Patent foramen ovale (PFO) is associated with embolic stroke; however, the prognostic significance of PFO detected by cardiac computed tomography (CT) remains unclear. Objectives: This study aimed to evaluate the association between CT-detected PFO and subsequent ischemic stroke risk, and to assess its agreement with transthoracic echocardiography with agitated saline (Bubble-TTE). We retrospectively analyzed 1,028 patients who underwent cardiac CT between 2016 and 2018. PFO was diagnosed on cardiac CT using criteria adapted from previous reports. In a subset of 86 patients, intermodality agreement between cardiac CT and Bubble-TTE was assessed. The primary outcome was ischemic stroke, and the secondary outcome was all-cause mortality. CT-detected PFO was identified in 212 patients (20.6%). In the subset analysis, cardiac CT showed moderate agreement with Bubble-TTE for PFO detection (κ = 0.41, p < 0.001). During follow-up, ischemic stroke occurred in 49 patients (4.7%), and 116 patients died (11.3%). CT-detected PFO was independently associated with ischemic stroke (adjusted hazard ratio 2.41, 95% confidence interval 1.36-4.29, p = 0.003), whereas no significant association was observed with all-cause mortality (adjusted hazard ratio 0.96, 95% confidence interval 0.61-1.50, p = 0.86). In conclusion, CT-detected PFO was associated with an increased risk of ischemic stroke but not with all-cause mortality, suggesting prognostic relevance for ischemic stroke.

Artificial intelligence (AI)-assisted systems are increasingly used in coronary computed tomography angiography (CCTA), but their role in resident training and subsequent unaided interpretation remains unclear. This multicenter randomized pilot feasibility study evaluated a functionally standardized AI-assisted CCTA learning workflow with longitudinal unaided assessment in radiology resident training. Ten novice radiology residents from three centers were randomized 1:1 to conventional workstation-based or AI-assisted workflow training. Locally available AI platforms were required to meet predefined core-function criteria. After standardized instruction, residents completed a 4-week learning phase with next-day standardized disclosure of invasive coronary angiography (ICA) reference results and no additional expert case-by-case teaching. Formal assessments were independently performed without any support at baseline, after 2 and 4 weeks of learning, and 1 week after learning completion. Feasibility outcomes included completion, protocol adherence, data completeness, multicenter implementation, and collection of prespecified exploratory metrics. Exploratory metrics included diagnostic time, confidence, inter-rater consistency, agreement with ICA, and diagnostic discrimination for ICA-defined stenosis ≥70%. All residents completed training and scheduled assessments, with no withdrawals or missing assessment data. The workflow was implemented across all centers, and all exploratory metrics were collected at each time point, with descriptive learning-related changes in both groups. In conclusion, functionally standardized AI-assisted CCTA learning with longitudinal unaided assessment was feasible in structured multicenter resident training, supporting larger trials of training effectiveness.

Drug-eluting resorbable scaffolds (DRS) have been developed to overcome the key limitations of conventional endovascular therapies for below-the-knee peripheral artery disease (PAD), including acute recoil, restenosis, and the sequela of long-term permanent metallic implants. DRS provides a temporary mechanical support and localized antiproliferative drug delivery after which the scaffold is gradually resorbed, ultimately restoring native vessel architecture to preserve future revascularization options. Over the past decade, numerous prospective and observational studies have evaluated both polymer- and magnesium alloy-based DRS platforms and have demonstrated favorable patency, wound healing, and limb salvage outcomes in patients with advanced infrapopliteal PAD. Most recently, randomized evidence from the LIFE-BTK trial has demonstrated superior patency and reduced rates of revascularization with DRS treated lesions as compared with plain balloon angioplasty. In this state-of-the-art review, we summarize the existing evidence evaluating DRS devices for below-the-knee PAD and present an updated systematic review and meta-analysis of clinical outcomes for DRS-based endovascular interventions.

Severe tricuspid regurgitation (TR) is associated with adverse outcomes, particularly in patients with cardiac implantable electronic devices (CIEDs), in whom transvalvular leads may contribute to valve dysfunction. Evidence supporting tricuspid transcatheter edge-to-edge repair (T-TEER) in this population remains limited. We performed a systematic review and meta-analysis to evaluate whether the presence of transvalvular CIED leads is associated with differences in procedural success, early safety, or mid-term outcomes after T-TEER. PubMed, Scopus, and Cochrane Library databases were systematically searched for studies comparing T-TEER outcomes in patients with and without CIEDs. Prespecified analyses focused on procedural success, early safety, functional status, residual TR, and 1-year all-cause mortality. Pooled mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CIs) were calculated using a random-effects model. Eight observational studies were included, comprising 2,779 patients, of whom 820 (29.5%) had transvalvular CIED leads. Procedural success was comparable between groups (RR 1.00; 95% CI 0.95-1.04). No significant differences were observed in early safety outcomes or functional status at 30 days. At 1-year follow-up, no significant differences were observed in residual TR ≤2+ (RR 0.95; 95% CI 0.88-1.02), while all-cause mortality was higher in patients with CIEDs (RR 1.33; 95% CI 1.03-1.72). In conclusion, in this meta-analysis, T-TEER demonstrated comparable procedural success and early safety in patients with and without transvalvular CIED leads. Despite similar TR reduction at 1 year, patients with CIEDs exhibited higher mid-term mortality, suggesting a possible discordance between valve-level technical success and patient-level clinical outcomes.

No-reflow complicates 7-25% of primary percutaneous coronary interventions (PCI) for ST-elevation myocardial infarction (STEMI) and is associated with adverse outcomes. This trial evaluated whether intracoronary adenosine prevents no-reflow and improves left ventricular function. This single-center randomized controlled trial enrolled 200 STEMI patients undergoing primary PCI. Patients received either intracoronary adenosine (1-2 mg, n=100) or standard care (n=100) after achieving TIMI 1 flow. Primary endpoints were post-procedural TIMI flow grade and myocardial blush grade (MBG). Secondary endpoints included left ventricular ejection fraction (LVEF) and dimensions. Adenosine significantly reduced the incidence (33% vs. 60%, P < 0.001) and improved TIMI III flow (86% vs. 49%, P < 0.001) and MBG III (68% vs. 42%, P = 0.003). Post-PCI LVEF was higher in the adenosine group (42.64±8.92% vs. 38.40±9.34%, P=0.001) with smaller left ventricular volumes. Intracoronary adenosine administered after establishing TIMI 1 flow significantly reduces no-reflow, improves myocardial perfusion, and preserves ventricular function in STEMI patients undergoing primary PCI. In conclusion, intracoronary adenosine administered during primary PCI was associated with reduced angiographic no-reflow, improved reperfusion markers, and more favorable early echocardiographic parameters among patients with STEMI. Given the single-center design and absence of long-term clinical outcomes, these findings should be considered preliminary and require external validation.