Background: Preterm birth may result in persistent alterations in peripheral airway development. We aimed to compare impulse oscillometry (IOS) parameters between school-aged children born preterm and healthy term-born controls and to investigate factors associated with peripheral airway dysfunction. Methods: This cross-sectional comparative study included 46 children born at ≤32 weeks of gestation and 40 independently recruited healthy term-born controls. IOS parameters, including R5, R20, R5–R20, X5, X20, AX, and Fres, were assessed. Multivariable linear regression was used to evaluate whether between-group differences persisted after adjustment for anthropometric measures. Results: Children born preterm had significantly higher R5 (0.75 vs. 0.48 kPa·s/L), R5–R20 (0.37 vs. 0.19 kPa·s/L), and AX (2.93 vs. 1.41 kPa/L) than controls (all p = 0.001), whereas R20, X5, X20, and Fres did not differ significantly. R5–R20 was the most frequently abnormal IOS parameter in the preterm group (34.8%). After adjustment for age, height z-score, and weight z-score, prematurity remained significantly associated with higher R5 (p = 0.005), R5–R20 (p < 0.001), and AX (p = 0.002). No significant associations were identified between R5–R20 and gestational age, bronchopulmonary dysplasia, mechanical ventilation, or other evaluated neonatal characteristics. Conclusions: School-aged children born preterm exhibit persistent differences in peripheral airway mechanics that are not explained by anthropometric differences. IOS may provide a useful complementary tool for long-term respiratory assessment after preterm birth.

OBJECTIVE:To examine the associations of maternal psychological distress and neonatal medical risk during Neonatal Intensive Care Unit (NICU) hospitalization with child developmental outcomes, parental burnout, and perceived family impact at 18 to 24 months corrected age in a middle-income country setting with limited perinatal mental health infrastructure. METHODS:This prospective, observational study included 175 mother-infant dyads admitted to a tertiary NICU transitional unit. Maternal depression and anxiety were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Perinatal Anxiety Screening Scale-Turkish Version (PASS-TR), respectively. Neonatal medical complexity was quantified using a composite Neonatal Risk Score (NRS). At 18 to 24 months corrected age, 112 infants and 96 mothers completed follow-up assessments including the Ages and Stages Questionnaire (ASQ-3), the Parental Burnout Assessment, and the Impact on Family Scale. RESULTS:Maternal depressive (39.9%) and anxiety (75.8%) symptoms were common during the NICU stay but not linked to sociodemographic factors. Higher EPDS and PASS-TR scores were associated with developmental delays in communication, problem-solving, and personal-social domains. Parental burnout correlated with maternal depression, poorer child communication and motor outcomes, and higher NRS. Mothers of infants with hydrocephalus reported the highest distress and burnout. CONCLUSION:Maternal mental health and neonatal medical risk during NICU hospitalization were important correlates of later child and family outcomes. Routine psychosocial screening and risk stratification in NICU settings may facilitate early identification of at-risk dyads. In low-resource settings, integrated perinatal mental health support may be essential to improving long-term developmental and psychosocial outcomes.

Aim: To compare sleep disturbances, quality of life, and physical activity levels between school-aged children born before 32 weeks of gestation and healthy term-born peers, and to examine the associations of sleep disturbances with physical activity and quality of life in both children and their parents. Methods: This cross-sectional comparative study included 55 children aged 7–8 years who were born before 32 weeks of gestation and 55 healthy term-born controls. Controls were frequency matched to the preterm group by age and sex to ensure comparable distributions of these key demographic characteristics. Sleep disturbances were assessed using the Sleep Disturbance Scale for Children (SDSC), children’s quality of life using the Pediatric Quality of Life Inventory (PedsQL), parental quality of life using the PedsQL Family Impact Module, and physical activity using the Physical Activity Questionnaire for Older Children (PAQ-C). Results: The total SDSC score was significantly higher in preterm children than in the control group (p = 0.044). Significant differences were observed particularly in the subscales assessing difficulties initiating and maintaining sleep (p = 0.007) and sleep–wake transition disorders (p = 0.019). Regarding children’s quality of life, only the emotional functioning subscale was significantly poorer in the preterm group (p = 0.002). For parental quality of life, the emotional functioning (p = 0.01) and daily activities (p = 0.04) subscales were significantly impaired, whereas physical activity levels were comparable between the groups. No significant associations were found between sleep disturbance and either children’s quality of life or physical activity in the preterm group. In multivariable analysis, children’s quality of life and total sleep disturbance score were identified as independent predictors of parental quality of life. Conclusions: School-aged children born before 32 weeks of gestation experience a greater burden of sleep problems, particularly disturbances involving sleep initiation and maintenance and the transition between sleep and wakefulness. Sleep disturbances were independently associated with poorer parental quality of life, regardless of children’s quality of life. These results emphasize the need to incorporate regular evaluation of sleep and a family-centered perspective into the long-term care of children born preterm.

Background: Children born preterm may have persistent alterations in airway function that extend into school age; however, exercise-induced bronchoconstriction (EIB) in this population remains insufficiently characterized. This study aimed to determine the prevalence of EIB in school-aged children born at ≤32 weeks of gestation and to investigate associated clinical and neonatal factors. Methods: This single-center cross-sectional study included 42 children born at ≤32 weeks of gestation who were evaluated at 7–8 years of age. Perinatal, neonatal, respiratory, and atopic characteristics were obtained from medical records and parental reports. Baseline spirometry was performed before a standardized treadmill exercise challenge. Spirometry was repeated at 5, 10, 15, and 30 min after exercise. EIB was defined as a ≥10% decrease in forced expiratory volume in one second (FEV1) from baseline at any post-exercise time point. Results: The median gestational age was 29 (25–32) weeks, and 31% had a history of bronchopulmonary dysplasia. EIB was identified in 13 of 42 children (31%). Post-exercise EIB positivity was observed at 5, 10, 15, and 30 min in 9.5%, 16.7%, 11.9%, and 9.5% of participants, respectively. Dyspnea was the most frequent exercise-related symptom (38%). No significant differences were observed between EIB-positive and EIB-negative children regarding gestational age, birth weight, bronchopulmonary dysplasia, neonatal respiratory support, baseline pulmonary function, total IgE, or peripheral eosinophil count. Conclusions: EIB was detected in approximately one-third of school-aged children born at ≤32 weeks of gestation. These findings suggest that clinically relevant exercise-related airway hyperresponsiveness may persist into school age despite relatively preserved baseline spirometry.

Evidence suggests that increased intravascular and interstitial fluid load in neonates with transient tachypnea of the newborn (TTN) may delay the clearance of fetal alveolar fluid (FAF). Restricted fluid (RF) therapy may accelerated FAF clearance and improve outcomes in these infants. Term and late preterm infants with TTN requiring nasal intermittent positive pressure ventilation (NIPPV) were randomized within first 2 h after birth to receive either RF or standard fluid (SF) therapy. Primary outcomes were the duration of NIPPV and the day of discharge. Secondary outcomes included changes in weight, urine output, biochemical parameters, and monitoring of potential adverse effects. Forty-four infants were analyzed. NIPPV duration (36 ± 25 vs. 57 ± 23 h; p = 0.012) and the time to full enteral feeding (65 ± 25 vs. 94 ± 20 h; p < 0.005) were shorter in the RF group. Although the day of discharge was earlier in the RF group, the difference did not reach statistical significance (6.5 ± 1.3 vs. 7.5 ± 2.3 days; p = 0.084). Mean weight loss on postnatal day 5 was higher in the RF group (p < 0.005). No significant differences were observed in urine output, serum electrolytes, or renal function tests. Hypernatremia (ranging from 146 to 150 mmol/L) developed in seven patients (four in the SF group and three in the RF group), and no hypoglycemia or serious adverse events occurred. Restricted fluid therapy appears safe and effective in TTN infants requiring NIPPV, reducing respiratory support duration and enabling earlier full enteral feeding. ClinicalTrials.gov, NCT07549945. Registered 23 April 2026, retrospectively registered. The study was conducted between October 2021 and July 2023. During the final stages of the study, the devastating earthquakes that struck southeastern Türkiye in February 2023 caused major disruptions to clinical and academic activities at our institution, contributing to delays in manuscript preparation and trial registration.

PURPOSE:This study aimed to characterize pathogen distribution and antimicrobial resistance patterns of gram-negative bloodstream infections in a tertiary neonatal intensive care unit and to determine which factors were associated with multidrug resistance (MDR) and 28-day mortality. METHODS:In this retrospective cohort study, 197 neonates with healthcare-associated gram-negative bloodstream infections diagnosed between January 2010 and December 2025 were included. Demographic, perinatal, clinical, and microbiological data were extracted from electronic medical records. Factors associated with MDR infection and 28-day mortality were evaluated using univariable and multivariable logistic regression analyses. RESULTS:Of the 197 neonates, 114 (57.9%) had MDR gram-negative bloodstream infections. Klebsiella spp. was the most frequently isolated pathogen (51.3%), followed by Acinetobacter spp. (23.9%) and Escherichia coli (14.7%). Extended-spectrum beta-lactamase production was detected in 68.6% of isolates, MDR in 57.9%, and carbapenem resistance in 39.1%. Acinetobacter spp. showed the highest rates of carbapenem resistance (95.7%) and MDR (97.9%). In multivariable analysis, older postnatal age at infection onset, mechanical ventilation, and previous carbapenem exposure were independently associated with MDR infection, whereas appropriate empirical therapy was protective. Overall, 83 neonates (42.1%) died within 28 days. Mechanical ventilation and inotropic support were independently associated with mortality, while appropriate empirical therapy remained independently protective. MDR status and pathogen distribution were not independently associated with mortality. CONCLUSION:Neonatal gram-negative bloodstream infections were characterized by a high burden of MDR. Mortality was more strongly related to indicators of illness severity than to microbiological resistance profiles. Appropriate empirical therapy was protective against both MDR infection and 28-day mortality.

INTRODUCTION:Heterogeneous outcomes were reported in studies targeting left atrial (LA) pressure reduction by interatrial shunting in heart failure (HF). Right ventricular (RV) performance and pulmonary arterial (PA) afterload are essential in assuring the efficient blood flow shunting through the pulmonary circulation. We investigated whether baseline RV-PA coupling, expressed as the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio, is associated with outcomes after atrial flow regulator (AFR) implantation in the PRELIEVE study. METHODS:In this post hoc analysis of the multicentre, single-arm PRELIEVE study (NCT03030274), 106 patients with symptomatic HF (62 with reduced and 44 with preserved ejection fraction) underwent AFR implantation and were followed for 12 months. TAPSE/PASP was measured by echocardiography at baseline and 3 months. The primary composite endpoint was cardiovascular (CV) death or HF hospitalization (HFH). RESULTS:During follow-up, 19 patients (18%) experienced the composite endpoint. At baseline, these patients had higher NT-proBNP [1261 (567, 1790) vs. 317 (114, 1200) pg/mL; P = .009] and lower TAPSE/PASP [0.43 (0.33-0.53) vs 0.53 (0.43-0.76), P = .04]. In Kaplan-Meier analysis, lowest TAPSE/PASP ratio tended to show the worst outcome (P = .07). Using recurrent-event Poisson regression, lower baseline TAPSE/PASP was associated with a higher cumulative incidence of HFHs [incidence rate ratio 2.4 (95% CI 1.0-5.6) for lowest vs middle tertile, P = .039]. CONCLUSION:In patients with HF undergoing interatrial shunting, impaired baseline RV-PA coupling assessed by a low TAPSE/PASP ratio was associated with higher rates of CV death or recurrent HF hospitalizations. The potential value of baseline RV-PA uncoupling in identifying responders to LA shunt therapies requires prospective evaluation in adequately powered prospective studies.

Background: Neonatal septic arthritis is a rare but potentially devastating infection that can present with subtle clinical signs and rapidly progress to joint destruction, osteomyelitis, and permanent sequelae. We aimed to describe the clinical and microbiological characteristics, imaging findings, management, and follow-up outcomes of neonatal septic arthritis patients and to report ultrasonography (US) and magnetic resonance imaging (MRI) findings within the same cohort. Methods: This retrospective observational study was conducted in a tertiary neonatal intensive care unit and included neonates who were diagnosed with septic arthritis between January 2016 and December 2025. Demographic, clinical, laboratory, microbiological, imaging, treatment, and outcome data were systematically obtained from medical records. The diagnosis was based on compatible clinical findings supported by laboratory and/or microbiological evidence, with imaging used to support diagnosis and guide management. Results: Twelve neonates were included. The median gestational age was 36.5 weeks (26–40), and the median birth weight was 2435 g. The median symptom onset was 22 days of life. The hip (n = 4) and knee (n = 4) were most commonly affected. Pseudoparalysis and swelling were the most frequent findings. Synovial cultures were positive in 10/12 (Staphylococcus aureus, n = 7; methicillin-resistant Staphylococcus aureus (MRSA), n = 3), and blood cultures were positive in 6/12. US detected joint effusion in 33% of the patients, whereas MRI revealed inflammatory changes in all the patients. Concomitant osteomyelitis occurred in 5/12 patients. Orthopedic sequelae developed in 6/12; no mortality was observed. Conclusions: Neonatal septic arthritis is associated with a substantial risk of osteomyelitis and early sequelae. Delayed recognition may worsen outcomes. Normal ultrasonographic findings should not exclude the diagnosis when clinical suspicion persists, and MRI may provide complementary information for timely management.

Neonatal heel-prick screening is a key component of preventive healthcare, and its effectiveness is strongly influenced by parents’ knowledge, perceptions, and willingness to engage in screening. The aim of this study was to evaluate the relationships between mothers’ sociodemographic characteristics and their attitudes and behaviors toward the screening process and the level of concern they experience regarding newborn screening. This cross-sectional study included 350 mothers. Data on sociodemographic characteristics and knowledge, attitudes, and behaviors regarding neonatal heel-prick screening were collected using a researcher-developed structured questionnaire. Maternal concern, defined as a self-reported binary outcome (present/absent), was the primary outcome variable. Associations were analyzed using the chi-square test or Fisher’s exact test, as appropriate, and variables with p < 0.10 in univariable analyses were entered into a multivariable Firth’s penalized logistic regression model. The results are presented as adjusted odds ratios (aORs) with 95

Neonatal candidemia remains a major cause of morbidity and mortality in neonatal intensive care units, particularly among preterm and very-low-birth-weight infants. This retrospective cohort study evaluated the clinical characteristics, microbiological profiles, and factors associated with 28-day all-cause mortality in neonates with culture-proven candidemia admitted to a tertiary neonatal intensive care unit between January 2011 and December 2025. Demographic, clinical, microbiological, treatment, feeding, and outcome data were collected from medical records, and factors associated with mortality were analyzed using univariate and multivariable Firth-penalized logistic regression. A total of 48 neonates were included, with a median gestational age of 28 weeks (IQR 25–36) and a median birth weight of 967.5 g (IQR 765–2400). The incidence of candidemia was 0.4%. Candida albicans was the most frequently isolated species (66.7%). The 28-day all-cause mortality rate was 47.9% (23/48). Non-survivors had lower gestational age and birth weight and developed candidemia earlier than survivors. In the univariable analysis, breast milk exposure before the onset of candidemia was significantly more common among survivors than among nonsurvivors and should be considered a hypothesis-generating finding. In the multivariable analysis, inotropic support (aOR 14.69, 95% CI 2.66–124.74; p = 0.001) and thrombocytopenia (aOR 5.91, 95% CI 1.36–34.44; p = 0.017) were independently associated with 28-day all-cause mortality. In this cohort, inotropic support and thrombocytopenia were independently associated with 28-day all-cause mortality, whereas the association between breast milk exposure and survival was limited to the univariable analysis.

Background. The impact of peripheral artery disease (PAD) on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is not well studied. Methods. We analyzed the association of PAD with CTO-PCI outcomes using data from the PROGRESS-CTO registry of procedures performed at 47 centers between 2012 and 2023. Results. The prevalence of PAD among 12 961 patients who underwent CTO PCI during the study period was 13.9% (1802). PAD patients were older, more likely to be current smokers, and had higher rates of dyslipidemia, diabetes, cerebrovascular disease, hypertension, prior myocardial infarction, PCI, and coronary artery bypass graft surgery. Their PROGRESS-CTO (1.35 vs 1.22; P < . 001) and J-CTO (2.63 vs 2.33; P < . 001) scores were higher, lesion length was longer, and angiographic characteristics were more complex. Their access site was more likely to be bifemoral (33.6% vs 30.9%; P= . 024) compared with patients with no PAD. Technical (82.9% vs 87.7%; P < . 001) and procedural (80.5% vs 86.6%; P <. 001) success rates were lower in patients with PAD, while the incidence of major adverse cardiovascular events (MACE) was higher (3.1% vs 1.8%; P < . 001), with higher incidence of death (0.8% vs 0.4%; P = . 034), acute myocardial infarction (0.9%vs 0.4%; P = . 010), and perforation (6.6% vs 4.5%; P < . 001). In multivariable analysis, PAD was associated with higher MACE (odds ratio [OR]: 1.53; 95% CI, 1.01-2.26; P = . 038) and lower technical success (OR: 0.82; 95% CI, 0.690.99; P = . 039). Conclusions. PAD patients undergoing CTO PCI have higher comorbidity burden, more complex CTOs, higher MACE, and lower technical success.

BACKGROUND:There is limited information on the use of drug-coated balloons (DCBs) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). AIMS:To assess the frequency and outcomes of DCB use in CTO PCI. OBJECTIVE:This study evaluated the frequency and outcomes of DCB use in a large, multicenter CTO PCI registry. METHODS:We analyzed 12,146 patients who underwent 12,157 successful CTO PCIs at 59 centers from 2018 to 2025. RESULTS:DCBs were used in 454 patients (3.7%) with increasing frequency over time (p = 0.020). A DCB-only strategy was used in 48.4% of the patients and a hybrid strategy combining DCBs and drug-eluting stents (DES) was used in 51.6% of patients. Patients treated with DCB (both strategies) had low prevalence of comorbidities. Compared with the DES cases, DCB only cases had favorable angiographic characteristics, lower mean J-CTO (Japanese CTO) score (1.83 ± 1.03 vs. 2.27 ± 1.23; p < 0.001), and similar technical success (96.3% vs. 97.3%; p = 0.640), and in-hospital major adverse cardiac events (MACE). The hybrid and DCB-only strategies had comparable technical success and in-hospital MACE. During a median follow-up of 323 (170-429) days, DCB only cases had lower MACE than the other strategies (hazard ratio [HR] 0.41, 95% CI 0.17-0.96, p = 0.040). After multivariable adjustment, the association remained significant (HR 0.39, 95% CI 0.16-0.92, p = 0.032). CONCLUSIONS:DCBs are increasingly being used in CTO PCI. A DCB only strategy was used in less complex lesions and was associated with similar technical success and in-hospital MACE compared with hybrid or DES strategies. A DCB only strategy was associated with lower long-term MACE.

Necrotizing enterocolitis (NEC) is a severe and often catastrophic gastrointestinal emergency that predominantly affects neonates, especially those born prematurely, and is associated with high rates of morbidity and mortality. Despite its significant clinical impact, the precise etiology and molecular pathogenesis of NEC remain incompletely understood. In this study, we conducted global transcriptomic profiling using high-throughput RNA sequencing in 11 premature neonates diagnosed with NEC, following rigorous inclusion and exclusion criteria. Compared to healthy controls, we identified 1,204 differentially expressed genes (DEGs), including 636 upregulated and 568 downregulated transcripts. Notably, genes involved in hypoxia-induced apoptosis (e.g., HIF1 AAS3, HIF1 AAS1), the caspase cascade (BCL2, BCL6, CASP5, CASP7), and inflammation (IL1RAP, IL6ST, TNFAIP3, TNFRSF10 A, TLR6, TLR10) were significantly upregulated. In contrast, IL18, a key modulator of inflammatory responses, was downregulated. Interestingly, several genes encoding selenoproteins (GPX1, GPX4, SELENON, SELENOM, SELENOF, SELENOW, SELENOT) were also downregulated, suggesting molecular evidence of selenium deficiency. Gene ontology and pathway enrichment analyses revealed widespread dysregulation in pathways related to hypoxia response, systemic inflammation, coagulation, antimicrobial defense, mitochondrial function, autophagy, selenium metabolism, and apoptosis. Collectively, our findings provide novel insights into the molecular underpinnings of NEC in premature infants and suggest that systemic hypoxia, oxidative stress, selenium deficiency, and programmed cell death contribute significantly to its pathogenesis.

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. Compared with patients without OSAS, patients with OSAS were older; more likely to be men; and had higher prevalence of diabetes, hypertension, dyslipidemia, cerebrovascular disease, previous heart failure, coronary artery bypass graft surgery, and prior PCI. They had higher J-CTO (2.73 ± 1.20 vs. 2.30 ± 1.25; p < 0.001) and PROGRESS-CTO (1.35 ± 1.01 vs. 1.16 ± 0.96; p < 0.001) scores, longer lesion length, and more complex angiographic characteristics. Compared with patients without OSAS, OSAS patients had similar technical success (87.6% vs. 88.3%, p = 0.552) and procedural success (85.9% vs. 87.2%, p = 0.260). There were no differences in terms of in hospital MACEs and death. After a median follow-up of 71 days, the incidence of MACEs (3.9% vs. 1.6%, p = 0.026) and death (2.6% vs. 0.6%, p = 0.003) was higher in patients with OSAS. In multivariable analysis, OSAS was independently associated with higher follow-up MACEs (hazard ratio 2.32, 95% confidence intervals 1.22-3.26, p = 0.006). CONCLUSION:OSAS is common in patients undergoing CTO PCI. Compared with patients without OSAS, OSAS patients had more comorbidities and more complex CTOs, similar rates of periprocedural success and complications, and higher incidence of follow-up MACEs.

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 (2.78%) underwent IVL and 381 (2.45%) RA. Patients treated with IVL had more co-morbidities and more complex CTO lesions. Antegrade wiring was the most used initial and successful crossing strategy for lesions treated with both IVL and RA, although the retrograde approach was more frequently used in IVL cases. Procedure and fluoroscopy times, and air kerma radiation doses and contrast volumes, were greater in patients treated with RA than those treated with IVL. There were no significant differences between the groups in technical success (97.2% vs 95.3%, p = 0.20), procedural success (94.7% vs 91.8%, p = 0.14), and in-hospital major adverse cardiac events (MACEs) (3.0% vs 4.2%, p = 0.47). However, coronary artery perforations were more frequent in patients who underwent RA (9.5% vs 3.2%, p <0.001). Multivariable logistic regression analysis revealed that IVL compared with RA was not independently associated with technical success, procedural success, or in-hospital MACE. In patients who undergo CTO PCI, IVL is associated with similar in-hospital MACE, technical success, and procedural success but lower incidence of coronary artery perforation compared with RA.

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. RESULTS:VASC occurred in 158 of 16,810 CTO PCIs (0.9%). VASC patients were older (67 ± 11 vs. 64 ± 10 years, p < 0.001), more likely to be women (28.4% vs. 19.1%, p = 0.004) and less likely to be current smokers (18.9% vs. 27.2%, p = 0.026). They were more likely to have at least one femoral access (89.2% vs. 75.3%, p < 0.001) and less likely to have any radial access (38.0% vs. 52.3%, p < 0.001). Transfemoral access was more common in patients with VASC (60.1% vs. 45.7%, p < 0.001). VASC cases had higher J-CTO (2.57 vs. 2.38, p = 0.05) and PROGRESS-CTO major adverse cardiac events (MACE) scores (3.27 vs. 2.58, p < 0.001). They had similar technical (87.3% vs. 87.1%, p > 0.9) and procedural (82.3% vs. 85.9%, p = 0.2) success, but higher MACE (6.3% vs. 1.9%, p < 0.001) and bleeding (23.4% vs. 0.4%, p < 0.001). Female gender (odds ratio [OR] 1.95, 95% confidence intervals [CI] 1.24-3.00, p = 0.003), at least one femoral access (OR 2.02, 95% CI 1.09-4.04, p = 0.034) and sheath size (7-F: OR 2.16, 95% CI 1.12-4.60, p = 0.031; 8-F: OR 2.11, 95% CI 1.03-4.70,p = 0.051) were associated with VASC in multivariable analysis. CONCLUSION:Female sex, femoral access and larger sheaths ≥ 7 F were associated with VASC in patients undergoing CTO PCI.

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. The CTO vessels were classified as small (≤ 2.75 mm), medium (2.76-3.00 mm), and large (> 3.00 mm) diameter. RESULTS:Among 13,423 patients who underwent CTO-PCI at 47 centers between 2012 and 2024, the target CTO vessel was small in 4858 (36%), medium in 5393 (40%), and large in 3172 (24%). Compared with patients who had medium and large CTO target vessels, those who had small vessels were older and had a higher prevalence of diabetes, hypertension, dyslipidemia, and peripheral arterial disease. Large target vessel diameter CTOs had more complex angiographic characteristics such as higher J-CTO scores, longer lesion length, and more complex angiographic characteristics. Compared with CTO PCI of small and large vessel patients, medium vessel patients had higher technical (p = 0.008) and procedural (p = 0.010) success. The incidence of perforation was higher in large-diameter vessels. In multivariable logistic regression using restricted cubic spline analysis, a vessel diameter of 2.75-3.00 mm was associated with higher technical (OR 2.05 95% CI 1.12-3.76; p < 0.001) and procedural (OR 2.48 95% CI 1.49-4.13; p < 0.001) success compared with a vessel diameter of less than 2.75 or greater than 3.00 mm. CONCLUSIONS:Large and small CTO target vessels were associated with lower technical and procedural success compared with medium-sized vessels.

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 (6.0%). The mean patient age was 65.1 ± 10.7 and 80.6% were men, with a high prevalence of diabetes mellitus, hypertension, prior PCI, and prior myocardial infarction. The mean occlusion length was 40.5 ± 25.1 mm, 52.2% had moderate to severe calcification, and the mean Japanese-CTO score was 2.8 ± 1.1. Lesions treated with the Ostial Flash balloon were more frequently located in the right aorto-ostium (79.6% vs 66.0%, P = .002). In the Ostial Flash group, the most common successful CTO crossing technique was antegrade wiring (46.3%), followed by the retrograde approach (40.7%); intravascular imaging was used in 61.1% of cases. Technical success (92.6% vs 87.9%, P = .300) and the incidence of major adverse cardiac events (MACE) (5.6% vs 3.6%, P = .450) was similar in the Ostial Flash vs non-Ostial Flash patients, respectively. In multivariable analysis, PCI of proximal right coronary artery CTOs was independently associated with use of the Ostial Flash balloon (odds ratio 2.2; 95% CI, 1.1-4.8; P = .036). CONCLUSIONS:The Ostial Flash balloon is infrequently used in aorto-ostial CTO PCI. Although there were no differences in MACE with use of the balloon, randomized controlled trials are needed to determine its effectiveness.