The aim of this French physician initiated, multicentre, prospective, randomised trial with blinded criteria for re-intervention was to evaluate the efficacy of paclitaxel coated balloons (DCBs) in the treatment of arteriovenous fistula stenosis. One hundred and fifty patients with an arteriovenous fistula stenosis were included, and 145 were randomised 1:1 in the ABISS trial (Angioplastie au Ballon Imprégné de paclitaxel vs. angioplastie Standard pour le traitement des Sténoses sur fistule artérioveineuse; ClinicalTrials.gov identifier: NCT02753998) between a DCB (Lutonix, BD, Franklin Lakes, NJ, USA) and a placebo balloon. The main outcome was the rate of primary patency loss at 6 months. The primary analysis was performed in the modified intention to treat population. Missing outcome data were handled using a conservative imputation approach. The per-protocol analysis excluded patients who were included by mistake, not treated according to the randomisation arm, lost to follow up, or who missed a visit. In the modified intention to treat analysis, there was no significant difference between the groups regarding primary patency loss at 6 months (31% [22 of 70] in the DCB group vs. 42% [30 of 71] in the placebo group; p = .09; hazard ratio = 0.62 [95% confidence interval {CI} 0.36 - 1.07]). Primary patency loss was lower in the DCB than in the placebo group at 3 months (4.2% vs. 22.5%; p = .002; hazard ratio = 0.18 [95% CI 0.05 - 0.60]), but not at 12 months (58.6% vs. 57.7%; p = .57; hazard ratio = 0.88 [95% CI 0.57 - 1.35]). In the per-protocol analysis, the primary patency loss was significantly lower in the DCB group than in the placebo group (26% [16 of 61] in the DCB group vs. 50% [28 of 56] in the placebo group; p = .004). In the ABISS trial, the use of a DCB was not superior to a placebo balloon at 6 months in the modified intention to treat analysis.
To determine which primary endovascular revascularisation strategy represents the most clinical and cost-effective treatment for patients with chronic limb threatening ischaemia who require an endovascular femoro-popliteal, with or without an infra-popliteal revascularisation. Three-arm open-label pragmatic multicentre randomised phase 3 superiority trial. Thirty-five UK NHS vascular units. Patients with chronic limb threatening ischaemia who required an endovascular femoro-popliteal with or without an infra-popliteal revascularisation. Participants were randomly assigned (1 : 1 : 1) to either a femoro-popliteal plain balloon angioplasty with or without bare metal stenting (considered as control or reference), or a drug-coated balloon angioplasty with or without bare metal stenting, or a drug-eluting stenting first revascularisation strategy. The primary outcome was amputation-free survival defined as time to first major amputation or death from any cause. Secondary outcomes included overall survival, limb salvage, major adverse limb events, major adverse cardiac events and other pre-specified clinical and patient reported outcome measures. Serious adverse events were collected up to 30 days following the first revascularisation procedure. Between 29 January 2016 and 31 August 2021, 481 participants [167 (35%) women] of mean age 71.8 years (standard deviation 10.8) were randomised. Major amputation or death occurred in 106 of 160 (66%) participants in the plain balloon angioplasty ± bare metal stenting group, 97 of 161 (60%) participants in the drug-coated balloon angioplasty ± bare metal stenting, and 93 of 159 (58%) participants in the drug-eluting stenting group [adjusted hazard ratios: plain balloon angioplasty ± bare metal stenting vs. drug-coated balloon angioplasty ± bare metal stenting: 0.84 (97.5% confidence interval 0.61 to 1.16), p = 0.22; plain balloon angioplasty ± bare metal stenting vs. drug-eluting stenting: 0.83 (97.5% confidence interval 0.60 to 1.15), p = 0.20]. There were no differences in serious adverse events between the groups. There were no differences in mortality when drug technology arms were pooled versus plain balloon angioplasty ± bare metal stenting. When compared to plain balloon angioplasty, drug-eluting stenting was less costly [-£724 (95% confidence interval -£4975 to £2631)] and resulted in additional 0.048 quality-adjusted life-years (95% confidence interval -0.060 to 0.148). Drug-coated balloon angioplasty was unlikely to be a cost-effective option (probability 52% of being cost-effective at £20,000 per quality-adjusted life-year) while drug-eluting stenting was potentially cost-effective (probability 76% of being cost-effective at £20,000 per quality-adjusted life-year). Neither drug-coated balloon angioplasty ± bare metal stenting, nor drug-eluting stenting, conferred significant clinical benefit over plain balloon angioplasty ± bare metal stenting when used in the femoro-popliteal segment in patients undergoing femoro-popliteal ± infra-popliteal endovascular revascularisation for chronic limb threatening ischaemia. Drug-eluting stenting and drug-coated balloon angioplasty in chronic limb threatening ischaemia patients were found to offer moderate benefits in health economic outcomes particularly when drug-eluting stenting was compared to plain balloon angioplasty. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 13/81/02. Atherosclerosis, or narrowing of the arteries, can be caused by smoking, diabetes, high blood pressure and high blood cholesterol. It can affect any artery in the body. When atherosclerosis happens in the arteries in the leg, it is called peripheral arterial disease. The most severe form of this disease is chronic limb-threatening ischaemia, which causes severe pain in the foot, as well as ulcers and gangrene. People with chronic limb-threatening ischaemia need to have the blood supply to their leg improved or they can be at high risk of amputation or death. Improving the blood supply to the leg is called revascularisation. A technique called ‘endovascular revascularisation’ allows doctors to improve blood flow without major surgery. This involves using a balloon (angioplasty) to squeeze the arteries open or inserting small metal tubes (stents) to keep the artery open. Some devices may be coated with a drug designed to help the artery stay open and stop it becoming narrowed again. The Balloon versus Stenting in Severe Ischaemia of the Leg-3 trial compared how well these drug-coated devices worked against plain balloons. In the trial, 481 people with chronic limb-threatening ischaemia were randomly chosen to be treated with drug-coated balloons, drug-coated stents or plain balloons and were followed up for at least 2 years. The trial found that the amount of amputation and death was similar across the groups, with the drug-coated devices being slightly better. The results, however, did not demonstrate that any one method is better than any other.
Percutaneous coronary intervention via the left internal mammary artery (LIMA) graft is technically challenging and carries a risk of graft injury, particularly during delivery of specialty balloons. A 40-year-old man with premature coronary artery disease and prior coronary artery bypass grafting 17 years ago presented with refractory angina. Coronary angiography demonstrated severe left anterior descending artery stenosis distal to the LIMA anastomosis. After inadequate lesion expansion, scoring balloon was required. To minimize the risk of LIMA graft trauma during device delivery, an integrated microcatheter-guide extension system was advanced into the distal LIMA, allowing safe delivery of the scoring balloon followed by stenting with excellent angiographic results. This case highlights a novel strategy to protect the LIMA graft during high-risk device delivery, using an integrated microcatheter-guide extension system. Integrated microcatheter-guide extension systems may reduce the risk of LIMA graft injury and facilitate delivery of specialty balloons in complex percutaneous coronary intervention.
Intracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke worldwide, and is particularly prevalent in Asian populations. Patients with symptomatic severe ICAS remain at a high risk of recurrent stroke despite medical management (MM) alone, which has driven interest in elective endovascular revascularization. This review summarizes the history, evidence, and current controversies surrounding endovascular therapy for symptomatic ICAS, with emphasis on the periods before and after the pivotal randomized controlled trials, the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial and the Vitesse Intracranial Stent Study for Ischemic Stroke Therapy (VISSIT) trial. In the pre-SAMMPRIS/VISSIT era, percutaneous transluminal angioplasty (PTA) or PTA and stenting (PTAS) using coronary or dedicated intracranial stents demonstrated technical feasibility and seemingly acceptable short-term outcomes in observational studies. However, SAMMPRIS and VISSIT subsequently showed that PTAS was inferior to MM alone, largely because of high periprocedural stroke or death rates and the frequent occurrence of in-stent restenosis, establishing MM as the standard first-line treatment. Later observational studies suggested that outcomes may improve with stricter patient selection, avoidance of acute-phase intervention, adherence to on-label indications for the Wingspan system (Stryker Neurovascular, Fremont, CA, USA), and exclusion of high-risk lesion types, such as perforator-associated disease. Recent trials have renewed interest in elective endovascular revascularization. In particular, the Balloon Angioplasty for Symptomatic Intracranial Artery Stenosis (BASIS) trial demonstrated the superiority of submaximal balloon angioplasty plus MM over MM alone, suggesting that the procedure may reduce procedural risk while preserving long-term benefits. In parallel, drug-eluting stents and drug-coated balloons have shown promise in reducing restenosis and late ischemic events, while technical innovations-such as first-balloon-then-stent approaches, novel exchange guidewires, and tailored lesion-specific device and procedural selection-may further improve safety. Although current evidence does not support PTAS as a first-line therapy for symptomatic ICAS, evolving strategies suggest that selective patients may benefit from elective endovascular revascularization. Further large-scale, well-designed studies are needed to determine the optimal candidates, timing, devices, and techniques for this treatment.
Intragastric balloon (IGB) therapy is a minimally invasive intervention for weight management. However, maintenance after balloon removal and predictors of sustained weight loss at 1year remain uncertain. This retrospective single-center study included patients who underwent fluid-filled IGB placement between January 2015 and December 2019 at Istishari Teaching Hospital, Amman, Jordan. Inclusion criteria were age ≥13 years and IGB insertion for weight control. Balloons were endoscopically placed and removed at 6 months per standard protocol. No concurrent weight loss interventions were permitted. Total weight loss percentage (TWL%) was calculated at balloon removal (6 months after balloon insertion), at 6 and 1year after balloon removal. Patients were stratified by pretreatment body mass index (BMI): Group 1 (25-29.9), Group 2 (30-34.9), Group 3 (35-39.9), and Group 4 (≥40 kg/m2). Multivariate linear and logistic regression identified predictors of BMI and ≥10% TWL at 1year after balloon removal, respectively. A total of 478 patients (74.3% female; mean age 31.3 ± 8.8 years; mean pretreatment BMI 36.1 ± 8.1 kg/m2) were included. Mean TWL% was 12.8% at removal, 7.5% at 6 months after removal, and 4.0% at 1year after removal (P < .0001). Higher pre-treatment BMI predicted greater TWL% at all time points (P < .001) but was also associated with higher BMI at 1year (β range: +4.45 to +20.92; P < .001). Age was modestly associated with higher BMI (β = +.07; P = .002). In logistic regression, age predicted ≥10% TWL at 1year (odds ratio [OR] 1.04; P = .040), while Groups 3-4 had lower odds (OR .29 and .24; P < .05). In contrast, sex (P = .051) and BMI Group 2 (P = .447) were not significant predictors of achieving ≥10% TWL at 1year. Pretreatment BMI and age independently influenced weight trajectories following IGB therapy. Patient selection based on lower BMI categories (25-35 kg/m2) and integration with postremoval support programs may be key to optimizing 1-year outcomes.
Endovascular treatment of vertebral artery ostial (VAO) stenosis can be technically challenging in the presence of severe supra-aortic tortuosity, particularly a Type III aortic arch where stable guide catheter positioning is often difficult to maintain. During device delivery, inadequate proximal support may result in guide catheter prolapse into the aortic arch, compromising procedural success. Although adjunctive support techniques such as the buddy-wire technique may improve system stability, extreme vascular tortuosity can still impede the advancement of balloons or stents.1 A deep inspiration maneuver with transient breath-holding may facilitate device delivery by inducing caudal displacement of the aortic arch and proximal subclavian artery.2 Because the distal vertebral artery remains relatively fixed within the transverse foramina, this maneuver generates temporary axial tension across the V1 segment, partially straightening the tortuous vascular course and improving device trackability.3This technical video (video 1) demonstrates step-by-step endovascular reconstruction of an extremely tortuous right VAO lesion in a patient with prior failed stenting caused by hostile vascular anatomy and subsequent recurrent stenosis. Despite the Type III arch anatomy, a transfemoral approach was mandated over a radial approach due to the acute ostial geometry, providing the necessary antegrade delivery vector. We highlight a dual strategy approach combining distal wire-anchor support to enhance guiding stability and respiratory-induced vascular straightening to facilitate device navigation, ultimately enabling precise stent deployment and complete revascularization.neurintsurg;jnis-2026-025713v1/V1F1V1Video 1.
Carotid webs (CWs) are an increasingly recognized cause of ischemic stroke and transient ischemic attacks (TIAs), particularly in patients without an alternative clearly identified etiology, although they likely remain underdiagnosed because of their subtle radiographic appearance and the absence of significant carotid stenosis. The lesion is considered an intimal variant of fibromuscular dysplasia that may promote local blood stasis, thrombus formation, and distal cerebral embolization. We present the case of a 59-year-old woman with recurrent transient neurological deficits and initially negative stroke imaging who was ultimately diagnosed with a bilateral CW. Computed tomography angiography demonstrated bilateral thin linear filling defects at the carotid bulbs, more prominent on the left side, consistent with a CW. Magnetic resonance imaging performed using a stroke protocol showed no evidence of acute ischemic or hemorrhagic stroke. Electroencephalography was normal, and no definitive cardioembolic source was identified. Subsequent digital subtraction angiography confirmed abnormal flow dynamics involving both carotid bulbs. Balloon occlusion testing demonstrated insufficient collateral circulation, supporting the hemodynamic significance of the lesion. Given the recurrent ischemic symptoms and angiographic findings, the patient underwent endovascular carotid reconstruction with angioplasty and placement of a left internal carotid artery stent. Post-procedural angiography demonstrated improved carotid flow dynamics without complications. The patient remained neurologically stable during follow-up without recurrent cerebrovascular events. This case highlights the importance of considering CWs in patients with recurrent cryptogenic TIAs or stroke-like symptoms despite negative initial neuroimaging. Early recognition through dedicated vascular imaging may facilitate timely intervention and potentially reduce recurrent cerebrovascular events.
An 8-month-old domestic shorthair cat was presented for rectal tenesmus and pain on defecation. The clinical examination revealed a rectal stricture, and the radiological examination with contrast medium allowed the localization and extension of the stricture to be identified. The latter was treated with balloon endoscopy balloon dilation with a single balloon system, which resulted in complete resolution of the stenosis. No recurrences were observed during the following months. The previous medical history is unclear since the cat was adopted from a shelter, but an inflammatory origin is suspected. Eine 8 Monate alte Europäisch Kurzhaar-Katze wurde aufgrund von rektalem Tenesmus und Schmerzen bei der Defäkation vorgestellt. Die klinische Untersuchung ergab das Vorliegen einer rektalen Striktur. Die röntgenologische Untersuchung mit Kontrastmittel ermöglichte die Einschätzung der Ausdehnung der Stenose. Diese wurde mittels endoskopischer Ballondilatation mit einem Einfachballonsystem behandelt, was zur vollständigen Beseitigung der Engstelle führte. In den darauffolgenden Monaten traten keine Rezidive auf. Die vorausgehende medizinische Vorgeschichte ist unklar, da die Katze aus einem Tierheim adoptiert wurde; es wird jedoch eine entzündliche Genese vermutet.
Balloon pulmonary valvuloplasty (BPV) is the most common interventional procedure for treating severe pulmonic stenosis (PS) in dogs. Due to the cardiovascular compromise associated with PS, anaesthetic management must be carefully planned to ensure patient safety. To describe the anaesthetic protocols, perioperative complications, and clinical outcomes of dogs with severe PS undergoing BPV. A retrospective review of medical records was performed for 21 dogs with severe pulmonic stenosis (echocardiographic pressure gradient > 80 mmHg) that underwent balloon pulmonary valvuloplasty between 2024 and 2025. Anaesthetic protocols were individualized based on cardiovascular assessment. Data were analyzed descriptively, and statistical analyses were performed using IBM SPSS Statistics for Windows (version 25). A significance level of p < 0.05 was adopted. Twenty-one dogs were included, with a median age of 18 months (range: 3-84) and median body weight of 7.75 kg (range: 2.2-26). French Bulldogs were the most common breed (33.3%). Syncope (42.9%) and fatigue (38.1%) were the most frequent clinical signs. Anaesthetic induction was predominantly performed using etomidate-midazolam-based protocols (95%), and anaesthesia was maintained with mainly isoflurane combined with intravenous adjuncts. Hypotension (MAP < 65 mmHg) was the most common intraoperative complication, occurring in 66.7% of dogs, frequently requiring vasoactive support. Cardiac arrhythmias, including ventricular arrhythmias and bradyarrhythmia's, were also observed. Balloon pulmonary valvuloplasty resulted in a significant reduction in right ventricular pressure gradient in 90% of cases. Balloon pulmonary valvuloplasty effectively reduced right ventricular pressure in dogs with severe pulmonic stenosis. Anaesthetic management was heterogeneous, with frequent use of etomidate- and benzodiazepine-based induction and inhalant anaesthesia combined with intravenous adjuncts. Intraoperative hemodynamic instability and arrhythmias were common, reinforcing the need for individualized anaesthetic planning and vigilant perioperative monitoring.
暂无摘要（点击查看详情）
This case report describes a rare clinical scenario involving a 40-year-old Ethiopian female patient with very severe rheumatic mitral stenosis, found to have an anomalous transposition of the inferior vena cava (IVC). She successfully underwent a technically challenging percutaneous mitral balloon commissurotomy. To the best of our knowledge, this is the first documented case in an African patient where such a procedure has been successfully performed in the context of a congenital IVC anomaly.
Transcatheter aortic valve implantation (TAVI) carries a small but serious risk of periprocedural stroke. Prompt recognition and rapid management are essential to prevent permanent neurological injury. We describe an acute ischemic stroke occurring during TAVI for bicuspid aortic stenosis, immediately identified by the interventional cardiologist through carotid angiography. The patient developed sudden left hemibody weakness and aphasia after balloon predilatation, and angiography revealed an occlusion of the right middle cerebral artery (M1). While maintaining hemodynamic stability with valve implantation, the operator restored partial flow in the ophthalmic artery and activated the stroke team. Mechanical thrombectomy was rapidly performed using an aspiration catheter, achieving complete recanalization, with a modified Thrombolysis in Cerebral Infarction grade 3 within 30 min of symptom onset. Post-procedural imaging confirmed the absence of hemorrhage, and neurological deficits improved markedly. This case highlights how immediate in-laboratory carotid angiography performed by the structural interventional cardiologist can significantly shorten the diagnostic-to-reperfusion interval and facilitate ultra-rapid multidisciplinary rescue in periprocedural stroke. Immediate in-laboratory carotid angiography by the structural operator may significantly shorten time-to-reperfusion in periprocedural stroke. Peripheral interventional skills are essential for structural cardiologists, enabling them to promptly recognize and address extracardiac complications. Multidisciplinary collaboration between interventional cardiologists, neurologists, and interventional radiologists is vital to achieve optimal outcomes in life-threatening complications. The absence of cerebral embolic protection did not compromise the outcome, consistent with recent randomized evidence showing no significant reduction in clinical stroke with routine use of protection devices.
Pressure-wire fractional flow reserve (FFR) can guide balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension, but lesion crossing with a distal wire increases cost and procedural risk. We developed an angiography-derived physiologic index-pulmonary artery flow reserve (PFR)-computed from selective pulmonary angiography using fluid-dynamic modeling without distal pressure-wire advancement. In this prospective observational study, selective pulmonary angiography was acquired in 2 projections for type A (ring-like), type B (web lesion) and type C (subtotal) pulmonary artery lesions. Proximal pressure (Pa) was measured at the target vessel ostium using a pressure-sensor catheter; flow velocity was estimated by frame counting; pressure drop (ΔP) was computed by a proprietary computational fluid dynamics approach, and PFR was derived as (Pa - ΔP)/Pa. Pressure-wire FFR (Pd/Pa) served as the reference standard (FFR ≤0.80). Diagnostic performance was assessed by receiver operating characteristic analysis and agreement by Bland-Altman analysis. Fifty-two vessels in 29 patients were analyzed. Mean FFR and PFR were 0.57 ± 0.23 and 0.58 ± 0.24; 44 vessels had FFR ≤0.80. PFR showed excellent discrimination for FFR ≤0.80 (area under the curve 0.981, 95% CI 0.935-1.000), with sensitivity 94.1% (95% CI 80.9%-98.7%) and specificity 87.5% (95% CI 64.0%-97.0%) at an optimal PFR cutoff of 0.77. Agreement was high (bias 0.0076; 95% limits of agreement -0.1037 to 0.1190), and correlation was strong (r=0.970, P<0.001). At 3-month follow-up (n=45 vessels), PFR maintained high performance (area under the curve 0.985; bias 0.0071; r=0.967; all P<0.001). Angiography-derived PFR demonstrated strong agreement with pressure-wire FFR for physiologic assessment of pulmonary artery stenoses in chronic thromboembolic pulmonary hypertension and may provide a simpler alternative to distal pressure-wire measurements to support physiology-guided balloon pulmonary angioplasty.
To compare the outcomes of self-expandable (S-EXP) and balloon-expandable (B-EXP) bridging stents used with the E-nside off-the-shelf inner-branch endograft for thoracoabdominal and complex abdominal aortic aneurysm repair within the ItaliaN Branched Registry of E-nside EnDograft (INBREED) registry. All patients enrolled in the INBREED registry between January 2021 and December 2024 were analyzed. Clinical, anatomical, and procedural data were collected for all target vessels (TVs). The most frequently used self-expandable (S-EXP) and balloon-expandable (B-EXP) bridging stents were identified and compared. The primary endpoint was target vessel instability (TVI), defined as a composite of occlusion, significant stenosis, type Ic/IIIb/IIIc endoleak, kinking, disconnection, rupture, or target vessel-related mortality. Secondary endpoints included technical success and reintervention rates. A total of 581 target vessels (TVs) from 148 patients were analyzed: 423 (72.8%) were bridged with B-EXP and 158 (27.2%) with S-EXP stents. Overall technical success was 99.5%. During a mean follow-up of 22.1 ± 12.3 months, TVI occurred in 40/581 vessels (6.9%), with a lower incidence in the S-EXP group (3.2%) compared to the B-EXP group (8.3%; p = .03). However, this association did not remain statistically significant at multivariable analysis, which identified only renal target vessels (OR 1.87; 95% CI, 1.05-3.82; p = .045) and pre-existing target vessel stenosis (OR 1.93; 95% CI, 1.13-4.11; p = .047) as independent predictors of TVI. Inner-branch endovascular repair with the E-nside endograft achieved high technical success and favorable mid-term outcomes. A lower crude rate of target vessel instability was observed with self-expandable stents; however, this association did not remain significant after multivariable adjustment. Renal target vessels and pre-existing stenosis were identified as the main predictors of instability.
暂无摘要（点击查看详情）
Balloon pulmonary angioplasty (BPA) is an established treatment for chronic thromboembolic pulmonary hypertension (CTEPH). However, some totally occlusive lesions remain uncrossable with conventional antegrade BPA because the proximal entry of the occlusion cannot be identified angiographically. To evaluate the outcomes of transcollateral retrograde BPA for lesions that are not amenable to antegrade recanalization. We retrospectively investigated the procedural outcomes of 30 lesions in 19 patients treated with transcollateral retrograde BPA at our institution between April 2016 and December 2025. All lesions were either uncrossable with a guidewire despite antegrade attempts or had an indistinct proximal end of the occlusion, precluding identification of a safe antegrade entry point despite angiographic and intravascular imaging assessment. Procedural success was defined as successful balloon dilation restoring antegrade flow. Procedure-related complications were defined as hemoptysis, respiratory deterioration requiring positive-pressure ventilation, or procedure-related death. Procedural success was achieved in 15 of 30 lesions (50%). When divided into three sequential groups of 10 lesions each, success rates were 50%, 30%, and 70%, respectively. Mild hemoptysis occurred in 3 cases (10%), whereas severe complications or death did not occur. Causes of procedural failure included inability to cross the collateral channel (12 cases) and failure to penetrate the occlusion (3 cases). Difficult collateral channels were characterized by severe tortuosity, small vessel diameter, and capillary-like connections. Transcollateral retrograde BPA may enable recanalization of otherwise untreatable occlusive pulmonary artery lesions with an acceptable safety profile.
Risk-taking behavior varies across different life domains, yet neuroimaging research has primarily focused on financial incentives, thus limiting our understanding of the neural basis for domain-specific risk-taking. This study investigates whether neural correlates of risk-taking differ between financial and social incentive domains using functional magnetic resonance imaging (fMRI). Thirty-nine participants completed an adapted Balloon Analogue Risk Task with financial (monetary rewards) and social (gifts for children) incentive conditions. Behavioral data show that participants demonstrate less risk-seeking behavior in the social compared to financial condition. Neuroimaging results revealed both domain-general and domain-specific components of risk processing. A conjunction analysis of both incentive conditions identified a common neural network across both incentive types, including bilateral striatum, dorsal anterior cingulate cortex, and left insular cortex, supporting theories of domain-general risk processing mechanisms. Contrasting both reward conditions revealed significantly stronger activation in the right inferior parietal lobule during financial compared to social risk-taking, thus indicating a neural substrate for domain-specific risk preferences. These data might bridge the gap between behavioral evidence for domain-specific risk-taking and neuroimaging research, highlighting the importance of considering the type of incentives when studying risk behavior and its neural correlates.
Platelets can undergo at least two distinct types of regulated cell death, apoptosis and mPTP-driven necrosis. Apoptosis is believed to be responsible for platelet clearance, while strong platelet activation by physiological agonists leads to necrosis, producing procoagulant platelet remnants that are essential for blood coagulation during thrombosis and hemostasis. To thoroughly compare morphological and functional features of apoptotic and necrotic-like procoagulant platelets in vitro, their procoagulant activity, ability to bind coagulation proteins, and adhesive protein composition were evaluated. Confocal and electron microscopy were used to analyze morphology. Both apoptotic and necrotic-like procoagulant platelets had balloon-shaped morphology with phosphatidylserine-enriched "caps", as well as similar abilities to bind blood coagulation factors and participate in procoagulant reactions. However, apoptotic platelets did not release their alpha-granules and, consequently, did not have the "coat" of alpha-granular proteins such as P-selectin, fibrin(ogen), and von Willebrand factor on their surface, which was characteristic for the necrotic-like procoagulant ones. They were completely unable to bind external fibrinogen. They were completely unable to bind external fibrinogen. During storage of platelet concentrates, PS-positive platelets of both apoptotic (PS+/CD62P-) and necrotic-like procoagulant (PS+/CD62P+) phenotypes were observed to accumulate.
Frailty is common among TAVR candidates. While guidelines recommend formal geriatric assessment for risk stratification, frailty is often evaluated in daily practice using physician judgment - "eyeball test". This study compared outcomes of frail versus non-frail patients undergoing TAVR using frailty classification based on eyeballing or formal geriatric assessment. This study included all patients undergoing TAVR for severe aortic stenosis (AS) with balloon-expandable or self-expandable valves between 2012 and 2024. Frailty was assessed in two cohorts: by physician clinical judgment (the "eyeball" cohort) or by formal comprehensive geriatric assessment, which was reserved for cases deemed uncertain by the treating clinician. The primary endpoint was 1-year all-cause mortality. A total of 6343 patients were included in the study. Frailty was assessed by eyeballing in 4603 patients and by comprehensive geriatric assessment in 1740 patients. In the eyeball assessment cohort, frail patients exhibited significantly higher rates of in-hospital mortality (2.1% vs. 1.0%, p = 0.006) and 1-year mortality (8.1% vs. 6.3%, p = 0.024). In the formal geriatric assessment cohort, frail patients demonstrated a numerically higher 1-year mortality rate compared with non-frail patients (7.3% vs. 5.3%); however, this difference did not reach statistical significance (p = 0.160). In both cohorts, there were no significant differences in the composite safety endpoint, PPM implantation, or moderate or greater PVL. Frailty assessed by routine clinical "eyeballing" provided prognostic stratification after TAVR. A pragmatic two-step strategy - routine eyeballing with comprehensive geriatric assessment reserved for uncertain cases, may represent an efficient approach for frailty evaluation in contemporary TAVR practice.
The 2018 change in the US heart transplant allocation system was associated with a significant increase in the use of short-term mechanical circulatory support. Using a large national database, we aimed to analyze changes in mechanical circulatory support device use and clinical outcomes after the allocation change. According to the United Network for Organ Sharing database, 5325 adult patients were identified who underwent heart transplantation in 2019 or 2024 (2019: n = 2226; 2024: n = 3099). Mechanical circulatory support type at registration and transplant, patient demographics, and 90-day unadjusted and adjusted survival were compared between the groups. Compared with 2019, patients being registered for heart transplantation in 2024 were more likely to have an Impella device (26.4% vs 3.3%, P < .001). At the time of heart transplantation, 2024 patients were less likely to be on a durable ventricular assist device (19.8% vs 42.4%) or an intra-aortic balloon pump (23.5% vs 37.8%), whereas the proportion of patients on extracorporeal membrane oxygenation slightly increased (9.2% vs 6%) and those with the Impella drastically increased (35.3% vs 4.2%, P < .001). Unadjusted and adjusted 90-day survivals were similar in 2019 and 2024 (95% vs 94.8%, P = .92). Unadjusted and adjusted 90-day survivals were similar for patients on extracorporeal membrane oxygenation (92% vs 92%, P = .63), intra-aortic balloon pump (97% vs 96%, P = .63), or the Impella (97% vs 96%, P = .27) in both years. Since the adoption of the new allocation system, there has been a dramatic increase in the use of Impella devices. Overall and device-specific survival remain unchanged.