Background: The optimal timing to perform percutaneous coronary interventions (PCIs) in patients undergoing transcatheter aortic valve replacement (TAVR) is not well established. In this meta-analysis, we aimed to compare the outcomes of patients undergoing PCI before versus after TAVR. Methods: A comprehensive literature search was performed including Medline, Embase, and Cochrane electronic databases up to 5 April 2024 for studies that compared PCI before and after TAVR reporting at least one clinical outcome of interest (PROSPERO ID: CRD42023470417). The analyzed outcomes were mortality, stroke, and myocardial infarction (MI) at follow-up. Results: A total of 3 studies involving 1531 patients (pre-TAVR PCI n = 1240; post-TAVR PCI n = 291) were included in this meta-analysis following our inclusion criteria. Mortality was higher in the pre-TAVR PCI group (OR: 2.48; 95% CI: 1.19–5.20; p = 0.02). No differences were found between PCI before and after TAVR for the risk of stroke (OR: 3.58; 95% CI: 0.70–18.15; p = 0.12) and MI (OR: 0.66; 95% CI: 0.30–1.42; p = 0.29). Conclusions: This meta-analysis showed in patients with stable CAD undergoing TAVR that PCI after TAVR is associated with lower mortality compared with PCI before TAVR.

Intravascular imaging has revolutionized the assessment and management of coronary artery disease, providing unparalleled insights into plaque morphology, lesion severity, and percutaneous coronary intervention (PCI) optimization. This comprehensive review explores the current landscape of intravascular imaging, detailing the principles and clinical utility of intravascular ultrasound (IVUS) and optical coherence tomography (OCT). We discuss the role of these technologies in various clinical scenarios, ranging from stable coronary artery disease to acute coronary syndromes, emphasizing their ability to refine diagnostic accuracy and therapeutic decision-making. A key focus is placed on their application in identifying vulnerable plaques, a critical step in preventing adverse cardiovascular events. Furthermore, we highlight the role of intravascular imaging in guiding PCI, improving stent deployment, and reducing procedural complications. Finally, we explore emerging imaging modalities and technological advancements poised to further enhance coronary assessment, including hybrid imaging techniques. In addition to established modalities, this review examines emerging imaging technologies and the growing integration of artificial intelligence (AI) and hybrid imaging systems, which hold promise for automated plaque characterization, improved reproducibility, and enhanced decision support during PCI. By summarizing the latest evidence and future directions, this review aims to provide a comprehensive reference for clinicians and researchers seeking to optimize the use of intravascular imaging in contemporary cardiovascular practice.

Transcatheter aortic valve implantation (TAVI) now represents the mainstay of treatment for severe aortic stenosis. Owing to its exceptional procedural efficacy and safety, TAVI has been extended to include patients at lower surgical risk, thus now encompassing a diverse patient population receiving this treatment. Yet, long-term outcomes also depend on optimal medical therapy for secondary vascular prevention, with antithrombotic therapy serving as the cornerstone. Leveraging data from multiple randomized controlled trials, the current guidelines generally recommend single antithrombotic therapy, with either single antiplatelet therapy (SAPT) or oral anticoagulation (OAC) alone in those patients without or with atrial fibrillation, respectively. Yet, individualization of this pattern, as well as specific case uses, may be needed based on individual patient characteristics and concurrent procedures. This review aims to discuss the evidence supporting antithrombotic treatments in patients treated with TAVI, indications for a standardized treatment, as well as specific considerations for an individualized approach to treatment.

Transcatheter Aortic Valve Implantation (TAVI) now represents the mainstay in the treatment of severe aortic stenosis. Owing to its exceptional procedural efficacy and safety, TAVI has been extended to include patients at lower surgical risk, thus now encompassing a diverse patient population receiving this treatment. Yet, long-term outcomes also depend on optimal medical therapy for secondary vascular prevention, with antithrombotic therapy serving as a cornerstone. Leveraging data from multiple randomized controlled trials, current guidelines generally recommend single antithrombotic therapy, with either single antiplatelet therapy (SAPT) or oral anticoagulation (OAC) alone in those patients without, or with atrial fibrillation respectively. Yet, individualization of this pattern, as well as specific case uses, may be needed based on individual-patient characteristics and concurrent procedures. This review aims to discuss the evidence supporting antithrombotic treatments in patients treated with TAVI, indications for a standardized treatment, as well as specific considerations for an individualized approach to treatment.