The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Background: With heavily calcified coronary and peripheral artery lesions, lesion preparation is crucial before stent placement to avoid underexpansion, associated with stent thrombosis or restenosis and patency failure in the long‐term. Intravascular lithotripsy (IVL) technology disrupts superficial and deep calcium by using localized pulsative sonic pressure waves, making it to a promising tool for patients with severe calcification in coronary bed.Aims: The aim of the study is to systematically review and summarize available data regarding the safety and efficacy of IVL for lesion preparation in severely calcified coronary arteries before stenting.Methods: This study was conducted according to the PRISMA guidelines. We systematically searched PubMed, SCOPUS, and Cochrane databases from their inception to February 23, 2023, for studies assessing the characteristics and outcomes of patients undergoing IVL before stent implantation. The diameter of the vessel lumen before and after IVL, as well as stent implantation, were analyzed. The occurrence of major adverse cardiovascular events (MACE) was assessed using a random‐effects model.Results: This meta‐analysis comprised 38 studies including 2977 patients with heavily calcified coronary lesions. The mean age was 72.2 ± 9.1 years, with an overall IVL clinical success of 93% (95% confidence interval [CI]: 91%−95%, I² = 0%) and procedural success rate of 97% (95% CI: 95%−98%, I² = 73.7%), while the in‐hospital and 30‐days incidence of MACE, myocardial infarction (MI), and death were 8% (95% CI: 6%−11%, I² = 84.5%), 5% (95% CI: 2%−8%, I² = 85.6%), and 2% (95% CI: 1%−3%, I² = 69.3%), respectively. There was a significant increase in the vessel diameter (standardized mean difference [SMD]: 2.47, 95% CI: 1.77−3.17, I² = 96%) and a decrease in diameter stenosis (SMD: −3.44, 95% CI: −4.36 to −2.52, I² = 97.5%) immediately after IVL application, while it was observed further reduction in diameter stenosis (SMD: −6.57, 95% CI: −7.43 to −5.72, I² = 95.8%) and increase in the vessel diameter (SMD: 4.37, 95% CI: 3.63−5.12, I² = 96.7%) and the calculated lumen area (SMD: 3.23, 95% CI: 2.10−4.37, I² = 98%), after stent implantation. The mean acute luminal gain following IVL and stent implantation was estimated to be 1.27 ± 0.6 and 1.94 ± 1.1 mm, respectively. Periprocedural complications were rare, with just a few cases of perforations, dissection, or no‐reflow phenomena recorded.Conclusions: IVL seems to be a safe and effective strategy for lesion preparation in severely calcified lesions before stent implantation in coronary arteries. Future prospective studies are now warranted to compare IVL to other lesion preparation strategies.

Arterial hypertension is an epidemic currently affecting almost a billion people worldwide. The consequences from high blood pressure vary, from peripheral arterial disease and chronic kidney failure to acute myocardial infarction and stroke. MicroRNAs (miRNAs) are small non-coding RNA molecules comprised of 22-26 nucleotides and provide posttranscriptional protein expression regulation. The many biological processes in which they are implicated, such as cell proliferation, apoptosis, metabolism, cell differentiation and morphogenesis confirms the functional significance of miRNAs. It has been found that miRNAs are expressed in cardiovascular disorders and seem to be important players in the pathogenesis of arterial hypertension. The elucidation of which miRNAs are key players and at what level is of high value since it is necessary in order to better understand the mechanisms underlying hypertension, thus leading to better diagnostic modalities and therapeutic regimes.

The Bicuspid Aortic Valve (BAV) is the most common congenital anomaly in adults, with a global incidence of 1.3%. Despite being well documented, BAV presents significant clinical challenges due to its phenotypic heterogeneity, diverse clinical manifestations, and variable outcomes. Pathophysiologically, BAV differs from tricuspid valves in calcification patterns and hemodynamic effects, leading to increased shear stress and aortic root dilatation, while it is influenced by genetic and hemodynamic factors. This is why therapeutically, BAV presents challenges for both surgical and transcatheter interventions, with surgical approaches being traditionally preferred, especially when aortopathy is present. However, transcatheter aortic valve implantation (TAVI) has emerged as a viable option, with studies showing comparable outcomes to surgery in selected patients, while advancements in TAVI and a better understanding of BAV’s genetic and pathophysiological nuances are expanding treatment options. The choice between mechanical and bioprosthetic valves also presents considerations, particularly regarding long-term durability and the need for anticoagulation. Future research should focus on long-term registries and genetic studies to refine therapeutic strategies and improve patient outcomes. This review aims to evaluate current approaches in the surgical and interventional management of BAV, focusing on its anatomy, pathogenesis, pathophysiology, and therapeutic strategies.