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ObjectiveA meta-analysis of all randomised controlled studies that compare outcomes of transradial versus the transfemoral route to better define best practice in patients with ST elevation myocardial infarction (STEMI).DesignA Medline and Embase search was conducted using the search terms ‘transradial,’ ‘radial’, ‘STEMI’, ‘myocardial’ and ‘infarction’.SettingRandomised controlled studies that compare outcomes of transradial versus the transfemoral route.PatientsA total of nine studies were identified that consisted of 2977 patients with STEMI.InterventionsStudies that compare outcomes of transradial versus the transfemoral route.Main outcome measuresThe primary clinical outcomes of interest were (1) mortality; (2) major adverse cardiac events (MACE); (3) major bleeding and (4) access site complications.ResultsTransradial PCI was associated with a reduction in mortality (OR 0.53, 95% CI 0.33 to 0.84; p=0.008), MACE (OR 0.62, 95% CI 0.43 to 0.90; p=0.012), major bleeding events (OR 0.63, 95% CI 0.35-1.12; p=0.12) and access site complications (OR 0.30, 95% CI 0.19 to 0.48; p<0.0001) compared with procedures performed through the femoral route.ConclusionsThis meta-analysis demonstrates a significant reduction in mortality, MACE and major access site complications associated with the transradial access site in STEMI. The meta-analysis supports the preferential use of radial access for STEMI PCI.

Background: Only a few studies have investigated the risk factors for the prognosis of progressive cerebral infarction (PCI) and the relationship between PCI and cerebral infarction (CI) recurrence. Objective: The objective of this study is to analyze the risk factors for PCI and PCI prognosis and evaluate the relationship between PCI and CI recurrence, mortality, short-term outcomes. Methods: The retrospective study included 221 CI patients. PCI and non-PCI patients were divided into the observation (91) and control (130) groups, respectively. Patients' clinical data, including diabetes history, laboratory blood indices, National Institutes of Health Stroke Scale (NIHSS) scores at admission, and presence of carotid and intracranial artery stenoses, were retrospectively analyzed. Instances of CI recurrence, adverse short-term outcomes, and death within 1 year postanalysis were recorded. Results: Diabetes, homocysteine, NIHSS score at admission, fibrinogen, and intracranial artery stenosis were associated with PCI. Age, NIHSS score at admission, and pneumonia were associated with PCI prognosis. By 12-month follow-up, the mortality and adverse outcome rate in the observation group were significantly increased than those of the control group. There was no diference in CI recurrence rates between the groups. Adverse outcomes were associated with PCI, age, and homocysteine. Conclusions: PCI risk factors included diabetes, homocysteine, NIHSS score at admission, fibrinogen, and intracranial artery stenosis. The independent risk factors for PCI prognosis included age, high NIHSS score at admission, and pneumonia. PCI did not affect CI recurrence but may affect adverse short-term outcomes.

Despite advances in stent design, pharmacotherapy, and procedural techniques that have improved percutaneous coronary intervention (PCI) outcomes and reduced PCI-related complications, these events still occur and are associated with adverse outcomes. Moreover, complex PCI procedures, which predispose to increased risk of complications, are increasingly performed. Understanding risk factors, underlying mechanisms, evidence-based management, and preventive strategies are essential to optimize procedural outcomes. This review aims to summarize current evidence and highlight gaps in knowledge related to PCI-associated complications. This narrative review used a focused PubMed search through October 2025, prioritizing randomized trials, large observational studies, guidelines, and consensus statements. Acute vessel closure, which most commonly results from dissection or thrombosis and perforation are frequently associated with hemodynamic compromise and increased procedural mortality. Device-related complications such as entrapment and fracture, although rare, can potentially lead to significant morbidity and mortality. Preventive strategies emphasize appropriate lesion preparation, proper device selection and sizing, gentle manipulation, and the use of adjunctive imaging modalities such as intravascular ultrasound and optical coherence tomography to minimize risk. Early recognition and prompt management of these complications are essential to decreased adverse outcomes of PCI in both short and long term. However, due to the low incidence of these events, current management strategies are largely based on case reports, observational studies, and expert consensus. Future large-scale studies and registry data, along with artificial intelligence-guided risk modeling are warranted to facilitate individualized prediction, enhance procedural safety, and advance precision management across preprocedural, intraprocedural and postprocedural phases.

Coronary computed tomography angiography (CCTA) is increasingly recognized as a comprehensive tool for planning percutaneous coronary intervention (PCI). By integrating plaque morphology, calcium burden, and CT-derived coronary physiology, CCTA enables non-invasive assessment of lesion complexity and supports precision-guided revascularization. This narrative review synthesizes current evidence on CT-guided PCI from original studies, registries, expert consensus documents, and international guideline recommendations. The literature was identified through PubMed, Embase, and Google Scholar, focusing on CCTA-based plaque characterization, calcium assessment, bifurcation and ostial lesions, chronic total occlusions (CTO), FFR-CT, virtual PCI simulation, and fusion imaging. Particular attention was given to contemporary investigations such as SYNTAX III, P3, and the ongoing P4 trial. CCTA reliably characterizes stenosis severity, plaque distribution, and calcification, demonstrating strong concordance with intravascular imaging. CT-based measurements support accurate stent sizing, prediction of calcium modification requirements, and identification of high-risk features in bifurcation and ostial disease. In CTO PCI, CCTA enhances visualization of proximal cap morphology, occlusion length, tortuosity, and distal vessel quality, outperforming angiographic scoring systems. CT-derived physiology and virtual PCI planning improve lesion selection and allow prediction of post-PCI hemodynamics. Emerging technologies—including photon-counting CT, artificial intelligence-assisted plaque analysis, and CT–fluoroscopy fusion—further expand the applicability of CT-guided PCI. The ongoing P4 trial is expected to provide definitive validation of CT-guided PCI and may support its incorporation into routine clinical workflows.

IntroductionPercutaneous coronary intervention (PCI) is used to treat increasingly complex coronary disease but requires exposure to ionising radiation. The additional risk of incident cancer from these exposures has generally been considered clinically insignificant. Recent data from the REVIVED-BCIS2, EXCEL and ISCHEMIA trials have, however, signalled higher rates of incident cancer in patients who underwent PCI, compared to non-PCI treatment. The aim of this study was to quantify the radiation exposure of patients undergoing complex PCI and determine whether exposure has increased over time.MethodsAll patients recruited at the lead centre for REVIVED-BCIS2 were included. Data were collected from the trial case report form including randomisation date and treatment assignment (PCI or optimal medical therapy (OMT)). Radiation exposure was quantified by the dose area product (DAP) for all angiographic procedures. In patients assigned to PCI, procedural complexity was defined by patients with chronic total occlusion (CTO) and complex high-risk indicated PCI (CHIP). Patients were grouped into three timeframes: 2013-2015, 2016-2017, and 2018-2020. The radiation doses between each timeframe and between complex and non-complex PCI procedures were compared with ANOVA or unpaired T-tests.ResultsOne hundred and twenty-four patients were included in the analysis; 62 were randomised to PCI. Mean age was 68.5 years (SD = 9.0 years). The mean total DAP in the OMT arm was 1689 cGycm2 (SD = 1430 cGycm2), compared to 10606 cGycm2 (SD = 9946 cGycm2) in the PCI arm (P < 0.001). The additional dose in the PCI arm is approximately 17.8 mSv, equivalent to an additional 6.61 years of background radiation. For patients undergoing non-complex procedures, a non-significant decrease in mean DAP was noted over time, despite the number of stents increasing. 16.7% of PCIs were complex in 2013-2015, 20.8% in 2016-2017, and 52.6% in 2018-2020. Figure 1 summarises the DAP received by patients during their PCI procedures.ConclusionRadiation doses received by PCI patients in the REVIVED trial increased over time, largely driven by an increasing proportion of complex procedures. Clinicians should consider radiation exposure when considering PCI and consenting patients, particularly given the marginal benefit of PCI in stable coronary disease.Abstract 51 Figure 1a logarithmic (base 2) chart highlighting the DAP received by patients at the lead centre for REVIVED-BCIS2 from their PCI procedure alone, excluding radiation dosage from angiography.Key: DAP = Dose Area Product, PCI = percutaneous coronary interventionConflict of InterestNone

Whether physiology-guided complete revascularization of nonculprit lesions is superior to culprit lesion-only percutaneous coronary intervention (PCI) in patients with myocardial infarction (MI) and multivessel disease remains debated. Online databases were searched for randomized controlled trials comparing physiology-guided complete revascularization and culprit lesion-only PCI in patients with MI. The outcomes of interest were all-cause death, cardiovascular (CV) death, repeat revascularization, MI, stent thrombosis, and contrast-associated nephropathy/acute kidney injury. Pooled odds ratios, along with 95% confidence intervals (CI) were calculated. A total of 4,849 patients (n = 2,288 physiology-guided complete revascularization, n = 2,561 culprit lesion-only PCI) were included. The mean age was 66 years and 76% were men. At a mean follow-up of 2.5 years, physiology-guided complete revascularization was associated with significant reductions in CV death (odds ratio 0.72, 95% CI 0.54 to 0.97, p = 0.03) and repeat revascularizations (0.50, 95% CI 0.38 to 0.66, p <0.00001) compared with culprit lesion-only PCI. There were no differences between the 2 approaches in all-cause death (0.91, 95% CI 0.69 to 1.19, p = 0.50), MI (0.85, 95% CI 0.59 to 1.21, p = 0.36), stent thrombosis (1.24, 95% CI 0.58 to 2.69, p = 0.58), and contrast-associated nephropathy/acute kidney injury (1.07, 95% CI 0.88 to 1.31, p = 0.50). In conclusion, among patients with MI and multivessel disease, physiology-guided complete revascularization was associated with significant reductions in CV death and revascularizations compared with culprit lesion-only PCI.

The fabrication of an integrated circuit requires a variety of physical and chemical processes to be performed on a semiconductor substrate. In general, these processes fall into three categories: film deposition, patterning, and semiconductor doping. Films of both conductors and insulators are used to connect and isolate transistors and their components. By creating structures of these various components millions of transistors can be built and wired together to form the complex circuitry of modern microelectronic devices. Fundamental to all of these processes is lithography, ie, the formation of three-dimensional relief images on the substrate for subsequent transfer of the pattern to the substrate. This book presents a complete theoretical and practical treatment of the topic of lithography for both students and researchers. It comprises ten detailed chapters plus three appendices with problems provided at the end of each chapter. Additional Information: Visiting http://www.lithoguru.com/textbook/index.html  enhances the reader's understanding as the website supplies information on how you can download a free laboratory manual, Optical Lithography Modelling with MATLAB®, to accompany the textbook. You can also contact the author and find help for instructors.

In a randomized trial, optical coherence tomography–guided PCI resulted in a larger minimum stent area than angiography-guided PCI, but there was no between-group difference in target-vessel failure at 2 years.

Background The Peritoneal Cancer Index (PCI), calculated intraoperatively, has previously yielded mixed results when correlated with computed tomography. This study aimed to quantify variation in this scoring method comparing radiologists’ and surgeons’ radiologic PCI (rPCI) assessment. Methods The rPCI of 104 patients treated at a single institution for peritoneal carcinomatosis was calculated by an abdominal radiologist and a surgeon. An additional 36-patient cohort was studied to compare preoperative rPCI with intraoperative gold standard PCI. Agreement was compared using kappa statistics. Results The rPCI of the 104 patients studied ranged from 2 to 39 (median, 12; interquartile range [IQR], 6–23) by the radiologist’s analysis and 2 to 37 (median, 9; IQR, 6–15) by the surgeon’s analysis. There was good agreement for PCI cutoffs of 15 (77.48%; kappa, 0.40) and 20 (78.63%; kappa, 0.24). The 36-patient cohort undergoing surgical exploration showed a median rPCI of 4 (IQR, 2–5.75) and a median intraoperative PCI of 11 (IQR, 6–12), with a significant difference in score by method ( p  < 0.001, Wilcoxon signed-rank test). Conclusions For rPCI cutoffs greater than 15 and 20, the surgeon’s and radiologist’s rPCI showed strong concordance, denoting the interobserver reproducibility of rPCI. Moreover, concordance with intraoperative PCI translated to radiographic assessment. The rPCI consistently underestimated intraoperative PCI, suggesting that rPCI may be a useful conservative tool for assessing peritoneal burden. Although surgical exploration is needed to “rule in” patients as candidates for CRS, the authors suggest that rPCI can be used to “rule out” patients as CRS candidates based on institutional PCI cutoffs.

Percutaneous coronary intervention (PCI) is an established alternative to coronary artery bypass grafting for the treatment of select patients with unprotected left main (LM) coronary artery disease (CAD). This study evaluates the safety and clinical impact of treating additional coronary arteries during LM-PCI. Consecutive patients undergoing PCI with drug-eluting stents for unprotected LM-CAD between 2010 and 2021 at The Mount Sinai Hospital, New York, USA were eligible for inclusion. Patients were stratified based on whether they underwent treatment of the LM complex alone or had concomitant PCI to an additional vessel outside the LM complex. The primary outcome was major adverse cardiovascular events (MACE), a composite of death, myocardial infarction, or stroke, at 1 year following PCI. Among 869 consecutive patients (mean age 70.9, 33.0% female, 27.9 mean SYNTAX score) undergoing LM-PCI, 479 (55.1%) underwent treatment of the LM complex alone, and 390 (44.9%) had concomitant PCI of an additional non-LM vessel. Compared with LM complex PCI only, there were no significant differences in the rate of MACE at 1 year [HR 12.0% vs 13.3%; HR: 0.95; 95% CI (0.62–1.44), p = 0.797], even after adjustment for potential confounders [HR 12.0% vs 13.3%; HR: 0.87; 95% CI (0.56–1.36), p = 0.550]. In conclusion, in a large, real-world cohort of patients undergoing unprotected LM-PCI, treatment of an additional non-LM vessel did not increase the risk of MACE at 1 year compared to LM complex PCI alone.