Optimal vascular access and effective closure are fundamental for ensuring the safety and success of percutaneous cardiovascular interventions. As procedural complexity has increased, various access and closure devices have been developed to enhance efficacy and minimize complications. Radial artery access is favored for coronary interventions because it is associated with a lower risk of bleeding and fewer access site complications. However, femoral access remains indispensable for large-bore procedures. Large-bore sheaths are required for endovascular treatments of peripheral artery disease and structural heart interventions. Ultrasound-guided arterial and venous access has become essential for minimizing complications, especially with femoral access. Despite significant advances in closure techniques, complications such as retroperitoneal hemorrhage, pseudoaneurysm, and arteriovenous fistula remain challenging and can adversely affect patient outcomes. This review presents state-of-the-art strategies for the prevention and management of vascular access complications in cardiovascular intervention.

Background: This study was performed to characterize the incidence, costs, and risk factors associated with renal and cardiovascular adverse outcomes following primary percutaneous coronary intervention (pPCI) in patients with ST-elevation myocardial infarction (STEMI). Methods: Patients with STEMI who underwent pPCI using iso-osmolar contrast were enrolled at 39 centers. The incidence of acute kidney injury (AKI) and major adverse renal and cardiovascular events (MARCE) was analyzed, as well as inpatient costs. Logistic regression analysis was performed to identify risk factors. Results: Among 2,293 patients, the incidence of AKI and MARCE within 72 hours post-pPCI was 4.14% (n = 95) and 4.40% (n = 101), respectively. AKI and/or MARCE were associated with systolic blood pressure (AKI: odds ratio [OR], 1.009; 95% confidence interval [CI], 1.000–1.018), hypertension (AKI: OR, 1.815; 95% CI, 1.133–2.906; MARCE: OR, 1.760;95% CI, 1.118–2.769), anterior wall infarction (AKI: OR, 1.895; 95% CI, 1.196–3.004; MARCE:OR, 1.939; 95% CI, 1.240–3.032), Killip class (AKI: OR, 1.465; 95% CI, 1.117–1.922; MARCE:OR, 1.467; 95% CI, 1.131–1.903), and serum creatinine (SCr; MARCE: OR, 1.006; 95% CI, 1.000–1.012). Hospitalization costs for patients with STEMI who developed AKI or MARCE were significantly higher than for those without AKI (9,595 ± 5,795 vs. 8,279 ± 3,872 USD, P = 0.003) or without MARCE (9,890 ± 5,616 vs. 8,255 ± 3,859 USD, P < 0.001). Conclusions In patients with STEMI undergoing pPCI with iso-osmolar contrast, the incidence of AKI and MARCE was associated with higher hospitalization costs. Systolic blood pressure, hypertension, anterior wall infarction, Killip class, and SCr were identified as risk factors for these outcomes.

Abrupt vessel closure (AVC) is a complication of percutaneous coronary intervention (PCI) and is defined as the sudden cessation of forward coronary blood flow due to a variety of mechanisms. The incidence of AVC has markedly decreased from approximately 3.0% in the early era to about 0.3% today. Nevertheless, cardiovascular interventionists must remain prepared to manage AVC effectively, given its significant impact on clinical outcomes.AVC can arise from several mechanisms, including dissection, intramural hematoma, intracoronary thrombosis, air embolism, vasospasm, and no-reflow. The clinical impact of AVC varies depending on the extent of myocardium affected, ranging from asymptomatic events or transient ischemic chest pain to cardiogenic shock or cardiac arrest. Both a general approach for stabilizing hemodynamic consequences and an etiology-specific management strategy are essential. Hasty decision-making may worsen the situation, whereas a structured approach—focused on hemodynamic stabilization, logical diagnostic processes, and targeted interventions—can improve outcomes. In this narrative review, we describe the mechanisms underlying each etiology, outline mechanism-specific management strategies, and discuss general approaches to managing patients with AVC through logical diagnostic and treatment processes. We hope this review offers valuable insights into this uncommon but significant complication and enhances readers’ skills in managing AVC more effectively during PCI.

Background: The incidence of myocardial infarction (MI)-related mortality has decreased due to early reperfusion achieved through percutaneous coronary intervention (PCI).Nonetheless, early reperfusion triggers an inflammatory response, causing reperfusion injury that may significantly damage cardiomyocytes. Supersaturated oxygen therapy (SSO2) has recently emerged as a promising adjuvant therapy to overcome this limitation. SSO2 utilizes hyperoxemic oxygen infusate to salvage ischemic tissue by potentially improving coronary microvascular flow after epicardial flow restoration via PCI. Methods: We systematically searched PubMed, ScienceDirect, and Cochrane databases for studies assessing clinical outcomes of SSO2 in patients with MI undergoing PCI. The efficacy endpoint was infarct size, and the safety endpoints included composite major adverse cardiovascular events (MACE), all-cause mortality, reinfarction, and target vessel revascularization. Meta-analyses were performed on included studies. Odds ratios (ORs), mean differences (MDs), and 95% confidence intervals (CIs) were calculated using Review Manager v5.4.1. Results: Four studies, comprising a total of 1,610 patients, were included. In MI patients undergoing PCI, the use of SSO2 significantly reduced infarct size (pooled MD, −4.09; 95% CI, −6.48, −1.70; P < 0.01; I2 = 0%). However, there were no significant differences between SSO2 and PCI-only treatments regarding composite MACE (pooled OR, 0.83; 95% CI, 0.31, 0.97; P = 0.72; I2 = 54%), all-cause mortality (pooled OR, 0.89; 95% CI, 0.10, 8.18; P = 0.91; I2= 59%), reinfarction (pooled OR, 0.82; 95% CI, 0.32, 2.45; P = 0.82; I2 = 0%), or target vessel revascularization (pooled OR, 0.81; 95% CI, 0.33, 1.97; P = 0.64; I2 = 0%). Conclusions Our findings demonstrate that SSO2 therapy may yield promising results by reducing infarct size in MI patients undergoing PCI. Additionally, no safety concerns emerged from the studies included. Further research with larger samples is necessary to confirm our findings and explore potential subpopulations.

Background: There are limited long-term clinical outcome data comparing first-generation (1G) versus second-generation (2G) drug-eluting stents (DES) in patients with single-vessel disease (SVD). We sought to compare the efficacy and safety of 1G- and 2G-DES in SVD patients who underwent successful percutaneous coronary intervention (PCI) over 10 years of clinical follow-up. Methods: A total of 2,312 consecutive patients with SVD who underwent PCI with 1G-DES (paclitaxel- or sirolimus-eluting stents, n = 811) or 2G-DES (zotarolimus [Endeavor, Endeavor Resolute]- or everolimus-eluting stents [Promus Element, Xience], n = 1,082) were enrolled.After propensity score matching, 2 matched groups (538 pairs) were generated. Study endpoints included individual and composite clinical outcomes through 10 years. Results: During the 10-year follow-up, the 2G-DES group had lower incidences of myocardial infarction (MI; hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.22–0.92; P = 0.028) and target lesion revascularization (TLR; HR, 0.54; 95% CI, 0.32–0.91; P = 0.021) than the 1G-DES group. Rates of total death, cardiac death, non-target vessel revascularization, stroke, major adverse cardiac events, and major adverse cardiac and cerebrovascular events were similar between groups. Conclusions In our single-center, all-comer registry, 2G-DES were associated with lower incidence rates of MI and TLR compared to 1G-DES in SVD patients over 10 years of followup, indicating a safer and more durable effect than 1G-DES.

Mitral regurgitation (MR) is a common valvular heart disease that is associated with increased morbidity and mortality, especially in patients of advanced age or with multiple comorbidities.Transcatheter edge-to-edge repair (TEER) has emerged as a minimally invasive alternative to surgery for appropriately selected patients with primary or secondary MR. Although TEER is now established for patients who meet strict anatomical and clinical criteria, recent evidence from randomized trials and registries has broadened its application to include patients with atrial functional MR, severe ventricular dysfunction, acute MR, complex mitral anatomy, and failed prior surgery. Advancements in device technology, such as the introduction of multiple clip sizes and independent leaflet grasping, as well as improvements in imaging techniques, have further enhanced procedural safety and efficacy. This review summarizes the anatomical and clinical considerations for TEER, evaluates both trial-based and real-world data on emerging indications, and discusses technical factors and patient subsets in which TEER may provide benefits beyond current guideline-directed recommendations.