Field Of Interventional Cardiology Research Articles

Interventional cardiologists' perspectives and knowledge towards artificial intelligence.

Artificial intelligence (AI) is increasingly utilized in interventional cardiology (IC) and holds the potential to revolutionize the field. We conducted a global, web-based, anonymous survey of IC fellows and attendings to assess the knowledge and perceptions of interventional cardiologists regarding AI use in IC. A total of 521 interventional cardiologists participated in the survey. The median age range of participants was 36 to 45 years, most (51.5%) practice in the United States, and 7.5% were women. Most (84.7%) could explain well or somehow knew what AI is about, and 63.7% were optimistic/very optimistic about AI in IC. However, 73.5% believed that physicians know too little about AI to use it on patients and most (46.1%) agreed that training will be necessary. Only 22.1% were currently implementing AI in their personal clinical practice, while 60.6% estimated implementation of AI in their practice the next 5 years. Most agreed that AI will increase diagnostic efficiency, diagnostic accuracy, treatment selection, and healthcare expenditure, and decrease medical errors. The most tried AI-powered tools were image analysis (57.3%), ECG analysis (61.7%), and AI-powered algorithms (45.9%). Interventional cardiologists practicing in academic hospitals were more likely to have AI tools currently implemented in their clinical practice and to use them, women had a higher likelihood of expressing concerns regarding AI, and younger interventional cardiologists were more optimistic about AI integration in IC. Our survey suggests a positive attitude of interventional cardiologists regarding AI implementation in the field of IC.

A 2024 scientific update on the clinical performance of drug-coated balloons.

Continuous advances in the field of interventional cardiology have led to the development of drug-coated balloons (DCB). These represent a promising device for overcoming the well-known limitations of traditional metallic stents, which are associated with a persistent yearly increased risk of adverse events. This technology has the ability to homogeneously transfer the drug into the vessel wall in the absence of a permanent prosthesis implanted in the coronary vessel. Robust data support the use of DCB for the treatment of in-stent restenosis, but there is also currently growing evidence from long-term follow-up of large randomised clinical trials regarding the use of these devices in other scenarios, such as de novo small and large vessel disease, complex bifurcations, and diffuse coronary disease. Other critical clinical settings such as diabetes mellitus, high bleeding risk patients and acute coronary syndromes could be approached in the upcoming future by using DCB, alone or as part of a blended strategy in combination with drug-eluting stents. There have been important scientific and technical advances in the DCB field in recent years. The purpose of this paper is to review the most current data regarding the use of DCB, including the mid- and long-term follow-up reports on the safety and efficacy of this novel strategy in different clinical and angiographic scenarios.

Intravascular Imaging in Ultra-Low or Zero-Contrast Percutaneous Coronary Interventions: The Time Is Now?

Ultra-low contrast percutaneous coronary interventions (ULPCIs) are a novel field of interventional cardiology, aiming to reduce the risk of contrast-induced nephropathy (CIN), which is a well-described adverse event after angiography. CIN is a well-described adverse event following PCI, especially in high-risk patients, i.e., patients with an already deteriorating renal function or chronic kidney disease, as well as patients of advanced age or requiring an increased amount of contrast during their intervention. Among the techniques described for ULPCI procedures, intravascular imaging guidance seems a promising option, as it allows lesion recognition and characterization, stent implantation, and PCI optimization. Intravascular ultrasound (IVUS) is the modality most commonly used, as it does not require contrast injection, contrary to optical coherence tomography (OCT). Several clinical trials, assessing IVUS in the context of ULPCI, have shown that it can be safely used in this setting while offering a substantial reduction in contrast media volume, as well as renal adverse outcomes. This review aims to describe the need for ULPCI and technical considerations regarding the use of intravascular imaging in this setting, as well as analyze the available evidence from clinical trials regarding the safety and efficacy of IVUS-ULPCI, in order to provide a comprehensive summary for practicing physicians.

Retrospective investigation of percutaneous coronary intervention (PCI) via distal radial approach/artery(dRA) in daily practice: possible adaptability of variety of patients, diagnosis, devices

Abstract Background Distal radial approach(dRA) that features puncturing radial artery at snuff box is becoming well known gradually and widely in the fields of interventional cardiology. Although there are some reports about dRA, safety, feasibility and compatibility of this procedure are still unclear. Methods Total of consecutive 90 PCI attempted via dRA procedure done by the operators who has experience of more than 20 dRA catheterization before from December 2020 to January 2023 at the University of Tokyo Hospital were retrospectively investigated. Distal radial artery puncture was done with echo-guided method just before the PCI procedure. Diameter of conventional radial artery(cRA) and dRA were measured. PCI strategy and devices were decided by the operators. Results About patient characteristics, mean age was 73±10 years old, consisting of 82.2%(74/90) male and 17.8%(16/90) female. Mean height/weight/BMI was 162.8±8.5 cm, 64.1±12.4 kg and 24.0±3.5, respectively. LVEF was 56.6±15.7%. Approach side of dRA was right in 74.4%(67/90) and left in 25.6%(23/90). Former dRA prcedeure of the same side was 20.0%(18/90). There were 7 cases(7.8%) of hemodialysis patients(non-AV fistula side). Concerning antithrombotics, 100%(80/80) were on DAPT and 18.9%(17/90) were on triple therapy(DAPT + warfarin or any DOAC:direct oral anticoagulant). The dRA success rate was 90.0%(81/90) and the procedure success rate was 100%(90/90). Diagnosis were STEMI: 5.6%(5/90), NSTEMI: 2.2%(2/90), unstable AP: 10.0%(9/90), stable(effort) AP: 18.9%(17/90), staged PCI: 25.6%(23/90) and other: 37.8%(34/90). Mean sheath insertion time was about 4 minutes (255±139 seconds). There are 3 CTO cases. Rotational atherectomy was used in 3.3%(3/80) and orbital atherectomy device was used in 5.0%(4/80). ELCA(excimer laser coronary angioplasty) was used in 6.3%(5/80). More than 1 DES was deployed in 75.0%(60/80), DCB(drug coated balloon) was used in 23.8%(19/80). Imaging devices were used in 100%(80/80) consists of IVUS: 92.5%(74/80), OCT: 12.5%(10/80) and both: 10.0%(8/80). Mean total radiation dose was 1324±809 mGy and mean volume of contrast medium was 141.6±55.6 ml. Bleeding, neurological and other major complication was 0%(0/80). Blood transfusion was performed in 1 case that is not related to procedure. Procedure related dissection or perforation of dRA was observed in 2 cases(2.2%). Occlusion of dRA was observed in 1 case(1.1%). Diameter of cRA and dRA was 2.6±0.7 mm and 2.3 mm±0.7 mm, respectively. Conclusions PCI via dRA had high rate of dRA and procedure success when it is performed by experienced physicians. It is effective regardless of the preprocedural diagnosis(STEMI/NETEMI/uAP/eAP/other). As far as this study is concerned, no device(including Rota, OAC and ELCA) had limitation or malfunction during procedure. No major complications was observed. PCI via dRA seemed to be safe, feasible, and compatible for various situations and devices.

Abstract 15642: Discrimination Against Physicians in Interventional Cardiology

Background: Data on discrimination against physicians in the field of interventional cardiology are limited. Methods: We performed an online, anonymous, international survey of interventional cardiologists. Results: A total of 445 interventional cardiologists participated in the survey. Median age was 46-50 years and most (61%) practice in the United States. Among the participants, 13% were women and 13% belonged to underrepresented minority groups. Participants were asked to discern which characteristics contribute to discrimination against physicians in their workplace. Several characteristics were identified (Figure): language accent (48%), race/ethnicity (44%), age (44%), gender (43%), and appearance/clothing (40%). Women were more likely to have experienced discrimination by patients and families (81% vs 54%; p<0.001), peers (81% vs 45%; p<0.001), supervisors (73% vs 43%; p<0.001), support staff (64% vs 36%; p<0.001), and nursing staff (63% vs 37%; p=0.001), compared with men. Similarly, among participants who practice in the US, UK, Canada, and Australia (n=296), physicians whose first language was not English were more likely to have experienced discrimination from patients and families (73% vs 46%; p<0.001), peers (63% vs 35%; p<0.001), supervisors (56% vs 33%; p<0.001), support staff (51% vs 28%; p<0. 001), and nursing staff (52% vs 31%; p=0.001), compared with native English speakers. Both women (60% vs 7%; p<0.001) and underrepresented minority groups (28% vs 12%; p=0.003) were more likely to be mistaken for a non-physician employee, compared with men and non-underrepresented minority groups respectively. While 9% (n=42) of the total participants reported incidents of discrimination to their respective organizations, only 19% of those (n=8) expressed satisfaction with the response received. Conclusions: Our survey provides a snapshot of the current status of discrimination faced by interventional cardiologists.

Twitter (X) in Medicine: Friend or Foe to the Field of Interventional Cardiology?

Twitter (X) in Medicine: Friend or Foe to the Field of Interventional Cardiology?

Surface Engineering of Bioactive Coatings for Improved Stent Hemocompatibility: A Comprehensive Review.

Cardiovascular diseases continue to be a major contributor to illness and death on a global scale, and the implementation of stents has given rise to a revolutionary transformation in the field of interventional cardiology. The thrombotic and restenosis complications associated with stent implantation pose ongoing challenges. In recent years, bioactive coatings have emerged as a promising strategy to enhance stent hemocompatibility and reduce thrombogenicity. This review article provides an overview of the surface engineering techniques employed to improve the hemocompatibility of stents and reduce thrombus formation. It explores the mechanisms underlying thrombosis and discusses the factors influencing platelet activation and fibrin formation on stent surfaces. Various bioactive coatings, including anticoagulant agents, antiplatelet agents, and surface modifications, are discussed in detail, highlighting their potential in reducing thrombogenicity. This article also highlights a multitude of surface modification techniques which can be harnessed to enhance stent hemocompatibility including plasma treatment, physical vapor deposition (PVD), chemical vapor deposition (CVD), and electrodeposition. These techniques offer precise control over surface properties such as roughness, charge, and composition. The ultimate goal is to reduce platelet adhesion, tailor wettability, or facilitate the controlled release of bioactive agents. Evaluation methods for assessing hemocompatibility and thrombogenicity are also reviewed, ranging from in vitro assays to animal models. Recent advances in the field, such as nanotechnology-based coatings and bioactive coatings with controlled drug release systems, are highlighted. Surface engineering of bioactive coatings holds great promise for enhancing the long-term outcomes of stent implantation by enhancing hemocompatibility and reducing thrombogenicity. Future research directions and potential clinical applications are discussed, underscoring the need for continued advancements in this field.

Non-Invasive Approaches in Interventional Cardiology for Addressing Cardiovascular Disease Burden in Low-Income Countries.

Interventional cardiology has traditionally been associated with invasive procedures such as angioplasty and stenting. However, there is a growing recognition of the importance of non-invasive strategies in the field of interventional cardiology. This scientific article explores the role of non-invasive interventions, including lifestyle modifications, patient education, and comprehensive management approaches, in preventing and managing cardiovascular disease. By empowering patients and focusing on holistic care, these non-invasive strategies have the potential to significantly improve patient outcomes and reduce the burden of cardiovascular disease. This article highlights the various non-invasive interventions, their mechanisms of action, and their impact on patient well-being and long-term cardiovascular health. Additionally, it discusses the challenges and opportunities associated with implementing these strategies in clinical practice, emphasizing the importance of a multidisciplinary approach and patient-centered care. Through a comprehensive understanding of non-invasive strategies, interventional cardiologists can optimize patient care and contribute to the prevention and management of cardiovascular disease.

Technology Advance: Embolic Protection, Heart Failure, and Artificial Intelligence

IN a highly interesting session delivered at the European Association of Percutaneous Cardiovascular Interventions (EuroPCR) congress 2023, experts presented and discussed a range of exciting new technologies. Specifically, embolic protection devices, a clot aspiration pump, and a device that scores calcified aortic valves were presented, along with an intelligent conversational transcatheter aortic valve implantation (TAVI) agent. Chaim Lotan, Chief Innovation Officer, Hadassah Medical Centre, Israel, chaired the session, encouraging thought provoking discussion surrounding the application of these technologies within the field of interventional cardiology.

Review of the European Association for Percutaneous Cardiovascular Interventions Congress (EuroPCR) 2023

The European Association for Percutaneous Cardiovascular Interventions (EAPCI) hosted the 2023 edition of EuroPCR, a 4-day course, at the Palais des Congrès in Paris, France, attracting colleagues from around the world. This event transformed the Palais des Congrès into a vibrant hub for medical exchange and advancements in the field of interventional cardiology. The course served as a catalyst for international collaboration and innovation, creating an atmosphere of warmth and welcome to participants, as well as igniting advancement within the realm of cardiovascular medicine. Learning, collaboration, and first-hand exposure to cutting-edge innovations forging the next generation of pioneers were of great importance throughout the course.

Intracoronary Imaging: Current Practice and Future Perspectives

Intracoronary imaging has brought new insight in the field of interventional cardiology. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are the most commonly used imaging modalities. Regarding their technical characteristics IVUS and OCT have similarities as well as differences, a fact that could have significant clinical implications. Both techniques play an important role in percutaneous coronary intervention (PCI) guidance and demonstrated superiority compared to intravascular coronary angiography (ICA) guidance alone. Furthermore, their use can notably assist coronary plaque evaluation; both provide additional information of plaque characteristics, which can lead to a better understanding of the cause of an acute coronary syndrome (ACS) and better clinical outcomes. However, there is not enough clinical evidence for the superiority of one method compared to the other, something that is, also, reflected in the guidelines. In this review, we aim to compare role of IVUS and OCT in the different aspects of coronary artery disease (CAD), according to the latest scientific data. In addition, we present the future perspectives regarding the IVUS and OCT, with co-registration of the two methods or hybrid OCT-IVUS catheters.

Cardiology: what's new in 2022

The year of 2022 was marked by many novelties in the fields of interventional cardiology, heart failure, electrophysiology, cardiac imaging, and congenital heart disease. These advances will certainly change our daily practice, on top of improving the diagnosis and treatment of many heart conditions. In addition, the European Society of Cardiology has updated its guidelines on pulmonary hypertension, ventricular arrhythmias and sudden death, cardiovascular assessment of patients undergoing non-cardiac surgery. The members of the Cardiology division of Lausanne University Hospital (CHUV) here present the publications which they considered to be the most important of the past year.

The Expanding Uses of Medical Extended Reality in the Cardiac Catheterization Laboratory: Pre-procedural Planning, Intraprocedural Guidance, and Intraprocedural Navigation

The use of innovative imaging practices in the field of interventional cardiology and electrophysiology has led to significant progress in both diagnostic and therapeutic capabilities. 3D reconstructions of 2D images allows a proceduralist to develop a superior understanding of patient anatomy. Medical extended reality (MXR) technologies employ 3D interactive images for the user to improve depth perception and spatial awareness. Although MXR procedural navigation is a relatively new concept, the potential for use within interventional cardiology and EP is significant with the eventual goal of improving patient outcomes and reducing patient harm. This review article will discuss the current landscape of MXR use in the catheterization lab including pre-procedural planning, intraprocedural planning and intraprocedural guidance in diagnostic cardiac catheterization, valvar and coronary interventions, electrophysiology studies, and device implants.

Recanalisation of coronary chronic total occlusions.

Percutaneous treatment of coronary chronic total occlusions (CTO) has advanced greatly since its advent in the late 1970s through the development of dedicated wires and microcatheters, the improved skills of highly experienced operators and the adoption of new sophisticated strategies to guide procedural planning. The contemporary procedural success rate is 80-90% with a reduction in complications. Although there has been no improvement in prognosis in randomised trials to date, they, and other controlled registries of thousands of patients, confirm the pivotal role of CTO recanalisation in the treatment of angina and dyspnoea and an improvement in quality of life. Despite this evidence, CTO recanalisation is grossly underutilised. This review reports a detailed overview of the history, indications and treatment strategies for CTO recanalisation and hopes to increase interest among new, and especially young, operators inthis demanding, rapidly evolving field of interventional cardiology.

Design and Rationale of the National Tunisian Registry of Percutaneous Coronary Intervention: Protocol for a Prospective Multicenter Observational Study.

BackgroundCoronary artery diseases remain the leading cause of death in the world. The management of this condition has improved remarkably in the recent years owing to the development of new technical tools and multicentric registries.ObjectiveThe aim of this study is to investigate the in-hospital and 1-year clinical outcomes of patients treated with percutaneous coronary intervention (PCI) in Tunisia.MethodsWe will conduct a prospective multicentric observational study with patients older than 18 years who underwent PCI between January 31, 2020 and June 30, 2020. The primary end point is the occurrence of a major adverse cardiovascular event, defined as cardiovascular death, myocardial infarction, cerebrovascular accident, or target vessel revascularization with either repeat PCI or coronary artery bypass grafting (CABG). The secondary end points are procedural success rate, stent thrombosis, and the rate of redo PCI/CABG for in-stent restenosis.ResultsIn this study, the demographic profile and the general risk profile of Tunisian patients who underwent PCI and their end points will be analyzed. The complexity level of the procedures and the left main occlusion, bifurcation occlusion, and chronic total occlusion PCI will be analyzed, and immediate as well as long-term results will be determined. The National Tunisian Registry of PCI (NATURE-PCI) will be the first national multicentric registry of angioplasty in Africa. For this study, the institutional ethical committee approval was obtained (0223/2020). This trial consists of 97 cardiologists and 2498 patients who have undergone PCI with a 1-year follow-up period. Twenty-eight catheterization laboratories from both public (15 laboratories) and private (13 laboratories) sectors will enroll patients after receiving informed consent. Of the 2498 patients, 1897 (75.9%) are managed in the public sector and 601 (24.1%) are managed in the private sector. The COVID-19 pandemic started in Tunisia in March 2020; 719 patients (31.9%) were included before the COVID-19 pandemic and 1779 (60.1%) during the pandemic. The inclusion of patients has been finished, and we expect to publish the results by the end of 2022.ConclusionsThis study would add data and provide a valuable opportunity for real-world clinical epidemiology and practice in the field of interventional cardiology in Tunisia with insights into the uptake of PCI in this limited-income region.Trial RegistrationClinicaltrials.gov NCT04219761; https://clinicaltrials.gov/ct2/show/NCT04219761International Registered Report Identifier (IRRID)RR1-10.2196/24595

See One, Do One, Teach One? Not So Fast, My Friend

The field of interventional cardiology has become so subspecialized that it is impossible for anyone to be completely up to date and facile on all the technologies and techniques that are being utilized. Even highly subspecialized operators within the fields of coronary, structural, and peripheral intervention may benefit from instruction from others with more experience in a particular technique. In addition, less experienced operators such as recent graduates or operators branching out into a new space certainly stand to benefit from guidance from more experienced operators.

A-11 | Short Term Outcomes Comparing Biodegradable Drug Eluting Stents Versus Durable Polymer Stents in Coronary Artery Disease - A Systematic Review and Meta Analysis

With advancement in the field of interventional cardiology, drug eluting stents (DES) with biodegradable polymer (BD) were developed in comparison to durable polymers (DP) to improve clinical outcomes in coronary artery disease. However, Results reported by multiple randomized controlled trials (RCTs) remain controversial.

SCAI Position Statement on Best Practices for Clinical Proctoring of New Technologies and Techniques

The field of interventional cardiology continues to evolve with the introduction of new techniques and technologies. From the first angioplasty to transcatheter aortic valve replacement (TAVR), dissemination of new treatments has generally required a training program of didactics and observation, culminating in a hands-on experience with a patient. Trainees and facilities starting new programs often require support from outside experts, traditionally known as “medical proctors,” whose costs are typically borne by the medical device industry.

Trans-radial cerebral angiography-safety, efficacy and patient comfort: review of literature

A diagnostic cerebral angiography is a vital tool in the planning and management of various cerebrovascular conditions. Newer angiographic modalities, such as digital subtraction angiography offers dynamic imaging of the cerebral blood flow and is the preferred diagnostic modality of choice when a subsequent intervention is contemplated. Traditionally, the transfemoral route at the groin was used as the site for vascular access. However, landmark randomised controlled trials in the field of interventional cardiology have demonstrated the safety, efficacy and patient comfort attained by employing a trans-radial access for angiography and interventions. This has spawned numerous studies which were directed explicitly towards cerebral angiography and neuro-intervention. We present this review of literature to consolidate the current practices and to encourage the neuro-interventionalists to shift to a radial first approach.

Balloon expandable coronary stent materials: a systematic review focused on clinical success

Balloon expandable coronary stenting has revolutionized the field of interventional cardiology as a potential, minimally invasive modality for treating coronary artery disease. Even though stenting is successful compared to angioplasty (that leaves no stent in place), still there are many associated clinical complications. Bare metal stents are associated with in-stent restenosis caused mostly by neointimal hyperplasia, whereas success of drug-eluting stents comes at the expense of late-stent thrombosis and neoatherosclerosis. Even though innovative and promising, clinical trials with bioabsorbable stents reported thrombosis and a rapid pace of degradation without performing scaffolding action in several instances. It should be noted that a vast majority of these stents are based on a metallic platform which still holds the potential to mitigate major cardiovascular events and reduced economic burden to patients, alongside continuous improvement in stent technology and antiplatelet regimes. Hence, a systematic review was conducted following PRISMA guidelines to assess the clinically relevant material properties for a metallic stent material. From a materials perspective, the major causes identified for clinical failure of stents are inferior mechanical properties and blood-material interaction–related complications at the stent surface. In addition to these, the stent material should possess increased radiopacity for improved visibility and lower magnetic susceptibility values for artefact reduction. Moreover, the review provides an overview of future scope of percutaneous coronary interventional strategy. Most importantly, this review highlights the need for an interdisciplinary approach by clinicians, biomaterial scientists, and interventional cardiologists to collaborate in mitigating the impediments associated with cardiovascular stents for alleviating sufferings of millions of people worldwide.