Background: To compare atherectomy-assisted endovascular revascularization with balloon angioplasty for the treatment of common femoral artery disease (CFAD). Materials and methods: In a multi-centre retrospective research collaborative, data from consecutive patients who underwent endovascular revascularization of the groin were analysed. Primary endpoints were clinically driven target-lesion-revascularization (CD-TLR) and improvement of clinical symptoms by Rutherford categories (RC). Kaplan-Mayer analyses were used to evaluate these endpoints over time in patients undergoing atherectomy-assisted versus conventional endovascular treatment. In addition, retrospective case-control matching was performed, considering patient and lesion specific characteristics. Lesion calcification was assessed using the PACSS scoring system. Results: Of 225 patients, 179 (79.6%) underwent atherectomy-assisted treatment, whereas 46 (20.4%) underwent balloon angioplasty. Mean age was 72.0 (66.0-79.0) yrs, 139 patients (61.8%) had intermittent claudication and 84 (37.3%) had chronic limb-threatening ischemia (CLTI). Involvement of the deep femoral artery femoral was present in 137 (60.9%) cases, whereas lesion calcification was moderate to severe (PACSS 2-4) in most cases (88%). Atherectomy had low complication rates (perforation in one (0.6%) patient and distal embolization requiring re-intervention in 2 (0.9%) patients) and lower rates of bail-out stenting compared to angioplasty (5.1% versus 36.7%, p<.0001). No perforation or distal embolization was observed in the angioplasty group. After matching for patient and lesion characteristics CD-TLR (HR=4.0, 95%CI=1.0-15.0, p<.05) and RC improvement rates both favoured atherectomy (93.5% versus 73.1%, p<.05). Conclusions: Atherectomy-assisted endovascular revascularization of CFAD seems to be associated with lower stent placement and re-intervention rates compared to balloon angioplasty. Future prospective trials with longer follow-up duration are now warranted.

In patients with persistent atrial fibrillation, adverse atrial remodeling may induce annular enlargement causing severe mitral- or tricuspid valve regurgitation and heart failure symptoms. Herein, we describe a case of rapidly progressive right atrial (RA) adverse remodeling due to new onset persistent AF, causing tricuspid annular dilatation and torrential tricuspid regurgitation (TR) in a 79-year-old female patient. This condition could be diagnosed by echocardiography, which helped guiding further patient management. After successful electric cardioversion, reverse RA remodeling took place, resulting in resolution of RA enlargement, TR and clinical symptoms within a few weeks. To maintain sinus rhythm, the patient underwent cryoablation and her further clinical course was uneventful.

Abstract Background Outcomes with sirolimus-coated drug-eluting balloons (DEB) have been positive for the treatment of femoropopliteal arterial lesions but have not been studied in a broader patient population. Objectives Collect real-world safety and effectiveness data on the SELUTION SLR DEB in patients with claudication and chronic limb-threatening ischemia (CLTI). Methods This international multi-center, prospective, single-arm, post-market study (SUCCESS PTA) enrolled 723 patients at 27 sites. The primary endpoint was freedom from clinically driven target lesion revascularization (CD-TLR) after 1 year. Results Median age was 71.0 [63.0–79.0] years, 65% were male, 25.7% had CLTI. In total, 822 lesions were included; median lesion length was 100.0 mm [50.0–190.0] with 42.1% chronic total occlusions and 36.4% moderate-to-severe calcification. At 12 months, freedom from CD-TLR was 91.1%, 95% CI [88.6–93.1] and 52.1% of patients were asymptomatic. Median EQ-VAS score and ankle-brachial pressure index improved significantly from baseline to 12 months (65.0 [50.0–80.0] vs. 75.0 [60.0–85.0] ( p < 0.0001)) and (0.6 [0.5–0.8] vs. 0.9 [0.8–1.0] ( p < 0.0001)), respectively. At 12 months, outcomes in CLTI patients included major target limb amputation, 5.8%; major cardiac event rate, 4.3%; and death, 11.3%. Respective outcomes for those with claudication were 0.0%, 2.2% and 1.2%. Conclusions This real-world single-arm study is the largest assessment of a sirolimus DEB for treatment in claudication and CLTI. The outcomes were consistent with those reported for paclitaxel-coated balloons and support this DEB platform as a promising alternative, particularly in CLTI patients. Level of evidence Level 3.

PURPOSE:To evaluate the safety and effectiveness of intravascular lithotripsy (SEISMIQ intravascular lithotripsy [IVL] system; Boston Scientific Corporation, Marlborough, Massachusetts) for treating calcified above-the-knee (ATK) lesions in patients with peripheral artery disease. MATERIALS AND METHODS:RESTORE ATK was a prospective, single-arm study that enrolled from 10 sites between January 20, 2023, and December 13, 2023. Ninety-five patients with de novo, moderate to severe calcifications of the femoropopliteal segments were treated using the tested device to modify calcium. Adjunctive drug-eluting technology was not permitted. Primary endpoints were <50% residual diameter stenosis after IVL treatment (by independent core laboratory-adjudicated angiography) and 30-day incidence of major adverse events (MAEs): death, clinically driven target lesion revascularization (CD-TLR), or major amputation. Secondary endpoints included patency, ankle-brachial index, and Rutherford classification (RC) through 6 months. RESULTS:Baseline RC included RC2 (23.2%), RC3 (70.5%), or RC4 (6.3%). Lesions averaged 96.0 mm in length, with 93.7% severely calcified and a mean baseline diameter stenosis of 93.7%. Postprocedural residual stenosis of <50% was achieved in all patients, meeting the predefined performance goal. Three patients (3.2%) received provisional stent placement. Patients had a mean residual stenosis of 21.2% and acute luminal gain of 3.2 mm. No MAEs occurred through 30-day follow-up. At 6 months, target lesion patency was 66.3%, and freedom from CD-TLR was 97.9%. A high proportion of patients demonstrated ≥1 RC improvement at 30-day (93.5%) and 6-month (91.2%) follow-up. CONCLUSIONS:This IVL system demonstrated effective treatment of calcified ATK lesions by successfully reducing calcific stenoses with minimal complications and sustained clinical improvement through 6 months.

Background:Computed coronary tomography angiography (CCTA) is an important diagnostic tool in patients with suspected acute coronary syndromes (ACS). We present a case of vasculitis and coronary involvement, in which CCTA provided critical insights for both diagnosis and management. Case summary:A 54-year-old male patient with a history of arterial hypertension, hyperlipidaemia, chronic hepatitis B, and smoking presented with stable angina and exertional dyspnoea. He reported intermittent fever up to 38.5 °C, and unintentional weight loss over the past 4 months. Physical examination revealed erythematous papules on the arms and palpable purpura on the lower legs, present for 2 weeks. Electrocardiogram and echocardiography were unremarkable, but due to elevated cardiovascular risk and mildly increased troponin levels, coronary artery disease (CAD) was suspected. He therefore underwent CCTA, which demonstrated mild to moderate stenosis of the right coronary artery along with pronounced concentric wall thickening in all three major coronary vessels, raising suspicion for vasculitis. Extensive screening for infectious, autoimmune, and connective tissue diseases was negative. A skin biopsy of the right calf confirmed cutaneous leukocytoclastic vasculitis despite negative serologic markers. The patient was initiated on immunosuppressive therapy with glucocorticoids, resulting in symptomatic improvement and regression of coronary stenoses on follow-up CCTAs. Discussion:To our knowledge, this is the first reported case of seronegative immune complex vasculitis with isolated cardiac involvement and no other systemic manifestations. In this case, CCTA not only provided detailed anatomic visualization of the coronaries but also offered precise insights into coronary wall composition, the presence of inflammation, and plaque characteristics.

Atherectomy has become an established tool for lesion preparation in the endovascular treatment of peripheral artery disease (PAD), particularly for complex and heavily calcified lesions. Despite the widespread clinical use of atherectomy, the long-term benefits of this tool remain controversial, and the available evidence is heterogeneous. This review aimed to provide a clinically oriented, expert-driven narrative evaluation of peripheral atherectomy, including the historical evolution, currently available technologies, and the contemporary clinical role of the procedure, while integrating randomized and real-world evidence to support rational patient and lesion selection. A narrative literature review was conducted based on continuous expert monitoring since 2021 and targeted PubMed searches using combinations of the terms “peripheral artery disease”, “atherectomy”, “critical limb ischemia”, and “intermittent claudication”. Randomized controlled trials, meta-analyses, major registries, and high-quality observational studies were identified, selected based on clinical relevance and methodological quality, and synthesized accordingly. Randomized trials have consistently shown that atherectomy does not provide superior long-term patency or limb salvage compared with balloon angioplasty, stenting, or drug-coated balloons (DCB). However, atherectomy has demonstrated reproducible procedural advantages across multiple studies, including greater luminal gain, fewer dissections, and less need for bailout stenting. Observational and registry data further suggest potential benefits in selected scenarios, particularly for heavily calcified lesions, long-segment occlusions, in-stent restenosis (ISR), and anatomically challenging mobile segments. Current evidence does not support the routine use of atherectomy in PAD. Nevertheless, when applied selectively in appropriately chosen patients and lesions, atherectomy represents a valuable strategy for vessel preparation. The responsible use of atherectomy requires careful integration of the available evidence with operator expertise, awareness of alternative technologies, and consideration of procedural risks and reimbursement issues.

During endovascular therapy (EVT) for peripheral artery disease (PAD), intravascular ultrasound (IVUS) and extravascular ultrasound (EVUS) can provide information that is not available from angiography alone, including accurate vessel sizing, plaque morphology, calcification distribution, and assessment of dissections or stent expansion. By complementing angiography, these imaging modalities may improve procedural precision and support appropriate treatment strategies. This narrative review summarizes the practical applications and limitations of IVUS and EVUS in contemporary EVT for PAD.

Background: Coronary computed tomography angiography (CCTA) is a well-established key diagnostic modality for ruling out obstructive coronary artery disease (CAD) in patients with suspected chronic coronary syndromes (CCSs) and low to intermediate pre-test probability. The widespread availability of preprocedural CCTA data in CCS patients undergoing percutaneous coronary intervention (PCI), however, creates a new opportunity for image-guided procedural planning. Objective: The PRECISION-CT study (Prospective Evaluation of Coronary CTA Integration for Strategy Improvement and Optimization of Non-Emergent PCI) aims to evaluate the impact of CCTA-guided PCI on patient safety and clinical outcomes. Methods: PRECISION-CT is a prospective, two-center, randomized controlled trial, enrolling patients with CCS scheduled for elective PCI due to obstructive CAD by CCTA. Patients are randomized 1:1 to either CCTA-guided PCI or standard angiography-guided PCI. In patients randomized to CCTA-guided PCI, advanced post-processing of CCTA datasets provides specific procedural planning recommendations based on the detailed assessment of coronary artery takeoff, lesion location and plaque characteristics. In addition, real-time integration of the advanced CCTA post-processing is available in the catheterization laboratory during the PCI procedure. Patients randomized to angiography-guided PCI are treated according to routine clinical practice. Results: The primary endpoint is a composite procedural safety and efficacy score including: (i) need for intravascular imaging, (ii) procedural complications, (iii) post-procedural high-sensitivity troponin T elevation, (iv) contrast media, (v) radiation exposure, and (vi) length of hospital stay. Secondary endpoints include major cardiac adverse events such as cardiac death, non-fatal myocardial infarction, target-lesion reintervention and probable or definitive stent thrombosis during 1 year of follow-up. Conclusions: The PRECISION-CT study will provide pragmatic evidence on the ability of CT-guided PCI in patients with CCS to optimize procedural outcomes. These findings may help inform the broader adoption of image-guided precision revascularization strategies in interventional cardiology.

Cardiac magnetic resonance imaging (CMR) provides decisive advantages, particularly in coronary heart disease, myocarditis and cardiomyopathy. It accurately detects ischemia, scarring, edema and microvascular disorders, enables reliable risk stratification and supports treatment decisions such as revascularization or medication adjustments. Modern quantitative perfusion methods and artificial intelligence (AI)-based analyses further increase the diagnostic accuracy. In inflammatory myocardial and pericardial diseases, CMR using mapping techniques and late gadolinium enhancement (LGE) forms the basis for differentiated diagnostics and estimation of the prognosis. It also enables a precise etiological classification and provides prognostically relevant parameters in cases of hypertrophic, dilated, arrhythmogenic and restrictive cardiomyopathies. In the diagnostics of valvular diseases and the planning of interventional procedures and cardiac tumors, CMR provides essential additional information and demonstrates a high sensitivity and specificity. New techniques such as quantitative 4‑dimensional (4D) flow measurements, high-resolution 3D imaging and electrocardiograph (ECG)-independent scans will further increase its value. Due to the increasing number of CMR examinations, standardized procedures, qualified personnel and structured training programs are essential to ensure a high quality of care in the long term.

The Central Role of CMR for Diagnosis and Risk Stratification in HCM

Abstract:Surgical and endovascular procedures are established treatments for extracranial stenoses of the internal carotid artery (ICA) according to current guidelines. Revascularization is generally recommended for symptomatic ICA stenoses between 50% and 99%. For asymptomatic stenoses, optimal medical therapy is the primary focus; revascularization should be considered for stenoses between 60% and 99%, depending on the individual risk. The choice between endarterectomy (CEA) and carotid artery stent implantation (CAS) is made by an interdisciplinary team, considering patient- and anatomy-specific factors. Interventional therapy is well-established; however, studies show an increased incidence of minor strokes and transient ischemic attacks (TIAs), which is why patient selection and embolic protection are becoming increasingly important in the field of endovascular revascularization. Technological advancements, such as innovative double-layer stents for improved plaque coverage, increase the safety of the procedure, and reduce the peri-procedural stroke rate. Anatomical features are essential for successful treatment when selecting devices and planning procedures.

Background Radiation-induced atherosclerosis represents an underestimated clinical entity. Case Summary We report on 2 cases of patients with upper-limb ischemia due to subclavian artery lesions. Both patients had radiation therapy due to cancer more than 15 years before symptom onset and no other signs of atherosclerosis. Angiography and intravascular ultrasound were performed in both cases, and lesions were treated with angioplasty and stent placement in the first patient, whereas intravascular lithotripsy was necessary in the second patient due to severe calcification and balloon underexpansion. Discussion & Take-Home Messages Intravascular ultrasound helps to accurately assess lesion characteristics, size the balloon and stent devices, and judge the effectiveness of the endovascular therapy. Since radiotherapy is linked to accelerated atherosclerosis, such patients may benefit from clinical and imaging surveillance by duplex ultrasound.