes remained favorable at 6-month follow-up.
BACKGROUND:Cerebral embolic protection (CEP) devices may mitigate the risk of embolization and stroke during transcatheter aortic-valve implantation (TAVI), yet their safety and efficacy remain debated. AIMS:To evaluate the safety and efficacy of CEP during TAVI. METHODS:We conducted a systematic search of PubMed, Embase, and the Cochrane Library from inception through April 2025 for randomized controlled trials (RCTs) and observational studies comparing TAVI performed with versus without the Sentinel CEP device. Pooled risk ratios (RRs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS:Seventeen studies (4 RCTs and 13 observational cohorts) involving 752,164 patients were included; among them, 86,916 (11.5%) received the Sentinel device. CEP use was associated with significantly lower rates of early stroke (within 72 h; RR 0.61; 95% CI 0.40-0.94), any stroke (RR 0.78; 95% CI 0.65-0.94), 30-day stroke (RR 0.47; 95% CI 0.26-0.85), disabling stroke (RR 0.49; 95% CI 0.29-0.84), and all-cause mortality (RR 0.66; 95% CI 0.49-0.89). No significant differences were observed in transient major vascular complications, bleeding events, or acute kidney injury (AKI). In the analysis restricted to RCTs, stroke and mortality outcomes were similar between groups, with no significant differences across safety endpoints. In prespecified subgroup analyses, patients with bicuspid aortic valves derived no significant benefit from CEP (OR O.80; 95% CI 0.40-1.61), whereas those with prior stroke experienced a reduced risk of recurrent stroke (RR 0.61; 95% CI 0.45-0.82). CONCLUSION:This meta-analysis suggests that the Sentinel CEP device is associated with lower risks of stroke and mortality following TAVI, without increasing the incidence of vascular complications, bleeding, or AKI.
Background: The optimal stenting technique for true complex LMCA bifurcation lesions remains uncertain. Aims: This study aims to compare 3-year cardiovascular mortality between patients with true complex left main coronary artery (LMCA) bifurcation lesions treated with a provisional stenting strategy and those undergoing the Nano-Inverted-T (NIT) dual-stent technique. Methods: Data were retrieved from a multicenter, prospective registry for complex LMCA from January 2019 to 2022. Baseline, procedural, and 3-year outcomes were analyzed for patients treated with provisional stenting and NIT after 1:1 propensity score matching. The primary study outcome was cardiovascular mortality at 3 years. All events were adjudicated by an independent clinical events committee, and analyses were performed according to the intention-to-treat principle. Results: At 3-year follow-up, the primary outcome occurred in 38 of 295 patients (12.8%) in the provisional group and in 12 of 295 patients (4.1%) in the NIT group (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.53-0.89; p < 0.001). Subgroup analyses were consistent with the overall results. No significant differences were observed between groups in all-cause mortality, myocardial infarction, target lesion revascularization, or stent thrombosis. Conclusions: In patients undergoing complex LMCA bifurcation PCI with last-generation drug-eluting stents, the NIT dual-stenting technique significantly reduced 3-year cardiovascular mortality compared to provisional stenting.
Coronary perforation (CP) is an uncommon but serious complication of orbital atherectomy (OA). Optical coherence tomography (OCT) evidence of catheter "tenting" against the healthy vessel wall may indicate unsatisfactory guidewire bias and elevated perforation risk during OA. We describe OCT findings of a case with OA-related CP.
