Clinical and Technical Predictors of Adverse Cardiovascular Events Following Coronary Lithotripsy in the BENELUX-IVL Registry.

Calcified occlusive lesions are independently associated with higher failure rates of endovascular treatment. Intravascular lithotripsy (IVL) is emerging as a promising innovation in calcified vessel preparation. The aim of this study was to assess the safety and efficacy of IVL in the treatment of calcified common femoral artery (CFA) lesions, and to evaluate the role of adjunctive stenting in maintaining mid-term patency. This is a retrospective, single-center observational study. Demographic, procedural (before and after IVL), and follow-up data were analyzed. IVL was used for moderate or severe calcifications (plaque > 180° of circumference) according to the PARC (Peripheral Academic Research Consortium) classification. Results are expressed as means with standard deviations. From September 2021 to May 2024, 37 calcified lesions in 30 patients were treated with IVL. Most presented with ischemic rest pain (78.4%, N = 29). Severe calcifications were present in 75.7% (N = 28) of cases. After IVL, vessel preparation was satisfactory (residual stenosis ≤ 30% without flow-limiting dissection) in 81% (N = 30) of lesions, with a median luminal gain of 50% [IQR: 40-66%]. No intra or postoperative complications were observed. Among the 37 lesions, 45.9% (N = 17) required stenting, either planned or as bail-out for significant recoil. At 6 months, primary patency was significantly higher in the stenting group versus the non-stenting group (100%vs.75%, p = 0.049). Kaplan-Meier analysis confirmed the benefit of stenting in maintaining mid-term vessel patency (log-rank p = 0.02). Our study highlights that an aggressive stenting strategy following IVL in the CFA should be favored. These findings question the commonly held preference for a "leave nothing behind" strategy associated with IVL.

Development and Characterization of a Large Animal Model for Iliofemoral Deep Vein Thrombosis Secondary to Chronic Iliac Vein Stenosis.

Median Arcuate Ligament Syndrome (MALS) is a rare condition resulting from external compression of the celiac trunk by the median arcuate ligament. The clinical presentation is often nonspecific typically postprandial abdominal pain, nausea, vomiting, and weight loss leading to frequent diagnostic delays. CT angiography plays a pivotal role in identifying the characteristic celiac artery stenosis and post-stenotic dilatation. We report three clinical cases: two young female patients and one 61-year-old male presenting with chronic abdominal pain and weight loss. CT angiography confirmed significant celiac trunk stenosis in all cases, with post-stenotic aneurysmal dilatation in two patients and collateral circulation in one. All underwent open surgical decompression through division of the median arcuate ligament. Postoperative outcomes were favorable, with marked improvement in abdominal symptoms and progressive weight gain. Follow-up CT angiography demonstrated a fully patent celiac trunk without residual stenosis. MALS is a challenging diagnostic entity requiring careful correlation between clinical manifestations and dynamic imaging findings. CT angiography remains essential for diagnosis and preoperative planning. Surgical decompression provides substantial symptomatic relief in appropriately selected patients. Larger prospective studies are needed to identify predictors of optimal postoperative outcomes

Arterial calcification is an important characteristic of vascular aging. Risk factors and clinical outcomes of percutaneous coronary intervention (PCI) procedure failure in patients with moderate-to-severe coronary artery calcification (MSCAC) have not been adequately assessed. We aimed to analyze the characteristics, risk factors, and long-term clinical outcomes for patients with MSCAC with PCI procedure failure. We analyzed 26253 patients undergoing PCI at Fuwai Hospital between January 2017 and December 2018. Procedure failure was defined as residual stenosis ≥ 50%, severe angiographic complications, in-hospital death, or in-hospital myocardial infarction (MI). The primary endpoint was CV events, including CV death, nonfatal MI, and nonfatal stroke. During a median 3-year follow-up, 613 CV events were recorded. The incidence of PCI procedure failure for MSCAC patients was 10.96%. Compared with non-MSCAC patients, the multivariable-adjusted hazard ratio (aHR) for CV events was 2.38 (95% CI: 1.65-3.44) for MSCAC with PCI failure subjects, while no significant difference could be found between non-MSCAC patients and MSCAC with PCI success patients. MSCAC patients with PCI procedure failure showed an increased risk of CV events (aHR: 2.16; 95% CI: 1.39-3.38) than those with procedure success. Application of intravascular ultrasound and rotational atherectomy were independent protective factors for the occurrence of MSCAC-PCI procedure failure in patients with severe calcification. MSCAC patients with PCI procedure failure showed unfavorable long-term clinical outcomes compared with those with PCI procedure success. IVUS and rotational atherectomy could reduce the risk of PCI procedure failure occurrence.

Background Coronary computed tomographic angiography (CTA) provides valuable anatomical and functional information before and during chronic total occlusion (CTO) - percutaneous coronary intervention (PCI). Although several studies have suggested that pre-procedural CTA may improve procedural planning and success rates, its impact has not been consistently demonstrated, particularly in real-world settings and in patients with complex lesions. This retrospective study aims to evaluate the effect of preoperative coronary CTA on the success rates of PCI in patients with CTO.Material and methods In this single-center retrospective study, we included CTO patients who underwent PCI from January 2020 to September 2023. Participants were divided into two groups based on whether they received preoperative coronary CTA: the CTA-guided group and a angiography-guided group. The primary endpoint was the success rate of recanalization, defined as a final TIMI flow grade ≥2 and residual stenosis ≤30 %.Results A total of 400 CTO patients were included, with 200 in the CTA-guided group and 200 in the angiography-guided group. The success rate of recanalization was significantly higher (93.5 %) in the CTA-guided group compared to in the angiography-guided group (84.0 %, p=0.003). In high-difficulty CTO cases (based on the Japanese CTO score system J-CTO score ≥2), the advantage of the CTA-guided group was more pronounced (82.0 %, p < 0.001). Regarding perioperative complications, the incidence of myocardial infarction within 24 hrs was 2.5 % in the CTA-guided group compared with 5.0 % in the angiography-guided group (p=0.047), and coronary perforation occurred in 1.0 % vs. 3.5 % of patients, respectively (p=0.035). However, At the 1 yr follow-up, there was no significant difference in major adverse cardiac events between the two groups (CTA-guided 4.5 % vs. angiography-guided 7.0 %, p=0.11), including cardiac death (1.0 % vs. 2.0 %, p=0.10) and recurrent myocardial infarction (2.0 % vs. 3.5 %, p=0.15).Conclusion The use of preoperative coronary CTA in CTO-PCI is associated with higher success rates, particularly in high-difficulty CTO cases. Additionally, CTA-guided PCI was associated with a reduction in perioperative complications such as myocardial infarction and coronary perforation. Further multicenter, randomized studies are warranted to evaluate its impact on long-term cardiovascular outcomes.

Intracranial atherosclerotic disease (ICAD) is a leading cause of stroke worldwide, with high rates of recurrent ischemic events in high-grade stenosis. Although endovascular treatment has faced challenges in early trials due to procedural complications and unfavorable outcomes, recent advancements in drug-eluting stents, such as the Resolute/Frontier Onyx (Medtronic), offer a promising alternative to bare-metal stents. This study evaluates the safety and efficacy of Resolute/Frontier Onyx in treating symptomatic ICAD. We conducted a retrospective, single-center study of 22 patients with symptomatic ICAD who underwent stenting with Resolute/Frontier Onyx. Inclusion criteria included ≥70% stenosis and recurrent stroke or transient ischemic attack, despite optimal medical therapy. Baseline characteristics, procedural details, and clinical outcomes were extracted from electronic medical records. Primary outcomes included cerebrovascular event recurrence (stroke or intracranial hemorrhage) and symptomatic in-stent restenosis. Descriptive statistics were used for analysis. The median age was 65 years (IQR, 61-72), and 72.7% (16/22) of patients were male. Hypertension was present in 90.9% (20/22), and the median time from the qualifying event to stenting was 1 day (IQR, 1-3). Procedural complications occurred in 4.5% (1/22) of patients and consisted of a common carotid artery dissection that occurred during stent insertion. At a median follow-up of 12 months (IQR, 6-23), no strokes or intracranial hemorrhages were reported. Symptomatic in-stent restenosis occurred in 9.0% (2/22) of patients, with 1 requiring reintervention. Residual stenosis of ≥30% was observed in 26.6% (4/15) of patients who underwent follow-up imaging. The Resolute/Frontier stent demonstrated favorable safety and efficacy in this cohort, with low procedural complication rates and no recurrent strokes or intracranial hemorrhages at follow-up. These findings, along with previous evidence supporting drug-eluting stents, highlight the potential of Resolute/Frontier Onyx as a promising therapeutic option for symptomatic ICAD.

Objective: This study aimed to present the procedure features, technical success, short-term patency rates, and complications in patients who underwent endovascular treatment due to native arteriovenous fistula failure or insufficient dialysis. Material and Methods: Between 2012 and 2018, 114 procedures were performed on 96 patients (54 males, 42 females) aged 26-86 years (mean: 58.5 years) who were treated percutaneously for native dialysis fistula dysfunction. AVF characteristics, stenosis/occlusion location, balloon or stent size, technical success, complications, and primary patency rates at 6 and 12 months were recorded. Results: Radiocephalic fistulas (83.4%) were the most common type treated. Percutaneous transluminal angioplasty (PTA) was performed alone (77.2%) or with other procedures in all patients with stenotic or occluded segments. A stent was placed in 5 patients due to residual stenosis. t-PA infusion via a thrombolytic catheter was performed in 16 patients, and mechanical aspiration in 5 patients where PTA alone would not suffice due to thrombus burden. The technical success rate of the endovascular treatments was 92.7%, with a complication rate of 3.1%. The median primary patency duration was 187 days, with primary patency rates of 67.5% and 58.5% at 6 and 12 months, respectively. Conclusion: AVF is the first choice of vascular access in hemodialysis patients. However, most AVFs require endovascular intervention due to stenosis and/or occlusions developing in one or more segments over time. Interventional procedures can be performed effectively and safely, with high technical success and low complication rates in the treatment of native AVF dysfunction.

Objective:To evaluate the feasibility of plaque-based radiomics extracted from high-resolution magnetic resonance imaging (HR-MRI) data for assessing the short-term outcomes of endovascular treatment in patients with symptomatic intracranial artery stenosis.Methods:HR-MRI was performed on patients with symptomatic intracranial artery stenosis. Plaque-based radiomics describing the morphological features and pixel value of the image were extracted from the HR-MRI data. Demographic features were also collected. The short-term favorable outcome was defined by a postoperative residual stenosis rate <35% with the absence of perioperative complications. Univariate analysis was conducted to identify features associated with favorable outcomes. Based on the results of this analysis, a prediction model was developed using logistic regression. The performance of both clinical and radiomic models was evaluated using the receiver operating characteristic (ROC) curve and the area under the curve (AUC).Results:From January 2022 to December 2023, 42 consecutive patients with symptomatic intracranial artery stenosis were enrolled. Digital subtraction angiography (DSA) revealed a more than 70% stenosis rate in these patients. The stents were implemented in all 42 patients; 21 (50%) of these were male, and the mean age of all patients was 52.74 ± 13.02 years. Thirty-five patients (83.33%) had impaired sensory or motor function of the limbs. In the univariate analysis, 11 morphologic or first-order radiomics features and five clinical features were initially identified as potentially associated with short-term favorable outcomes. Logistic multivariate analysis further indicated that shape-flatness (p = 0.04, Odd ratio (OR) = 169.02, 95% CI: 1.30–22,026.5) and first-order-minimum (p = 0.02, OR = 94.63, 95% CI: 1.93–4592.5) might be independently related to post-stenting outcomes. A prediction model constructed based on the above morphologic and first-order features showed an AUC of 0.82 in this small cohort.Conclusion:Plaque-based radiomic features, which describe the shape and voxel characteristics extracted from HR-MRI data, are associated with the short-term outcomes of patients treated with stent implementation.

In-stent occlusion (ISO) remains a significant challenge in postthrombotic syndrome (PTS), with limited histopathologic characterization. Between January 2022 and November 2024, 19 patients with PTS (12 men; mean age 44.3 ± 12.4 years) presenting with 20 iliofemoral venous ISO underwent thrombectomy using the RevCore system. Histopathology was performed on retrieved materials from 16 limbs. Technical success, stent patency, and Villalta score were assessed. Kaplan-Meier and Cox regression identified predictors of restenosis/occlusion. Technical success was 95% (19/20 limbs). In venous stent occlusions < 3 months duration (n = 12), retrieved materials contained more fresh thrombus (40.4%, p = 0.058) and old thrombus (41.3%, p = 0.040) than in occlusions ⩾ 3 months duration (n = 4), where diffuse intimal thickening (DIT) was predominant (73.8%, p = 0.008). Severe restenosis/occlusion occurred in 60% (12/20) of limbs during a median 209.5-day follow up, with median patency of 144.5 days. Villalta scores improved from 14.8 ± 7.1 to 9.4 ± 6.8 at 1 month (p = 0.002) and 9.5 ± 6.8 at the final follow up (p = 0.001). Retrieved materials containing > 50% old thrombus had a higher restenosis/occlusion risk (p = 0.026). Common iliac vein (CIV) residual stenosis ⩾ 30% (hazard ratio (HR) = 4.103; p = 0.037) and a restored common femoral vein (CFV) flow diameter < 8.0 mm (HR = 3.871; p = 0.026) predicted severe restenosis/occlusion. In PTS-related ISO, DIT predominated in occlusion ⩾ 3 months. Old thrombus, CIV residual stenosis ⩾ 30%, and a CFV flow diameter < 8.0 mm predicted restenosis/occlusion. Integrating histopathologic assessment into postthrombectomy evaluation may help tailor and optimize management strategies for iliofemoral ISO.

Pulmonary vein stenosis (PVS) is an uncommon but serious complication of atrial fibrillation (AF) ablation, often misinterpreted as primary pulmonary disease. Timely identification is essential to prevent irreversible injury and to guide appropriate referral for interventional management. Through the discussion of two practical case examples, we illustrate the challenges of early recognition, the role of imaging modalities, and the decision-making process in selecting the most effective interventional strategy. Both young male patients developed progressive dyspnoea, chronic cough, and recurrent pneumonia months after AF ablation and were initially managed for presumed pulmonary pathology. Multimodal imaging-including CT, transoesophageal echocardiography, and selective angiography-confirmed severe multivessel PVS, with a true bifurcation lesion in one case. The patients were referred for transcatheter pulmonary angioplasty. Procedures were performed under combined fluoroscopic and echocardiographic guidance. In Patient 1, after stenting of the left middle lobar vein in crossover with the left superior pulmonary vein (provisional approach), residual ostial stenosis of the left superior vein required escalation to a culotte bifurcation strategy. Remaining lesions in both patients were treated with large-diameter stents. Early recognition using echocardiography and CT angiography is crucial. Endovascular interventions-particularly stent implantation-provide effective restoration of venous flow, but standardized protocols, long-term patency assessment, and optimal antithrombotic therapy remain areas of ongoing investigation. Advances in coronary intervention may guide refined techniques for managing complex PVS. This paper presents a comprehensive clinical management approach, from symptom onset to definitive treatment.

Tirofiban is widely used in ischemic stroke, but its safety and efficacy during stenting of perforator-rich intracranial arteries are unclear. We speculate that prophylactic use of an intra-arterial bolus of tirofiban followed by intravenous maintenance after stenting of perforator-rich intracranial arteries may be safe and effective. We retrospectively analyzed patients with atherosclerotic stenosis treated with stenting for perforator-rich intracranial arteries between January 2021 and December 2024. The tirofiban group received tirofiban 10 µg/kg immediately after stenting via a microcatheter into the target artery, followed by intravenous infusion of 0.1 µg/kg/min for 24-72 hours, while controls received dual oral antiplatelet therapy. The primary efficacy endpoints were the incidence of acute in-stent thrombosis (AST) within 30 min after stent implantation and ischemic stroke in the target vascular territory within 7 days post-procedure. Secondary endpoints included modified Rankin Scale score at 6 months and the incidence of in-stent restenosis. The primary safety endpoint was the incidence of symptomatic intracranial hemorrhage within 7 days post-procedure. 150 patients were included: 72 received tirofiban and 78 received dual antiplatelets. AST occurred in 2.8% of the tirofiban group versus 12.8% of controls (RR 0.89; 95% CI 0.82 to 0.98; P=0.02). AST was associated with uncontrolled diabetes, aspirin or clopidogrel resistance, and final residual stenosis. Recurrent ischemic stroke rates at 7 days (2.8% vs 6.4%; P=0.45), symptomatic intracranial hemorrhage (1.4% vs 1.3%), 6 month in-stent restenosis (7.1% vs 9.0%; P=0.68), and modified Rankin Scale scores at 6 months showed no significant differences. Periprocedural intra-arterial with intravenous tirofiban reduced early AST, without increasing the risk of hemorrhage, for stenting of perforator-rich intracranial arteries.

Esophageal atresia (EA) is a rare congenital malformation commonly associated with tracheoesophageal fistula (TEF). Surgical repair in premature infants remains challenging due to fragile tissues and high postoperative complication risks, as highlighted in recent analyses (1, 2). We report the case of a premature female infant born at 34 weeks’ gestation weighing 1.8 kg, diagnosed with Gross type III EA. Primary end-to-end esophagoesophageal anastomosis with distal TEF ligation was performed under moderate tension. On postoperative day 7, an anastomotic leak occurred, which closed spontaneously by day 17. At one month, an anastomotic stricture developed and was successfully treated with five sessions of endoscopic balloon dilatation. The infant showed favorable growth, with a weight of 6.3 kg at six months, full oral feeding, and a normal barium swallow without residual stenosis. This case highlights the feasibility of conservative management for postoperative complications following EA repair, even in premature infants. Early recognition and endoscopic follow-up are essential to ensure optimal healing and long-term functional outcomes (3, 4, 5).

Cutting balloon versus standard balloon for lesion preparation of drug-coated balloon treatment in de-novo coronary artery lesions: Rationale and design of the randomized NATURE trial.

Incidence, Risk Factors, and Outcomes of Iliac Limb Occlusions After Endovascular Aneurysm Repair. A Scoping Review of Literature.

The aim of this work was to compare the safety and effectiveness of the BioMime and the thicker strut Ultimaster sirolimus-eluting stents (SESs) in patients presenting with ST-elevation myocardial infarction (STEMI) and single-vessel disease undergoing primary percutaneous coronary intervention (PCI). This prospective, single-center, non-inferiority study was carried out on 221 STEMI individuals aged 19 to 65 years, both sexes, diagnosed with STEMI. All patients were subjected to electrocardiograms, echocardiography, and clinical follow-up. Quantitative coronary angiography was done at baseline and follow-up. Post-procedure quantitative coronary angiography (QCA) demonstrated no significant differences regarding acute luminal gain and residual stenosis between the BioMime and Ultimaster groups. Binary restenosis was slightly greater in the BioMime group (7 [15.2%]) compared to the Ultimaster group (6 [13.3%], relative risk [95% confidence interval, CI]: 0.947 [0.329-2.725], P = 0.797). The variation in in-stent late lumen loss (LLL) between the groups was minimal (0.33 ± 0.3 mm in the BioMime group vs. 0.32 ± 0.4 mm in the Ultimaster group, Diff [95% CI]: 0.007 [-0.16-0.17], P = 0.935; prespecified non-inferiority = 0.024). Clinical endpoints at 30 days and 14 months, as well as patient- and device-oriented endpoints at 14 months, were not significantly different between the BioMime and Ultimaster groups. Subgroup analysis revealed a potential benefit of the Ultimaster stent in older patients (>70 years) regarding target vessel failure (TVF). In primary PCI for STEMI patients, BioMime stents were non-inferior to Ultimaster stents at one-year follow-up. Further studies with longer follow-up durations are warranted to validate these results.

Intravascular lithotripsy (IVL) has demonstrated excellent results in treating calcified coronary lesions. However, specific focus on different calcification patterns is still limited. The aim of our study was to evaluate the procedural and clinical outcomes of IVL in treating concentric vs. eccentric calcifications. The BENELUX-IVL prospective registry enrolled patients aged ≥18 years who underwent IVL. For this study, patients who underwent both IVL and intravascular ultrasound (IVUS) before and after the procedure were selected. Based on IVUS-derived calcium arc quantification, patients were categorized into two groups: concentric calcification (>180°) and eccentric calcification (≤180°). The primary technical endpoint was technical success, defined as successful IVL catheter crossing of the target lesion with residual stenosis <30%, with final TIMI 3 flow. The primary efficacy endpoint was the incidence of major adverse cardiac events (MACE) at 12-month follow-up. A total of 455 patients were enrolled in the registry, of whom 136 (29.9%) met the inclusion criteria for the study. Concentric calcifications were more prevalent (83.1% vs. 16.9%, P < 0.01). The median SYNTAX score was similar between the two groups [19 (10-29) vs. 20 (12-31), P = 0.64]. Technical success was achieved similarly between the two calcification patterns (93.0% vs. 95.7%, P = 0.98). At 12-month follow-up, MACE (6.2% vs. 4.3%, P = 0.66), cardiac death (1.8% vs. 4.3%, P = 0.44), and target vessel revascularization (4.4% vs. 4.3%, P = 0.99) were similar. IVUS-guided percutaneous coronary intervention of calcified lesions treated with IVL demonstrates comparable procedural outcomes and low adverse clinical event rates in both concentric and eccentric calcification patterns. However, further studies are warranted to draw definitive conclusions regarding long-term clinical outcomes.

Background/Objectives: Chronic mesenteric ischemia (CMI) due to superior mesenteric artery (SMA) stenosis can be effectively treated with endovascular therapy (EVT). Appropriate intraoperative assessment is crucial for ensuring technical success and long-term patency. This study assesses intra-arterial pressure measurement (IAPM), and cone beam computed tomography (CBCT) for detecting residual stenosis during SMA stenting in CMI. Methods: This prospective study included 50 consecutive elective patients with symptomatic, significant SMA stenosis scheduled for EVT. The patients in this study were a subset of an ongoing randomized trial with a different primary objective. Intraoperative diagnostic tools—digital subtraction angiography (DSA), IAPM and CBCT were performed after stent placement. Technical success was defined as <30% residual stenosis on DSA, a residual pressure gradient of <10 mmHg with IAPM and full stent expansion on CBCT. Results: Although there was a fair agreement between DSA and CBCT (Kappa 0.294, p = 0.024), the Odds ratio suggests that DSA detected fewer positive cases compared to CBCT (Odds ratio 0.176; 95% CI: 0.004–1.37; p = 0.13). DSA also differed significantly from IAPM (Kappa = 0.016, p = 0.882), (Odds ratio = 0.167; 95% CI: 0.018–0.749; p = 0.013), suggesting DSA under-detects residual stenosis (>10 mmHg). No significant difference was found between CBCT and IAPM (Kappa = 0.201, p = 0.161) (Odds ratio: 2.25, 95% CI: 0.628–10.0%; p = 0.27) indicating comparable results. Conclusions: DSA overlooks clinically important residual stenosis that could be treated during the primary procedure. CBCT aids structural assessment of the stent and allows for on-table optimizing of the procedural outcomes.

Background and aimInsulin resistance (IR) plays a significant role in the development of cardiovascular disease (CVD), even in non-diabetic individuals, with a 46% higher likelihood of coronary artery disease (CAD) for each 1 SD increase in IR. The estimated glucose disposal rate (eGDR) is a validated marker for IR. However, its association with the residual SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score (rSS), which assesses residual stenosis severity after percutaneous coronary intervention (PCI), has not been investigated in non-diabetic ST-segment elevation myocardial infarction (STEMI) patients. This study aims to explore the relationship between eGDR and rSS in non-diabetic STEMI patients undergoing PCI.MethodsThis single-center observational study enrolled 390 non-diabetic STEMI patients who underwent PCI. The complexity of CAD was assessed pre-PCI using the SYNTAX score, and post-PCI, the rSS was calculated. eGDR was derived using waist circumference, HbA1c, and hypertension status, based on a previously validated equation. The association between eGDR and rSS was analyzed using multivariable logistic regression. The optimal eGDR cut-off value for predicting higher rSS was determined using Youden’s index.ResultsThe cohort had a mean age of 58.74 ± 9.01 years and was predominantly male (76.66%). Participants were divided into lower and higher eGDR groups based on the median eGDR value of 7.74. Multivariable logistic regression identified lower eGDR as an independent predictor of higher rSS (adjusted OR = 1.84, 95% CI: 1.59–2.14, p < 0.001), after adjusting for demographic, clinical, and metabolic factors. The association remained consistent in a secondary model that included additional anatomical and procedural variables (adjusted OR = 1.81; p < 0.001; 95% CI: 1.37–2.39).The optimal eGDR cut-off value for predicting high rSS was 7.04 (AUC: 0.803, 95% CI: 0.747–0.882, p < 0.001), with a sensitivity of 76.04% and specificity of 73.20%.ConclusioneGDR, is an independent predictor of higher rSS in non-diabetic patients undergoing PCI for STEMI.

Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) enhances treatment of complex coronary artery lesions, including left main (LM) disease, by enabling lesion morphology assessment and stent optimization, thereby reducing major adverse cardiac events (MACE). The aim of this study was to evaluate the feasibility, safety, and mid-term outcomes of OCT-guided PCI for distal LM bifurcation lesions in the South-Asian population. This prospective, multicenter, observational registry included 100 consecutive patients (aged 20-80 years) undergoing OCT-guided PCI for distal LM bifurcation lesions. The primary endpoint was procedural success, defined as residual angiographic stenosis of < 30%, thrombolysis in myocardial infarction (TIMI) 3 flow in all major branches, and adequate stent expansion (≥ 80%) in all vessels. Secondary endpoints included MACE, all-cause mortality, myocardial infarction, stent thrombosis, and target vessel revascularization (TVR) at 12 months. The primary endpoint was attained in 85% of the patients. At the 12-month follow-up, MACE occurred in 1% of patients, including one (1%) cardiac mortality and one (1%) in-hospital definite stent thrombosis. No TVR or stroke was observed. The mean contrast volume used was 190.6 (71.3) mL, with significantly lower usage in the provisional stented group (174.7 mL) compared to the 2-/3-stented group (p < 0.001). The cumulative impact of OCT guidance was observed in 53% of the included patients (preprocedure: 49%, postprocedure: 13%). An extended follow-up of 18 months showed no additional MACE rates. OCT-guided PCI was found to be safe for distal LM bifurcation lesions with good procedural success and low rates of MACE and stent thrombosis. Clinical Trials Registry of India: CTRI/2021/07/034819.