Challenging TCT 2026 Cases Test Interventional Boundaries Across JACC Journals
Interventional cardiologists debuted complex procedural solutions and first-in-human device applications at Transcatheter Cardiovascular Therapeutics (TCT) 2026, with findings simultaneously published across the JACC family of journals. The presentations detailed advanced imaging integrations, structural heart interventions, and management strategies for refractory complications.
In a first-in-human procedure published in JACC: Cardiovascular Interventions, Sho Nakao, MD, and colleagues used a novel hybrid intravascular ultrasound and optical frequency domain imaging catheter to guide treatment for a 72-year-old man experiencing exertional angina with prior coronary stenting. In a separate case from the same journal, Toshiyuki Iwaya, MD, and team used multimodality imaging to trace severe left main coronary compression in a 31-year-old man back to a delayed periaortic hematoma following aortic valve replacement.
Targeted Microcirculatory Vasodilation Salvages Myocardium After STEMI
The investigators noted that extensive hibernating myocardium can remain dysfunctional following primary percutaneous coronary intervention (PCI) in STEMI patients. Continuous microcirculatory vasodilation effectively salvaged viable tissue and improved cardiac function, suggesting that expanding conventional emergency time windows with novel technology may be clinically justified.
Vascular Anchors and Valve Modifications Facilitate Complex Structural Repairs
Interventionalists outlined distinct procedural techniques to manage anatomical challenges during structural heart procedures.
In another technical report, Vahe Shahmoradi, MD, and team described balloon-augmented bicuspid scallop intentional laceration to induce circularization of the aortic implant (BA-BISILICA) prior to TAVR in a 62-year-old man with severe Sievers type I bicuspid aortic stenosis. The team emphasized that precise raphe targeting and laceration are critical determinants of procedure success, potentially influencing transcatheter heart valve durability and hemodynamics.
Additional structural cases included a staged transcatheter approach for a postinfarction ventricular septal pseudoaneurysm reported by Haibin Jiang, MD, where outlet occlusion was performed five months before inlet closure. Moiz Saeed, MD, and colleagues used preprocedural 3D computed tomography (CT) projection of an occluder footprint to guide transcatheter closure of an enlarging ascending aortic pseudoaneurysm near the right coronary ostium in an 82-year-old woman.
Vasospasm and Mechanical Thrombosis Add Diagnostic Challenges
Gabriela Barsante Nicolela, MD, and co-authors described a 63-year-old man with heart failure with reduced ejection fraction who suffered cardiac arrest and ST-segment elevation due to occlusive multivessel coronary vasospasm. Intracoronary nitroglycerin successfully identified and reversed the condition in coronaries that were previously nonobstructive.
For prosthetic valve complications, Ana Paula Tagliari, MD, PhD, FACC, and colleagues reported using large-bore percutaneous mechanical aspiration paired with controlled catheter-disc interaction under cerebral embolic protection to restore disc mobility in a 76-year-old man with obstructive mechanical aortic valve thrombosis.
Frequently Asked Questions About the TCT 2026 Case Reports
What imaging modalities guided the mitral repair in the esophagectomy patient?
Karl Abou Zeid and colleagues performed mitral transcatheter edge-to-edge repair exclusively under comprehensive two-dimensional and three-dimensional intracardiac echocardiography (ICE) guidance for a 69-year-old man with severe degenerative mitral regurgitation and prior esophagectomy, where transesophageal echocardiography was contraindicated.
How was torrential tricuspid regurgitation managed alongside aortic stenosis?
Jaiel Niamat, MD, and co-authors presented a 65-year-old man with advanced right heart failure who underwent concomitant TAVR and transcatheter tricuspid valve replacement in a single procedure, demonstrating feasibility in selected patients.
What caused the left main coronary compression in the 31-year-old patient?
Multimodality imaging identified a delayed periaortic hematoma as the direct cause of the compression following the patient’s prior aortic valve replacement.
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