Grigorios Korosoglou

Summary: Background: To compare atherectomy-assisted endovascular revascularization with balloon angioplasty for the treatment of common femoral artery disease (CFAD). Materials and methods: In a multi-centre retrospective research collaborative, data from consecutive patients who underwent endovascular revascularization of the groin were analysed. Primary endpoints were clinically driven target-lesion-revascularization (CD-TLR) and improvement of clinical symptoms by Rutherford categories (RC). Kaplan-Mayer analyses were used to evaluate these endpoints over time in patients undergoing atherectomy-assisted versus conventional endovascular treatment. In addition, retrospective case-control matching was performed, considering patient and lesion specific characteristics. Lesion calcification was assessed using the PACSS scoring system. Results: Of 225 patients, 179 (79.6%) underwent atherectomy-assisted treatment, whereas 46 (20.4%) underwent balloon angioplasty. Mean age was 72.0 (66.0–79.0) yrs, 139 patients (61.8%) had intermittent claudication and 84 (37.3%) had chronic limb-threatening ischemia (CLTI). Involvement of the deep femoral artery femoral was present in 137 (60.9%) cases, whereas lesion calcification was moderate to severe (PACSS 2–4) in most cases (88%). Atherectomy had low complication rates (perforation in one (0.6%) patient and distal embolization requiring re-intervention in 2 (0.9%) patients) and lower rates of bail-out stenting compared to angioplasty (5.1% versus 36.7%, p<.0001). No perforation or distal embolization was observed in the angioplasty group. After matching for patient and lesion characteristics CD-TLR (HR=4.0, 95%CI=1.0–15.0, p<.05) and RC improvement rates both favoured atherectomy (93.5% versus 73.1%, p<.05). Conclusions: Atherectomy-assisted endovascular revascularization of CFAD seems to be associated with lower stent placement and re-intervention rates compared to balloon angioplasty. Future prospective trials with longer follow-up duration are now warranted.

Cardiology and vascular medicine continue to rapidly evolve in terms of percutaneous therapeutic capabilities for our patients, yet accurate diagnosis and effective management of complex cardiovascular diseases remain major clinical challenges that require increasingly advanced diagnostic tools. Multimodality imaging is central to this process, offering essential insights into cardiac anatomy, perfusion, viability, function, and tissue characterization. Technological advances in recent decades have expanded clinicians' ability to assess complex clinical problems. Available modalities range from echocardiography, the established first-line imaging technique, to cardiac magnetic resonance (CMR) and computed tomography (CT), each with distinct strengths and limitations. Therefore, a multimodality imaging approach that combines their complementary advantages is often needed in clinical practice. The present collection presents real-world cases in which cardiovascular imaging, used alone or in combination, helped resolve diagnostic uncertainty, characterize pathology precisely, and guide optimal treatment strategies. Non-invasive imaging: From serial echocardiography to the integrative approach of multimodality imaging. Echocardiography was central to assessing cardiac dimensions and function in a 79-year-old woman with paroxysmal atrial fibrillation (10.3389/fcvm.2026.1762249). The patient presented with signs of congestive heart failure, and echocardiography revealed new-onset tricuspid annular dilatation with torrential tricuspid regurgitation. These findings guided management and led to deferral of minimally invasive tricuspid valve clipping. After successful electrical cardioversion, reverse right atrial remodeling occurred, with resolution of atrial enlargement and tricuspid regurgitation. Clinical symptoms also improved within a few weeks. To maintain sinus rhythm, the patient underwent cryoablation, and her subsequent clinical course was uneventful.The central role of non-invasive cardiovascular imaging for the diagnosis of microvascular dysfunction in a patient with cardiac amyloidosis is highlighted by Yuqian Dai et al in (10.3389/fcvm.2026.1710211). Cardiac amyloidosis (CA) is a rare but increasingly recognized cause of myocardial storage disease causing heart failure. [1][2][3] In a patient with lightchain (AL) cardiac amyloidosis and exertional angina, contrast adenosine stress echocardiography with Doppler-derived coronary flow velocity reserve (CFVR) showed impaired myocardial perfusion. These findings were consistent with CMR and laboratory results, confirming myocardial amyloid deposition. This case supports the use of contrast adenosine stress echocardiography as a practical adjunct to advanced imaging for evaluating microvascular dysfunction.The case presented by Yuting Yi et al (10.3389/fcvm.2026.1774080) underscores the central role of multimodality cardiovascular imaging in modern cardiology. In a 54-year-old woman with exertional dyspnea and signs of heart failure, multimodality imaging demonstrated apical hypertrophy with cavity obliteration, endocardial fibrosis, and calcification. 18 F-FDG PET-CT showed intense apical uptake, initially raising concern for malignancy. However, CMR with late gadolinium enhancement (LGE) supported a diagnosis of hypertrophic cardiomyopathy. Endomyocardial biopsy and genetic testing further identified a pathogenic MYH7 variant, consistent with this diagnosis. The importance of CMR and genetic testing in hypertrophic cardiomyopathy has also been highlighted in recent large multicenter studies. 4 Another case underscoring the role of multimodality imaging with cardiac masses has been presented by Juan Wang et al (10.3389/fcvm.2025.1685844). Pericardial involvement with myxoid liposarcoma is exceptionally rare and usually indicates metastatic disease. In the present case multimodal imaging (CT, ultrasound, CMR) revealed a pericardial mass compatible with metastatic liposarcoma. The diagnosis was confirmed by histopathology and molecular testing. The role of CMR for the diagnostic classification and risk stratification of patients with cardiac masses has been recently demonstrated in single-and multi-center studies. 5,6 In a related case with cardiac malignancy (10.3389/fcvm.2025.1688224), Konuş presents a 47-year-old female suffering from heart failure induced by a giant primary pericardial schwannoma. Although multimodality imaging established the presence and extension of the cardiac tumor, the definitive preoperative histological diagnosis was achieved using a method rarely employed in cardiovascular diseases, namely endoscopic ultrasoundguided fine needle aspiration (EUS-FNA). This report supports the use of this method as an alternative to open surgical biopsy for lesions situated favorably relative to the esophageal tract.The versatility of modern CMR allows the assessment of myocardial function, perfusion, viability and if required myocardial metabolism and tissue characterization and strain within a single examination and without radiation exposure for the patients. 7,8 However, extrasystoles may pose a significant limitation for image quality with CMR. This is highlighted in (10.3389/fcvm.2025.1596440), where Röwer et al report on the ability of real-time CMR to offer high image quality during free breathing and, in combination with an ECG provide a unique opportunity to analyze cardiac hemodynamics, which was not feasible using conventional CMR sequences. The utility of multimodality imaging in procedural guidance. In the report by Mandic et al. (10.3389/fcvm.2025.1637475), the authors present a 65-year-old female with severe hypertrophic obstructive cardiomyopathy diagnosed by multimodality imaging and referred for alcohol septal ablation. However, the presence of a rare congenital coronary artery anomaly with a single right coronary artery led to procedural failure, thus prompting the operators to use an...

Summary: Background: To evaluate the ability of atherectomy combined with scoring and drug coated balloon (DCB) angioplasty for the treatment of atherosclerotic common femoral artery (CFA) disease. Patients and methods: This dual-center retrospective study analyzed data from consecutive patients who underwent atherectomy-assisted endovascular revascularization followed by scoring and DCB angioplasty and if required stent placement in the CFA. The primary endpoints included target-lesion revascularization (TLR) and improvement in clinical symptoms as measured by Rutherford categories (RC). Lesion calcification was evaluated using the Peripheral Arterial Calcification Scoring System (PACSS). Results : Of 111 patients, 64 (57.7%) had lifestyle limiting claudication, whereas 47 (42.3%) had chronic limb-threatening ischemia (CLTI). Mean age was 71.9 ± 7.8 years, 45 (40.5%) were female and 32 (28.8%) had diabetes mellitus. CFA median lesion length was 3.2 (2.4–3.7cm) and median lesion calcification by PACSS was 3.0 (3.0–3.0), whereas 13 (11.7%) were chronic total occlusions. Atherectomy was performed in 46 (41.4%) patients using the Phoenix and in 65 (58.6%) patients using the Jetstream atherectomy device with low complication rates (zero perforations and 4 (3.6%) distal embolizations). Bail-out stenting was necessary in 6 (5.4%) patients. During median follow-up of 2.0 (1.5–2.2) years, TLR was necessary in 9 (8.1%) patients, whereas RC improvement of ≥2 categories was noticed in 79 (71.2%) patients. Severe calcification PACSS four was associated with higher TLR rates (p < .001). Conclusions: Atherectomy- and scoring balloon assisted lesion preparation combined with DCB resulted in a low rate of bail-out stenting, low TLR and clinically acceptable RC improvement rates in CFAD patients. Long-term prospective trials are warranted.

Atherectomy has become an established tool for lesion preparation in the endovascular treatment of peripheral artery disease (PAD), particularly for complex and heavily calcified lesions. Despite the widespread clinical use of atherectomy, the long-term benefits of this tool remain controversial, and the available evidence is heterogeneous. This review aimed to provide a clinically oriented, expert-driven narrative evaluation of peripheral atherectomy, including the historical evolution, currently available technologies, and the contemporary clinical role of the procedure, while integrating randomized and real-world evidence to support rational patient and lesion selection. A narrative literature review was conducted based on continuous expert monitoring since 2021 and targeted PubMed searches using combinations of the terms “peripheral artery disease”, “atherectomy”, “critical limb ischemia”, and “intermittent claudication”. Randomized controlled trials, meta-analyses, major registries, and high-quality observational studies were identified, selected based on clinical relevance and methodological quality, and synthesized accordingly. Randomized trials have consistently shown that atherectomy does not provide superior long-term patency or limb salvage compared with balloon angioplasty, stenting, or drug-coated balloons (DCB). However, atherectomy has demonstrated reproducible procedural advantages across multiple studies, including greater luminal gain, fewer dissections, and less need for bailout stenting. Observational and registry data further suggest potential benefits in selected scenarios, particularly for heavily calcified lesions, long-segment occlusions, in-stent restenosis (ISR), and anatomically challenging mobile segments. Current evidence does not support the routine use of atherectomy in PAD. Nevertheless, when applied selectively in appropriately chosen patients and lesions, atherectomy represents a valuable strategy for vessel preparation. The responsible use of atherectomy requires careful integration of the available evidence with operator expertise, awareness of alternative technologies, and consideration of procedural risks and reimbursement issues.

Background: Computed coronary tomography angiography (CCTA) is an important diagnostic tool in patients with suspected acute coronary syndromes (ACS). We present a case of vasculitis and coronary involvement, in which CCTA provided critical insights for both diagnosis and management. Case summary: A 54-year-old male patient with a history of arterial hypertension, hyperlipidaemia, chronic hepatitis B, and smoking presented with stable angina and exertional dyspnoea. He reported intermittent fever up to 38.5 °C, and unintentional weight loss over the past 4 months. Physical examination revealed erythematous papules on the arms and palpable purpura on the lower legs, present for 2 weeks. Electrocardiogram and echocardiography were unremarkable, but due to elevated cardiovascular risk and mildly increased troponin levels, coronary artery disease (CAD) was suspected. He therefore underwent CCTA, which demonstrated mild to moderate stenosis of the right coronary artery along with pronounced concentric wall thickening in all three major coronary vessels, raising suspicion for vasculitis. Extensive screening for infectious, autoimmune, and connective tissue diseases was negative. A skin biopsy of the right calf confirmed cutaneous leukocytoclastic vasculitis despite negative serologic markers. The patient was initiated on immunosuppressive therapy with glucocorticoids, resulting in symptomatic improvement and regression of coronary stenoses on follow-up CCTAs. Discussion: To our knowledge, this is the first reported case of seronegative immune complex vasculitis with isolated cardiac involvement and no other systemic manifestations. In this case, CCTA not only provided detailed anatomic visualization of the coronaries but also offered precise insights into coronary wall composition, the presence of inflammation, and plaque characteristics.