Paclitaxel Versus Sirolimus-Coated Balloons for Coronary Artery Disease: 2-Year Follow-Up of 2 Large Registries.

Comparison of Percutaneous Intervention With Drug Coated Balloons and Drug Eluting Stents for De Novo Coronary Artery Disease: CIRCE, a Systematic Review and Meta-Analysis.

To assess the feasibility, safety, and midterm outcomes of intravascular lithotripsy (IVL) in isolated heavily calcified lesions (HCLs) of the popliteal artery, a location historically regarded as a "no-stent zone". This retrospective monocentric cohort included 18 consecutive adult patients where IVL was used to treat a symptomatic isolated popliteal HCL-between November 2021 and September 2025. IVL was followed by interwoven stent implantation in case of residual stenosis ≥30%. In other cases, a drug-coated balloon was used. Technical success, primary and assisted patency, target lesion revascularization, and major adverse limb events (MALE) were recorded. Kaplan-Meier survival analysis was provided for patency and reintervention outcomes. Indication was a chronic limb-threatening ischemia in 39% of the cases. The median lesion length was 60 mm (interquartile range [IQR]: 55-100), and 39% were chronic total occlusions. The median degree of stenosis was 90% (IQR: 90-100). The median luminal gain achieved post-IVL was 60%. Bailout stenting was required in 39% of the cases. The technical success rate was 100%. Primary patency was 93% at 12 months and 73% at 24 months. During follow-up, MALE occurred in 22%, including 3 reinterventions that all occurred in patients treated without stenting. At last follow-up, 56% of the patients had received a stent in the target lesion. IVL is an effective and safe vessel preparation tool for isolated popliteal HCLs. Since most patients ultimately require stenting the benefit of IVL in a "nothing left behind" strategy remains questionable.

Longer total stent length (TSL) increases the risk of target lesion failure (TLF) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention with second-generation drug-eluting stents (DES). We aimed to assess the long-term impact of TSL on patient- and stent-related outcomes in STEMI patients treated with different newer-generation DES designs. We performed a post hoc subgroup analysis of the BIOSTEMI Extended Survival randomized trial (NCT05484310). Patients undergoing primary percutaneous coronary intervention for STEMI were randomized to ultrathin-strut biodegradable-polymer sirolimus-eluting stents (BP-SES) or thin-strut durable-polymer everolimus-eluting stents (DP-EES) and categorized according to TSL implanted at the culprit site (≤40 vs >40 mm). The device-oriented composite endpoint (TLF) was the composite of cardiac death, target-vessel myocardial reinfarction, or clinically indicated target lesion revascularization, and the patient-oriented composite endpoint was the composite of all-cause death, any myocardial reinfarction, any revascularization, or any stroke, at 5 years. A total of 1,686 STEMI patients were included (mean age, 62.4 years; female, 23%; mean TSL, 33.8 mm), of whom 423 (25%) were treated with TSL >40 mm. At 5 years, TSL >40 mm was associated with a significantly higher risk of patient-oriented composite endpoint compared with TSL ≤40 mm (31.7% vs 27.4%; hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.03-1.64; P = .029), whereas no difference was observed in TLF. However, there was a significant interaction between DES type and TSL for TLF at 5 years. Among patients with TSL >40 mm, BP-SES were associated with a lower risk of TLF compared with DP-EES (7.3% vs 17.1%; HR, 0.39; 95% CI, 0.21-0.74; P = .004; P for interaction = .032), a difference primarily driven by a lower rate of target vessel myocardial reinfarction. No significant differences between BP-SES and DP-EES were observed in patients with TSL ≤40 mm. After adjustment for multivessel treatment, increasing TSL with DP-EES, but not BP-SES, was independently associated with a higher risk of TLF (adjusted HR per 5-mm increase, 1.07; 95% CI, 1.02-1.11; P = .003). In STEMI patients treated with contemporary DES, TSL >40 mm was associated with an increased risk of patient-oriented, but not device-related, adverse outcomes at 5 years. Among patients requiring TSL >40 mm, ultrathin-strut BP-SES significantly reduced the risk of TLF compared with DP-EES, whereas no between-DES differences were observed in patients treated with TSL ≤40 mm. The BIOSTEMI ES trial is registered at ClinicalTrials.gov (NCT05484310).

Percutaneous coronary intervention (PCI) for ostial right coronary artery (RCA) lesions remains challenging and is associated with higher rates of restenosis and target lesion revascularization, even in the contemporary drug-eluting stent era. These unfavorable outcomes are largely attributable to the unique anatomical and histological characteristics of the aorto-ostial junction, including severe calcification, limited vessel compliance, and hinge motion. Intravascular ultrasound (IVUS) studies have identified distinct morphological patterns of ostial RCA lesions, including isolated ostial lesions, diffuse atherosclerotic disease without calcified nodules, and lesions characterized by calcified nodules, which are associated with poorer clinical outcomes. Optimal management of ostial RCA lesions requires careful lesion assessment and tailored therapeutic strategies. For de novo lesions, adequate lesion preparation using high-pressure/scoring balloon dilation, rotational atherectomy (RA), or intravascular lithotripsy is essential to achieve optimal stent expansion. Precise ostial stent placement and intravascular imaging-guided optimization are critical procedural components, and drug-coated balloon (DCB) therapy may be considered in selected cases with a high risk of restenosis. In-stent restenosis (ISR) of the ostial RCA is frequently driven by mechanical factors such as stent underexpansion or fracture. DCBs are the preferred first-line treatment for ISR, while additional lesion modification using high-pressure balloons, RA may be required in cases with significant mechanical constraints. This review summarizes current evidence on the morphology, mechanisms, and contemporary treatment strategies for ostial RCA lesions, with a particular focus on intravascular imaging-guided intervention and practical considerations in clinical practice.

Several studies have demonstrated the efficacy of paclitaxel drug-coated balloons (DCBs) for the treatment of femoropopliteal (FP) lesions in patients with peripheral artery disease (PAD). Despite the available evidence, long-term real-world efficacy data are limited. To report the 3-year outcomes of the prospective, multicenter, single-arm real-world registry conducted in the United States, assessing the clinical use of the Lutonix 035 DCB in arteries of the superficial femoral artery (SFA) and popliteal artery (PA). In the SAFE-DCB US Registry, a total of 1005 subjects at 74 investigational sites were treated with the Lutonix 035 DCB and were followed up to 36 months. The per protocol included 966 patients (mean age 69.1 years; 56.7% male). A total of 1237 target lesions were treated, in which 93.3% were de novo, 85.2% were located in the SFA, and 88% had mild-to-severe calcification. Forty-five percent of the patients were Rutherford 3, and 35.1% had critical limb-threatening ischemia. The primary efficacy endpoint is target lesion revascularization (TLR) at 12 months. Secondary endpoints included rate of primary patency at 12 months and freedom from TLR and freedom from target vessel revascularization (TVR) evaluated through 36 months. The safety endpoints evaluated through 36 months were freedom from the composite of device- and/or procedure-related perioperative (≤30 day) death, TVR, and freedom from major amputation of the target limb. Primary patency at 12 months post-index procedure by Kaplan-Meier estimates was 83.7%. Freedom from TLR at 12 months was 88.6%, 75.7% at 24 months, and 74.4% at 36 months. At 36 months, freedom from TVR post-index procedure by Kaplan-Meier estimates was 69.5%. Freedom from primary safety events at 30 days was 98.2%. Freedom from composite of all-cause perioperative (≤30 day) death and from the following: index limb amputation, index limb reintervention, and index-limb-related death by Kaplan-Meier estimates at 12 months was 80.8%, at 24 months 67.4% and 58.4% at 36 months. Freedom from major amputation of the target limb at 36 months was 95.6%. The results from the SAFE-DCB US Registry for femoral popliteal (FP) disease demonstrated sustained safety and efficacy over 3 years following the Lutonix 035 DCB intervention.Clinical ImpactThis prospective real-world population study supports long-term clinical outcomes of Lutonix and provides meaningful insights into the sustained efficacy of drug-coated balloon (DCB) therapy in real-world femoropopliteal population. The low-bailout stenting rate (1.7%), and the 36-month sustained Freedom from target lesion revascularization rate (74.4%) supporting DCB usage when a "leave nothing behind" approach is favored. Furthermore, these results reinforce the effectiveness of DCBs in the endovascular treatment peripheral artery disease.

To evaluate the efficacy and periprocedural safety of distal puncture-assisted bidirectional endovascular therapy (EVT) for de novo femoropopliteal chronic total occlusion (FP-CTO). This multicenter retrospective study included 5 institutions and was conducted between 2019 and 2022. Outcomes and complications were analyzed per procedure (94 procedures); major amputation and mortality were assessed per patient based on the index procedure (87 patients). Major complications were defined as the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification grade ≥3. Wire-crossing success was 98.9%, and technical success was 84.0%. Complications occurred in 23.4% of procedures, including major complications in 8.5% and distal access-site complications in 10.6%, with no major distal access-site complications observed. Distal embolization occurred in 6.4% of procedures and was uniformly graded as CIRSE grade 1. At 1 year, freedom from target lesion revascularization was 82.0%, whereas limb salvage and overall survival were 97.0% and 85.6%, respectively. In this selected multicenter cohort, distal puncture-assisted bidirectional EVT achieved a high wire-crossing success rate, with no adjudicated major distal access-site complication identified using the CIRSE classification. However, these safety findings should be interpreted with caution, as failed distal puncture attempts were not captured and the temporal attribution of distal embolization could not be fully established.Clinical ImpactDistal puncture-assisted bidirectional endovascular therapy may be a useful bailout or planned strategy for complex femoropopliteal chronic total occlusions when conventional antegrade crossing is difficult. This multicenter study provides contemporary procedural outcomes and Cardiovascular and Interventional Radiological Society of Europe-graded complication profiles, allowing clinicians to interpret not only technical success but also the severity and clinical relevance of complications. The findings may help operators discuss procedural risk, select appropriate access strategies, and standardize complication reporting in femoropopliteal CTO interventions. Further studies including attempted but unsuccessful distal puncture cases are needed to define the overall risk-benefit profile of this approach.

Background: To evaluate the outcomes of occluded lower limb bypass grafts treated by surgical thrombectomy and heparin-bonded covered stent graft deployment for distal anastomotic stenosis. Materials and methods: This was a single-centre, retrospective, single-arm study including consecutive patients with occluded infrainguinal bypass grafts treated between January 2020 and December 2024 with surgical thrombectomy followed by endovascular reconstruction of the distal anastomosis using a heparin-bonded covered stent graft. The primary endpoint was primary patency. Secondary endpoints were secondary patency, freedom from target lesion revascularization (TLR), mortality, and major amputation. Results: Thirty-two patients were included. Most patients presented with acute limb ischaemia (59.4%), followed by chronic limb-threatening ischaemia and claudication. Twenty-nine patients (90.6%) had a previously placed prosthetic bypass. Median hospital stay was 11 days (9-21). Intensive care unit treatment was required in 31%, while in-hospital morbidity and mortality were 34% and 9%, respectively. Primary patency at 3, 6, and 12 months was 55%, 49%, and 33%. Secondary patency at 12 months was 42%, freedom from TLR 43%, survival 80%, and freedom from major amputation 89%. Conclusions: In this high-risk cohort, surgical thrombectomy followed by covered stent graft reconstruction of distal anastomotic stenosis was associated with limited primary patency and frequent reintervention. These findings should be interpreted as descriptive outcomes of a complex hybrid bypass salvage strategy rather than isolated covered stent graft performance.

Ultra-Thin Sirolimus-Eluting Versus Everolimus-Eluting Stents in Diabetic Multivessel Coronary Artery Disease Patients: The TUXEDO-2 Trial.

Impact of Chronic Kidney Disease Severity and Drug-Coated Devices on 2-Year Clinically Driven Target Lesion Revascularization After Femoropopliteal Endovascular Intervention.

Three-Year Outcomes of Supera Interwoven Nitinol Stents Versus Eluvia Drug-Eluting Stents in Severely Calcified Femoropopliteal Lesions.

Coronary artery lesions are either de novo lesions, where the arterial lumen is narrowed for the first time, or in-stent restenosis, where re-narrowing of a previously stented arterial segment occurs. Sirolimus-coated balloons (SCBs) and paclitaxel-coated balloons (PCBs) are drug-coated balloons used in percutaneous coronary interventions to prevent restenosis without leaving a permanent implant. We conducted a systematic review and meta-analysis comparing SCBs versus PCBs for the treatment of coronary artery lesions, including de novo lesions and in-stent restenosis. Major databases were searched through September 2025. Pooled analyses were performed using random-effects models to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Ten studies involving 5246 patients (SCBs: n = 2964; PCBs: n = 2282) were included. Safety outcomes showed no significant differences in all-cause mortality (RR: 1.39, 95% CI, 0.50-3.89, P = 0.53), cardiac death (RR: 1.21, 95% CI, 0.50-2.92, P = 0.67), or myocardial infarction (RR: 0.98, 95% CI, 0.59-1.64, P = 0.95). Efficacy outcomes were similarly equivalent for target lesion failure (RR: 1.13, 95% CI, 0.85-1.50, P = 0.39), target lesion revascularization (RR: 1.23, 95% CI, 0.98-1.55, P = 0.068), major adverse cardiac events (RR: 1.14, 95% CI, 0.91-1.43, P = 0.27), and binary restenosis (RR: 1.18, 95% CI, 0.63-2.20, P = 0.61). None of the interventions (SCBs or PCBs) demonstrated superiority in terms of efficacy or safety for the treatment of coronary artery lesions. Therefore, device selection should be guided by lesion characteristics and overall clinical context.

Cardiovascular and limb outcomes with SGLT2 inhibitors in patients with diabetes following peripheral endovascular therapy.

Endovascular revascularization for lower limb arteriosclerosis obliterans (ASO) is often limited by long-term restenosis. This study evaluated whether the traditional Chinese medicine formula Danggui Sini Decoction (DGSD) could improve mid-term outcomes when combined with the standard procedure. To investigate the clinical efficacy of DGSD combined with endovascular revascularization in the treatment of ASO and its impact on patients' quality of life. A total of 38 ASO patients treated at Zhangjiajie People's Hospital from January 2023 to January 2025 were selected and randomly divided into a control group and an experimental group, with 19 patients in each group. The control group received conventional endovascular revascularization and basic treatment, while the experimental group was treated with DGSD in addition to the control group's treatment. The clinical effectiveness rate, freedom from clinically driven target lesion revascularization, primary patency rate, and quality of life scores were compared between the two groups. Within one month postoperatively, there was no significant difference in clinical effectiveness between the two groups (experimental group: 78.95% vs control group: 84.21%, P > 0.05), but the improvement in quality of life scores in the experimental group was significantly better than that of the control group (P < 0.05). At six months postoperatively, the clinical effectiveness rate in the experimental group was significantly higher than that of the control group (94.74% vs 73.68%, P < 0.05). The experimental group had a higher rate of freedom from clinically driven target lesion revascularization compared to the control group, but the difference was not statistically significant (100% vs 84.21%, P > 0.05). The primary patency rate in the experimental group was significantly better than that of the control group (P < 0.05). DGSD combined with endovascular revascularization can significantly improve the mid-term clinical efficacy in ASO patients, reduce the risk of lower limb arterial re-occlusion, and enhance quality of life, demonstrating significant clinical application value.

Introduction: Coronary artery disease remains a leading cause of mortality worldwide. Although advances in percutaneous coronary intervention (PCI) and stent technology have improved outcomes, in-stent restenosis (ISR) persists as a significant challenge contributing to repeat revascularization, rehospitalization, increased healthcare costs and adverse outcomes. Methodology: A single-center retrospective cohort study reviewed medical records from January 2021 to December 2024 to determine the incidence, risk factors and clinical outcomes associated with ISR. Results: Among 200 patients, ISR occurred in 58 (29%). Factors significantly associated with ISR included hypertension (p = 0.048), smaller stent diameter (OR=0.23, p&lt;0.001), longer stent length (OR=1.01, p&lt;0.001), multivessel stenting (OR=1.94, p = 0.038) and type B2/C lesions (OR=5.15, p&lt;0.001). Smaller left anterior descending (LAD) stent diameter (OR=0.37, p = 0.021), longer LAD stent length (OR=1.02, p = 0.011) and longer right coronary artery stent length (OR=1.02, p = 0.023) were associated with ISR. Median follow-up was 45 months. All ISR patients underwent target lesion revascularization and 17.2% experienced myocardial infarction. Kaplan-Meier analysis showed ISR-free survival of 98.5% at 1 year, 74.0% at 5 years and 11.2% at ≥10 years, with the greatest decline between years 3-8. Conclusion: ISR remains a substantial and multifactorial clinical burden highlighting the need for vigilant post-PCI surveillance, aggressive risk factor management and individualized interventional strategies—including optimal stent sizing, lesion preparation and adjunctive imaging use—to reduce restenosis risk and improve long-term outcomes. Keywords: Coronary artery disease (CAD), in-stent restenosis (ISR), percutaneous coronary intervention (PCI), drug-eluting stents (DES).

Background: To report long-term outcomes following stenting for aortoiliac occlusive disease, focusing on covered stents (CS) versus bare metal stents (BMS) in a real-world, multicentre European cohort. Design: Multicentre retrospective cohort study. Patients and methods: Prospectively maintained data from nine European vascular centres (2012-2020) were analysed. Two cohorts were evaluated: aortic-only stenting and aortoiliac stenting (stratified as CS/CS, CS/BMS, BMS/CS, and BMS/BMS). Primary outcomes were target lesion revascularisation (TLR), major amputation, and mortality, with median follow-up of 75 months. Cox regression and propensity score matching were performed to adjust for baseline anatomical and procedural differences between stent types. Results: A total of 201 patients were included (50% male, mean age 65 years, 34% with chronic limb-threatening ischaemia). In the aortic-only subgroup (n = 46), outcomes were comparable between CS and BMS. Among aortoiliac reconstructions (n = 155), patients treated with CS/CS had greater anatomical complexity, including higher prevalence of iliac chronic total occlusions, longer lesions, and heavier calcification. Independent predictors of TLR included iliac chronic total occlusion, subintimal aortic recanalization, and concomitant common femoral endarterectomy. After propensity score adjustment, there remained no significant difference in TLR (28/155), major amputation (4/155), or mortality (30/155) between CS/CS and BMS/BMS groups. Conclusions: CS was preferentially employed in more complex aortoiliac occlusive disease and achieved outcomes equivalent to BMS after adjustment for lesion severity using propensity score methods. These findings reinforce that operator selection patterns and lesion complexity, rather than stent type alone, influence the clinical outcomes, underscoring the need for individualised stent selection strategies in advanced aortoiliac disease.

Head-to-head comparisons of contemporary drug-eluting stents (DES) in patients with acute myocardial infarction (AMI) remain limited. We sought to compare the long-term clinical outcomes of four widely used DES platforms: Orsiro, Xience, Synergy, and Resolute. From the nationwide prospective Korea acute myocardial infarction registry-V, we identified 9284 patients with AMI undergoing percutaneous coronary intervention with one of the four study devices (Orsiro, n = 1634; Xience, n = 2576; Synergy, n = 2811; Resolute, n = 2263). The primary endpoint was target lesion revascularization (TLR). Inverse probability of treatment weighting was performed to adjust for baseline differences. During a median follow-up of 723 days, the cumulative incidence of TLR differed significantly among groups. In IPTW-adjusted analyses, compared with the Orsiro group (reference), the risk of TLR was significantly higher in the Synergy [hazard ratio: 2.30; 95% confidence interval (CI): 1.20-4.41, P = 0.013] and Resolute groups (hazard ratio: 2.30, 95% CI: 1.18-4.47, P = 0.014). The Xience group showed a comparable risk of TLR to Orsiro (hazard ratio: 1.40, 95% CI: 0.69-2.82, P = 0.346). Target vessel revascularization followed a similar pattern, favoring Orsiro. However, there were no significant differences in composite major adverse cardiovascular events or all-cause mortality among the four groups. In this large-scale, real-world AMI cohort, the ultrathin-strut, biodegradable-polymer Orsiro stent was associated with a lower risk of repeat revascularization compared with the Synergy and Resolute stents. Xience demonstrated comparable outcomes to Orsiro. Stent selection remains a crucial determinant of vessel-level outcomes in patients with AMI.

To describe early and midterm outcomes of Viabahn stenting for extensive aortoiliac occlusive disease involving the external iliac artery (EIA). In this single-center retrospective study, all consecutive patients in whom a covered self-expanding (SE) Viabahn stent was implanted (W.L. Gore & Associates, Inc, Flagstaff, Arizona) in the EIA for symptomatic Trans-Atlantic Intersociety Consensus (TASC) II C and D lesions between 2012 and 2020 were included. Lesions limited to the iliac artery were treated percutaneously. Iliac lesions extending down to the common femoral artery (CFA) were treated with a hybrid approach. Patency, major adverse limb events (MALEs), target lesion revascularization (TLR), and limb salvage rates were estimated using Kaplan-Meier curves. Of 118 limbs, 48 (41%) were treated for claudication, 33 (28%) for rest pain, and 37 (31%) for tissue loss. Lesions were TASC C (n = 43 limbs, 36%) or TASC D (n = 75 limbs, 64%). Chronic total iliac occlusions were identified in 26 limbs (22%). Concomitant CFA lesions were recorded in 97 limbs (82%). All lesions involved the EIA. Technical success was achieved in 100% of cases. Six (5.7%) perioperative major adverse cardiovascular events occurred, including 4 (3.8%) deaths. Eleven (7.6%) early MALEs were recorded. Two-year primary patency, assisted primary patency, and secondary patency were 85%, 88%, and 95%, respectively. After multivariate analysis, small-diameter stents (<8 mm) were associated with lower primary patency rates (hazard ratio [HR] 3.20, 95% confidence interval [CI]: 1.26-8.13, P = .014) and lower freedom from TLR rates (HR 2.61, 95% CI: 1.02-6.66, P = .045). Adjunctive CFA endarterectomy was significantly associated with higher primary patency rates (HR 0.38, 95% CI: 0.15-0.95, P = .038). The use of Viabahn SE covered stents for extensive aortoiliac disease involving the EIA provided acceptable postoperative morbidity and high rates of midterm secondary patency, similar to those usually reported with aortobifemoral bypass. Adjunctive CFA endarterectomy was a major determinant of patency and should be considered an essential component of the treatment strategy. Additional long-term data are necessary to evaluate the role of SE covered stents for the treatment of such lesions.Clinical ImpactThe endovascular management of extensive aortoiliac occlusive disease involving the external iliac artery remains challenging. This study represents one of the largest series dedicated to the treatment of TASC II C and D lesions involving the external iliac artery with self-expanding covered stents. The results suggest mid-term secondary patency rates comparable to those commonly reported after aortobifemoral bypass. Notably, concomitant common femoral bifurcation treatment and the use of ≥8-mm diameter stents were associated with improved patency rates, suggesting that aggressive management of common femoral artery lesions and the use of larger-diameter stents may contribute to optimizing long-term outcomes.

BackgroundNeoatherosclerosis (NA) and treatment modality may influence outcomes in patients with in‐stent restenosis (ISR). This study evaluated the prognostic impact of different NA patterns and percutaneous coronary intervention (PCI) strategies guided by optical coherence tomography (OCT).MethodsWe retrospectively analyzed 288 ISR lesions with OCT‐defined NA treated between January 2015 and December 2023. Lesions were classified as lipidic, calcified, or mixed NA. The primary endpoint was 1‐year target lesion failure (TLF), defined as a composite of cardiac death, nonfatal myocardial infarction, and clinically driven target lesion revascularization (CD‐TLR). Cox regression, interaction analysis, and propensity score matching (PSM) were performed.ResultsNo significant differences in TLF (p = 0.420) or CD‐TLR (p = 0.650) were observed among NA patterns. After adjustment for clinical and procedural covariates, DES reimplantation was associated with a lower risk of TLF (hazard ratio [HR] 0.390, 95% confidence interval [CI] 0.157–0.974; p = 0.044) and CD‐TLR (HR: 0.341, 95% CI: 0.114–0.925; p = 0.039) compared with DCB angioplasty. In patients with lipidic NA, a similar trend was observed (TLF: HR: 0.287; 95% CI: 0.097–0.849; p = 0.024; CD‐TLR: HR: 0.171; 95% CI: 0.039–0.750; p = 0.019). However, no significant interaction was observed between the NA pattern and treatment modality (p for interaction = 0.543).ConclusionNo significant differences in clinical outcomes were observed across NA patterns. Although DES showed numerically favorable outcomes in lipidic NA, no significant interaction between NA pattern and treatment modality was detected. And these findings are hypothesis‐generating and may relate to the additional mechanical scaffolding and plaque sealing provided by DES in lipidic NA.

Chronic kidney disease is associated with an increased incidence of stent thrombosis (ST) following drug-eluting stent (DES) implantation, but the clinical outcomes after DES-ST in hemodialysis (HD) patients compared with non-HD patients have not been fully elucidated. From the REAL-ST registry, we evaluated 655 patients with DES-ST, divided into 2 groups: HD group (n=59) and non-HD group (n=596). The primary endpoint was the cumulative 3-year incidence of all-cause death after the index ST event. Late ST was more prevalent in the HD group, whereas early and very late ST were common in the non-HD group. Following the index ST event, the HD group showed significantly higher 3-year incidences of all-cause death (48.2% vs. 22.9%, P=0.0005), cardiac death (33.4% vs.15.8%, P=0.003) and target lesion revascularization (TLR: 36.2% vs. 17.5%, P=0.0002) compared with the non-HD group. The cumulative 3-year incidence of recurrent ST did not differ significantly between groups (7.3% vs. 5.9%, P=0.88). After multivariable adjustment, HD remained significantly associated with an increased risk of all-cause death (adjusted hazard ratio [aHR], 1.95; 95% confidence interval [CI], 1.25-3.04; P=0.003), cardiac death (aHR, 1.75; 95% CI, 1.02-2.99; P=0.04) and TLR (aHR, 2.63; 95% CI, 1.52-4.57; P<0.001). Compared with non-HD patients, HD patients experienced worse clinical outcomes following their index DES-ST event.