Intervention of aorto-ostial stent restenosis is challenging due to coronary anatomical variations, possible non-selective ostial engagements, and difficulties crossing the central lumen. Aorto-ostial stent restenosis is intervened through the central lumen or protruding side struts using various techniques. These techniques are often difficult and complex such as double wire technique, balloon-assisted technique, snare technique, side-strut sequential ballooning technique, and guideline-facilitated side strut stenting technique. In this case report, we presented an intervention for right coronary artery (RCA) ostial stent restenosis using a combination of balloon-assisted double wire technique and side-strut stenting technique in an acute coronary syndrome patient.

Dear EditorWe read with great interest the report by Huang et al. describing an identical accessory pathway (AP) location and shared heterozygous TTN and LRP6 variants in monozygotic twins with Wol...

Background and Objectives: Stenting isolated Medina 0,0,1 ostial side-branch lesions can result in geographic miss or protrusion into the main vessel. Drug-coated balloon (DCB) angioplasty avoids a permanent implant, but lesion-specific outcome data remain limited. We assessed procedural performance, bailout stenting, and 6- and 12-month outcomes after an intended DCB-only strategy. Materials and Methods: In this retrospective, single-center observational cohort study, we screened 170 patients who underwent coronary DCB treatment at a single center between 1 January 2023 and 31 July 2025. Thirty-one patients with de novo isolated Medina 0,0,1 lesions were included. The primary endpoint was 12-month target lesion failure (TLF), defined as cardiovascular death, target-vessel myocardial infarction, or clinically driven target lesion revascularization (TLR). Results: DCB-only strategy success was achieved in 29/31 patients (93.5%), post-DCB angiographic success in 29/31 (93.5%), and study-defined overall procedural success in 31/31 (100%). Final TIMI grade 3 flow after DCB was present in 30/31 patients; no flow-limiting dissection occurred. Two patients required bailout stenting, one because of deterioration to TIMI grade 2 flow and one because of residual stenosis >30% with recoil. Thirty patients were alive with documented follow-up at 12 months; one patient died from a non-cardiovascular cause at month 1. No TLF was recorded within 12 months. One clinically driven TLR for target-lesion restenosis occurred at month 20, outside the prespecified window. Conclusions: In this selected cohort, an intended DCB-only strategy avoided stent implantation in most patients and had a low bailout rate. The findings support procedural feasibility but do not establish comparative efficacy. Larger prospective studies are required.

Atrial fibrillation (AF) and heart failure (HF) frequently coexist, but the clinical relevance of AF may differ according to whether it appears to be a potentially reversible contributor, an aggravating factor in established HF, or a marker of advanced substrate. The driver–modifier–marker lens used in this review is a provisional, nonvalidated aid to clinical reasoning and should not be interpreted as a treatment score. This narrative review was informed by dated searches of PubMed/MEDLINE, the Cochrane Library, and OpenAlex through 29 July 2026, followed by a targeted update on 30 July 2026. It considers HF with reduced, mildly reduced, and preserved ejection fraction together with AF timing, burden, ventricular-rate exposure, myocardial substrate, and reversibility. Early rhythm control may be particularly relevant when AF is recent or temporally associated with ventricular dysfunction, symptoms, decompensation, or inadequate cardiac resynchronization therapy delivery. Evidence supporting catheter ablation is most direct in suspected AF-mediated cardiomyopathy and selected HFrEF populations, whereas evidence in HFpEF more consistently supports symptom relief, improved exercise hemodynamics, and AF-burden reduction than mortality reduction. Pulmonary vein isolation remains the procedural foundation. Radiofrequency, cryoballoon, and pulsed-field ablation are effective in broad AF populations, but HF phenotype-specific prognostic superiority has not been established for any energy source. Clinical decisions should reflect the design and directness of the evidence together with expected benefit, rhythm durability, procedural risk, patient-reported outcomes, stroke prevention, guideline-directed HF therapy, risk-factor management, and patient preference.