How to identify and prepare calcified lesions safely and effectively

This review article provides a detailed analysis of strategies for the safe and effective identification and preparation of calcified coronary lesions—an increasingly relevant technical challenge in percutaneous coronary intervention (PCI). The presence of intravascular calcium can jeopardize procedural success by hindering device delivery and optimal stent expansion, thereby negatively affecting clinical outcomes. The paper emphasizes the importance of pre-procedural planning using advanced imaging techniques such as coronary computed tomography angiography (CTCA), intravascular ultrasound (IVUS), and optical coherence tomography (OCT) for accurate assessment of calcium morphology. It systematically reviews the main lesion modification techniques—including balloon angioplasty, rotational, orbital, and laser atherectomy, as well as intravascular lithotripsy—offering selection criteria based on lesion characteristics and operator experience. Supported by current clinical evidence, the article proposes a decision-making algorithm for personalized management of calcified lesions, aiming to improve outcomes through technological innovation and refined procedural techniques.

Review on the Role of TAVI in Failing Surgical Aortic Valves

This review explores the growing role of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) as a treatment strategy for degenerated surgical aortic bioprostheses. Bioprosthetic valve failure poses a significant clinical challenge, especially in elderly or high-risk surgical patients. ViV-TAVI has emerged as a less invasive and effective alternative to repeat surgical aortic valve replacement (SAVR), offering the potential to minimize procedural risks. The paper provides a comprehensive overview of the ViV-TAVI approach, including preprocedural planning, valve selection, implantation techniques, and potential complications such as patient–prosthesis mismatch and coronary obstruction—sometimes addressed through the BASILICA procedure. Backed by updated clinical evidence supporting favorable long-term outcomes, ViV-TAVI is positioned as a safe and reliable option for managing failed surgical aortic bioprostheses.

Post hoc analysis of the EASTBOURNE Registry

This post hoc analysis of the EASTBOURNE Registry examined how drug-coated balloons (DCBs), specifically sirolimus-coated balloons, perform in patients of different ethnic backgrounds—comparing clinical outcomes between East Asian and Caucasian populations with coronary artery disease. Drawing from over 2,000 patients treated across 38 international centers, the study used matched groups to ensure a fair comparison. While both groups had similar overall health profiles after matching, procedural practices and outcomes differed. Caucasian patients had higher rates of repeat treatment at the original lesion (target lesion revascularization), while East Asian patients experienced higher rates of bleeding. Other key outcomes such as heart attacks and mortality were similar between the two groups. These findings suggest that ethnicity may play a role in how patients respond to DCB treatment, emphasizing the importance of personalized approaches in interventional cardiology. .

Preventive Percutaneous Intervention of Vulnerable Coronary Plaques

The Preventive Percutaneous Intervention of Vulnerable Coronary Plaques is a narrative review exploring the evolving role of preventive percutaneous coronary intervention (PCI) for vulnerable coronary plaques—non-obstructive lesions that may precipitate acute coronary syndromes and sudden cardiac death. These plaques, often thin-cap fibroatheromas with large lipid cores and thin fibrous caps, are typically undetectable via standard coronary angiography. The paper highlights the value of high-resolution intravascular imaging (e.g., OCT and IVUS) in detecting high-risk plaque features such as superficial erosion, protruding calcified nodules, and necrotic cores. It reviews emerging clinical evidence suggesting that prophylactic PCI of such plaques—before clinical symptoms arise—may reduce the risk of future adverse cardiac events. By synthesizing current knowledge and addressing ongoing trials, the study underscores the potential for a paradigm shift in coronary artery disease management, from reactive to preventive strategies, aiming to improve long-term cardiovascular outcomes through early identification and stabilization of high-risk lesions.

ANDROMEDA study

The ANDROMEDA study is a meta-analysis comparing 3-year clinical outcomes of paclitaxel-coated balloon (PCB) angioplasty and drug-eluting stent (DES) implantation for small-vessel coronary artery disease (SV-CAD). The study combined individual patient data from three randomized trials involving 1154 patients and 1360 lesions. The results indicated that at 3 years, PCB showed a lower risk of major adverse cardiac events (MACE) compared to DES (HR 0.67, 95% CI 0.47–0.96). However, there were no significant differences in target lesion failure (TLF) between the two groups. The analysis also showed consistent results when including data from a fourth trial. These findings provide valuable insights into the comparative long-term outcomes of PCB and DES for treating SV-CAD.

The SCAI 2025 Guidelines for Chronic Venous Disease (CVD)

The SCAI 2025 Guidelines for Chronic Venous Disease (CVD) provide a comprehensive, evidence-based framework for the diagnosis and management of CVD, a condition affecting over 25 million adults in the U.S. alone. Developed by the Society for Cardiovascular Angiography & Interventions (SCAI), the guidelines offer nine key consensus recommendations, emphasizing compression therapy, endovenous ablation, sclerotherapy, phlebectomy, and deep venous interventions such as venoplasty and stenting guided by intravascular ultrasound. The guidelines also highlight four key knowledge gaps, including the role of phlebectomy in venous ulcers and the treatment of isolated femoral vein disease. While grounded in current evidence, the document acknowledges the limitations of available data and points toward future innovations such as microwave and mechanochemical ablation, AI-assisted monitoring, and 3D-printed stents. These guidelines mark a critical step toward standardized, minimally invasive, and patient-centered management of CVD, bridging current practice with emerging technologies and highlighting areas in need of further clinical research.