Background: Coronary artery calcification is a predictor of adverse outcomes after percutaneous coronary intervention (PCI). Intravascular lithotripsy (IVL) is a promising tool for the treatment of calcified lesions. The aim of this study was to assess the effectiveness and safety of IVL. Methods: A single-center observational study of PCI procedure, with assessment of the outcomes of patients undergoing PCI using IVL, was performed. Angiographic procedural success was used as the primary effectiveness endpoint. The primary safety endpoint was defined as a composite of cardiac death, myocardial infarction and target vessel revascularization within 30 days. Results: A total of 111 patients were included. Indications for PCI spanned the spectrum of chronic (53.2%) and acute coronary syndromes (43%). Lesion preparation before IVL was performed with non-compliant (42%), cutting or OPN (14.4%) balloons and with atherectomy techniques in 11% of procedures. Intravascular imaging was used in 21.6% of procedures. The primary effectiveness endpoint was achieved in 100% and the primary safety endpoint in 3.6% of procedures. Peri-procedural complications were minimal and successfully resolved. Conclusions: IVL was an effective and safe technique for the treatment of calcified coronary lesions. These findings contribute to the growing body of evidence supporting the use of IVL in the management of these challenging scenarios.

Several studies comparing optical coherence tomography (OCT) and intravascular ultrasound (IVUS) have revealed that OCT consistently provides smaller area and diameter measurements. However, comparative assessment in clinical practice is difficult. Three-dimensional (3D) printing offers a unique opportunity to assess intravascular imaging modalities. We aim to compare intravascular imaging modalities using a 3D-printed coronary artery in a realistic simulator and to assess whether OCT underestimates intravascular dimensions, exploring potential corrections. A standard realistic left main anatomy with an ostial left anterior descending artery lesion was replicated using 3D printing. After provisional stenting and optimization, IVI was obtained. Modalities included 20 MHz digital IVUS, 60 MHz rotational IVUS (HD-IVUS) and OCT. We assessed luminal area and diameters at standard locations. Considering all coregistered measurements, OCT significantly underestimated area, minimal diameter and maximal diameter measurements in comparison to IVUS and HD-IVUS (p<0.001). No significant differences were found between IVUS and HD-IVUS. A significant systematic dimensional error was found in OCT auto-calibration by comparing known reference diameter of guiding catheter (1.8 mm) to measured mean diameter (1.68 mm±0.04 mm). By applying a correction factor based on the reference guiding catheter area to OCT, the luminal areas and diameters were not significantly different compared to IVUS and HD-IVUS. Our findings suggest that automatic spectral calibration method for OCT is inaccurate, with a systematic underestimation of luminal dimensions. When guiding catheter correction is applied the performance of OCT is significantly improved. These results may be clinically relevant and need to be validated.

Invasive coronary physiology is underused and carries risks/costs. Artificial Intelligence (AI) might enable non-invasive physiology from invasive coronary angiography (CAG), possibly outperforming humans, but has seldom been explored, especially for instantaneous wave-free Ratio (iFR). We aimed to develop binary iFR lesion classification AI models and compare them with human performance. single-center retrospective study of patients undergoing CAG and iFR. A validated encoder-decoder convolutional neural network (CNN) performed segmentation. Manual annotation of target vessel and pressure sensor location on a segmented telediastolic frame followed. Three AI models classified lesions as positive (≤ 0.89) or negative (> 0.89). Model 1 uses preprocessed vessel diameters with a transformer. Models 2/3 are EfficientNet-B5 CNNs using concatenated angiography and segmentation - Model 3 employs class-frequency-weighted Cross-Entropy Loss. Previous findings demonstrated Model 3’s superiority for left anterior descending (LAD) and Model 1’s for circumflex (Cx)/right coronary artery (RCA) - they were therefore unified into a vessel-based model. Ten-fold patient-level cross-validation enabled full sample training/testing. Three experienced operators performed binary iFR classification using single frames of raw/segmented images. Comparison metrics were accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Across 250 measurements, AI accuracy was 72%, PPV 48%, NPV 90%, sensitivity 77%, and specificity 71%. Human accuracy ranged from 54 to 74%. NPV was high for the Cx/RCA (AI: 96/98%; operators: 94/97%), but AI significantly outperformed humans in the LAD (78% vs. 60–64%). An AI model capable of binary iFR lesions classification mildly outperformed interventional cardiologists, supporting further validation studies.

Cardiac metastases from colorectal cancer are exceedingly rare and pose significant diagnostic challenges, particularly in the absence of disseminated disease. A 55-year-old man with ulcerative colitis and previously treated rectal adenocarcinoma presented with rising carcinoembryonic antigen levels during surveillance. Colonoscopy excluded local recurrence. Multimodality imaging identified a right ventricular mass, with cardiac magnetic resonance revealing a 36 × 48 mm lesion arising from the right ventricular free wall with endoluminal growth and late enhancement. In the absence of extracardiac disease, intracardiac echocardiography-guided endomyocardial biopsy confirmed metastatic colorectal adenocarcinoma. Endomyocardial biopsy remains the gold standard for definitive etiological diagnosis of intracardiac masses and is generally safe when performed in experienced centers. Multimodality imaging and operator expertise are essential for accurate diagnosis of high-risk intracardiac masses.

We report the feasibility and safety of the first coronary angiography and angioplasty procedures using the advanced visualization capabilities of the Meta Quest 3 virtual reality (VR) headset (Meta Platforms, Inc.). Current VR devices provide high-resolution images and low latency, but their pass-through mode—which uses cameras to project surroundings onto miniaturized screens—falls short compared with direct vision for manipulating medical devices. To overcome this, we developed fusion mixed reality, which combines direct visualization with mixed reality capabilities. By removing the facial interface and using a halo-type head strap, we directly visualized interventional devices while superimposing virtual screens in front of the operator (Panel A). This preserves the wide field of view essential for procedures and allows precise handling of catheters and guidewires under direct visualization (Panel B). The mixed reality environment enables customization of screen placement and size via hand gestures, maintaining sterility (Panel C), and could save space in future cath labs by replacing physical screens.

An 80-year-old woman with a history of B-cell non-Hodgkin lymphoma presented to the emergency department with exertional dyspnea and lower limb edema. A transthoracic echocardiogram revealed a large extracardiac mass invading the right atrium. A diagnostic transcatheter endomyocardial biopsy guided by intracardiac echocardiography was performed. This case highlights the role of intracardiac echocardiography in enabling unusual endomyocardial biopsy targeting, allowing for correct positioning of the bioptome, adding to the procedure’s safety and precision, mainly when performed on atrial masses.