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•Renal artery stenting declined 41 % in Medicare patients from 2016 to 2020.•Recipients were medically complex with high 5-year mortality (∼40 %).•Black and dual-eligible patients had higher risks of renal and CV events.•Findings emphasize guideline-concordant patient selection for revascularization. Atherosclerotic renal artery stenosis (RAS) affects nearly 7% of adults over age 65 and is associated with increased cardiovascular and renal morbidity. Although early observational studies suggested benefit from renal artery stenting, subsequent randomized trials failed to show improvement in major clinical endpoints, contributing to substantial declines in procedural use. To characterize contemporary practice, we conducted a retrospective cohort study of Medicare beneficiaries older than 65 years who underwent renal artery stenting for atherosclerotic RAS between 2016 and 2020. Using Medicare claims data, we evaluated baseline characteristics, temporal utilization, and postprocedural outcomes, stratified by race, geographic region, and dual Medicare–Medicaid enrollment status. Among 19,130 patients, the mean age was 76.0 years (±6.4), 59.2% were female, and 90.3% were White; 84.2% had chronic kidney disease and 48.7% had heart failure. Procedural rates declined by 41.1% over the study period. Compared with White patients, Black patients had higher adjusted risks of hypertensive crisis hospitalization (aHR 1.45, 95% CI, 1.24–1.70) and dialysis initiation (aHR 1.78, 95% CI, 1.39–2.27); patients of Other races also had greater risk of dialysis initiation (aHR 1.98, 95% CI, 1.50–2.63). Patients in the South experienced higher unadjusted cardiovascular event rates (50.0%) but similar adjusted mortality compared with those in the Northeast (aHR 1.09, 95% CI, 0.98–1.21). Dual enrollment was associated with increased all-cause mortality (aHR 1.31, 95% CI, 1.20–1.43). In conclusion, renal artery stenting rates continued to decline in recent years, and contemporary recipients constitute an older, comorbid population with substantial cardiovascular risk. Outcomes differed markedly by race, socioeconomic status, and geography, highlighting the need for improved risk stratification and prospective evaluation of stenting in high-risk cohorts.

Background Cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity globally, and a number of treatment and preventive strategies have been tried for years. Lifestyle modification programs have been widely implemented as a primary prevention strategy to reduce the burden of CVDs. However, their effectiveness in patients with established CVD in monitoring modifiable risk factors is controversial and requires further investigation. Methods A comprehensive search was conducted in PubMed, Cochrane, Science Direct, and LILACS without date and language restrictions. All randomized controlled trials (RCT) comparing the effectiveness of lifestyle modification and/ or optimization of drug therapies among patients with established cardiovascular disease were included. The primary outcomes were changes in systolic blood pressure and low-density lipoprotein cholesterol. Secondary outcomes included changes in total cholesterol, diastolic blood pressure, and medication adherence. Meta-analysis results were reported as standardized mean difference (SMD) or risk ratio (RR) and 95% confidence intervals (CI). Sub-analyses examined programs that included both lifestyle modification and drug optimization or type of intervention alone if a minimum of three trials were identified. The quality of evidence was evaluated using GRADE and trial sequential analyses. Results Sixteen trials including 4450 participants were included in testing programs focused on both lifestyle modification and drug optimisation (seven RCTs) and lifestyle modification alone (nine RCTs). Overall the programs significantly reduced systolic blood pressure (SMD =  − 0.30, 95% CI − 0.43 to − 0.17, P  < 0.001), diastolic blood pressure (SMD =  − 0.18, 95% CI − 0.28 to − 0.08 P  < 0.001), total cholesterol (SMD =  − 0.28, 95% CI − 0.49 to − 0.07, P  = 0.009); however, the quality of evidence was rated as low. Conclusion Lifestyle modification and medication optimization interventions had a significant effect on monitoring blood pressure and serum cholesterol; however, the provision of the firm conclusion is less optimal with current evidence as the quality of evidence was low. Systematic review registration The systematic review and meta-analysis protocol was registered in PROSPERO CRD42024523078.

To evaluate short-term procedural outcomes and safety for infants < 2.5 kg who underwent catheterization with intended patent ductus arteriosus (PDA) device closure in a multi-center registry, as performance of this procedure becomes widespread. A multi-center retrospective review was performed using data from the Congenital Cardiac Catheterization Project on Outcomes (C3PO) registry. Data were collected for all intended cases of PDA closure in infants < 2.5 kg from April 2019 to December 2020 at 13 participating sites. Successful device closure was defined as device placement at the conclusion of the catheterization. Procedural outcomes and adverse events (AE) were described, and associations between patient characteristics, procedural outcomes and AEs were analyzed. During the study period, 300 cases were performed with a median weight of 1.0 kg (range 0.7–2.4). Successful device closure was achieved in 98.7% of cases with a 1.7% incidence of level 4/5 AEs, including one periprocedural mortality. Neither failed device placement nor adverse events were significantly associated with patient age, weight or institutional volume. Higher incidence of adverse events associated with patients who had non-cardiac problems ( p  = 0.017) and cases with multiple devices attempted ( p  = 0.064). Transcatheter PDA closure in small infants can be performed with excellent short-term outcomes and safety across institutions with variable case volume.

Magnetic particle imaging (MPI) is a novel imaging method that was first proposed by Gleich and Weizenecker in 2005. Applying static and dynamic magnetic fields, MPI exploits the unique characteristics of superparamagnetic iron oxide nanoparticles (SPIONs). The SPIONs' response allows a three-dimensional visualization of their distribution in space with a superb contrast, a very high temporal and good spatial resolution. Essentially, it is the SPIONs' superparamagnetic characteristics, the fact that they are magnetically saturable, and the harmonic composition of the SPIONs' response that make MPI possible at all. As SPIONs are the essential element of MPI, the development of customized nanoparticles is pursued with the greatest effort by many groups. Their objective is the creation of a SPION or a conglomerate of particles that will feature a much higher MPI performance than nanoparticles currently available commercially. A particle's MPI performance and suitability is characterized by parameters such as the strength of its MPI signal, its biocompatibility, or its pharmacokinetics. Some of the most important adjuster bolts to tune them are the particles' iron core and hydrodynamic diameter, their anisotropy, the composition of the particles' suspension, and their coating. As a three-dimensional, real-time imaging modality that is free of ionizing radiation, MPI appears ideally suited for applications such as vascular imaging and interventions as well as cellular and targeted imaging. A number of different theories and technical approaches on the way to the actual implementation of the basic concept of MPI have been seen in the last few years. Research groups around the world are working on different scanner geometries, from closed bore systems to single-sided scanners, and use reconstruction methods that are either based on actual calibration measurements or on theoretical models. This review aims at giving an overview of current developments and future directions in MPI about a decade after its first appearance.

Endovascular therapies have transformed cardiovascular medicine, yet restenosis, thrombosis, and device failure remain common and poorly predictable complications. Increasing evidence suggests that immunothrombotic processes critically shape vascular recovery after device implantation. This includes neutrophil extracellular trap (NET) formation, innate immune polarization, and endothelial damage responses. Concurrently, advances in artificial intelligence (AI) are increasingly enabling continuous multimodal monitoring and adaptive clinical decision-making throughout the medical device life cycle. Here, we propose the concept of immunologically adaptive endovascular devices: a closed-loop paradigm in which patient immune status informs device selection, device–tissue interactions are interpreted via mechanistic biomarkers, and real-world monitoring dynamically updates risk and management. The study introduces (i) an immune–device interaction phenotype taxonomy linking device design features to measurable thrombo-inflammatory trajectories, (ii) a mechanistic framework defining interface signaling processes that enhance or resolve NET-driven responses, (iii) a minimum evidence model encompassing preclinical testing, clinical validation, and post-market surveillance, and (iv) a reference AI architecture for risk prediction, drift detection, and safety monitoring. This study also outlined testable predictions and a translational roadmap toward precision endovascular intervention and next-generation adaptive cardiovascular devices.

Aneurysms pose life-threatening risks due to the dilatation of the arteries and carry a high risk of rupture. Despite continuous research efforts, there are still no satisfactory or clinically effective pharmaceutical treatments for this condition. Accelerated inflammatory processes during aneurysm development lead to increased levels of matrix metalloproteinases (MMPs) and destabilization of the vessel wall through the degradation of the structural components of the extracellular matrix (ECM), mainly collagen and elastin. Tissue inhibitors of metalloproteinases (TIMPs) directly regulate MMP activity and consequently inhibit ECM proteolysis. In this work, the synthesis of TIMP-1 protein was increased by the exogenous delivery of synthetic TIMP-1 encoding mRNA into aortic vessel tissue in an attempt to inhibit MMP-9. In vitro, TIMP-1 mRNA transfection resulted in significantly increased TIMP-1 protein expression in various cells. The functionality of the expressed protein was evaluated in an appropriate ex vivo aortic vessel model. Decreased MMP-9 activity was detected using in situ zymography 24 h and 48 h post microinjection of 5 µg TIMP-1 mRNA into the aortic vessel wall. These results suggest that TIMP-1 mRNA administration is a promising approach for the treatment of aneurysms.

Drug-coated cardiovascular devices (DCCDs), including drug-eluting stents (DESs) and drug-coated balloons (DCBs), have significantly advanced interventional cardiology by reducing restenosis and improving long-term outcomes. However, their effectiveness is limited by challenges such as patient-device mismatch, variability in drug delivery kinetics, and dependence on operator experience. Traditional strategies for device selection and performance evaluation are often inadequate to address patient-specific complexities. This narrative review aims to explore how artificial intelligence (AI) can improve the design, deployment, and monitoring of DCCDs, focusing on personalized treatment strategies, regulatory implications, and future innovations in interventional cardiology. A targeted literature search was conducted in PubMed, Scopus, and Web of Science between 2020 and 2025 using keywords such as \"artificial intelligence\", \"drug-eluting stents\", \"cardiovascular devices\", \"machine learning\", and \"intravascular imaging\". Studies were included based on their relevance to AI applications in DCCD design, procedural support, or post-procedural monitoring. AI has demonstrated significant potential throughout the DCCD lifecycle. In design, machine learning models enable optimization of drug release kinetics and device geometry. During procedures, AI improves real-time intravascular imaging interpretation and provides guidance for precise device placement. Post-intervention, predictive analyses using patient data can aid in the early detection of complications such as in-stent restenosis. Furthermore, technical, regulatory, and ethical challenges remain, including model validation, data bias, and the need for transparency in decision-making algorithms. AI-driven approaches offer a promising paradigm for advancing cardiovascular device technology toward more adaptable, personalized, and efficient care. Integrating explainable, clinically validated AI systems with DCCDs can improve outcomes, reduce procedural variability, and support value-based care. Future research should prioritize real-time intraoperative feedback systems, adaptive AI models based on longitudinal patient data, and regulatory compliance and fairness strategies.

Radial artery is the preferred access for coronary interventions. However, the procedure is sometimes interrupted by a spasm which causes pain, prolongs the procedure, and can force the access crossover. To observe factors contributing to a symptomatic radial artery spasm. In this prospective study, we present results of 103 consecutive patients regarding radial artery spasm and angiographic image of the punctured artery. Angiography of the radial artery was performed in 70 (68.0%) patients. Potential risk factors for radial artery spasm were evaluated. The overall incidence of the radial artery spasm was high - 25 (24.3%). Signs of spasm were present in 37.1% of radial artery angiographies before the procedure and 60.1% after, however, it did not always indicate a symptomatic spasm. Risk factors related to radial artery spasm included female sex (OR = 2.94, = 0.02), failure of the first puncture attempt (OR = 3.12, = 0.014) and use of non-hydrophilic sheath (OR = 9.56, = 0.036). Radial artery narrowing at the tip of the sheath was also a risk factor for spasm ( = 0.022). No spasms were observed after hydrophilic sheath application ( = 13). The administration of a radial cocktail was not observed to significantly decrease the spasm odds. Risk factors for radial artery spasm include female sex and multiple puncture attempts. Hydrophilic sheath coating protects against radial artery spasm. Overall signs of a spasm in the angiography are common and do not imply a symptomatic spasm, which can be predicted by a tight narrowing at the tip of the sheath.

In order to solve the problems of missing, discontinuous, and unstructured data in past cardiovascular interventional studies, this work constructed a database of specific cardiovascular interventional diseases. Within one year of its implementation in a top-three hospital in Zhejiang Province, the database collected a total of 728 cases of cardiovascular interventional patients, realizing the structuring of patient data and 360° whole-cycle management. With the support of a specific disease database, we proposed an improved LSTM-BLS model to predict the risk of death after cardiovascular interventions. Compared with the traditional long-short term memory (LSTM) model, the parallel learning structure-width learning system (BLS) was introduced to calculate the weights directly, which can solve the problems of overfitting and delay caused by the deep structure of LSTM, so as to improve the accuracy of prediction. The experimental results showed that the accuracy rate of the proposed model was 87.46%, the precision was 90.74%, and recall rate was 93.61%, which can objectively reflect the postoperative death risk of patients, and help doctors to make timely medical intervention for patients with high death risk.

Evidence on incision lengths for ports and cardiopulmonary bypass (CPB) cannulation in robotic cardiac surgery is limited. This study aimed to assess these metrics and influencing factors. 204 patients underwent robotic mitral valve repair (MVR) (54.9%), totally endoscopic coronary artery bypass grafting (TECAB) (30.9%), and minimally invasive direct coronary artery bypass grafting (MIDCAB) (14.2%). Total incision length (TIL) was measured intraoperatively and defined as the sum of thoracic incisions, portholes, and incisions for cannulation. In both univariate and multivariate analyses, TIL was calculated based on demographic and intraoperative variables. Additionally, TIL was linked with postoperative outcomes. The median length of thoracic access incisions and ports was 11.5 (5.0-51.0) cm, while for cannulation access, it was 5.0 (3.0-13.0) cm. The median total incision length was 16.5 (10.0-62.0) cm. Thirteen pre- and intraoperative variables were associated with TIL on univariate analysis. Multivariate analysis revealed that BMI (  = 0.003), procedure type (  < 0.001), conversion to sternotomy (  < 0.001), technical challenges (  = 0.034) and total procedure time (  < 0.001) were associated with extended incision length. Multivariate testing additionally showed an association of TIL with blood transfusion (  = 0.004) and hospital stay (  < 0.001). Incision length in robotic cardiac surgery is primarily linked to obesity, procedure type, surgical technical problems, conversion to sternotomy, and procedure time. Longer incisions are associated with an increased number of blood transfusions and longer hospital stay.