NVM Cardiology Meeting Reflections: TCT 25 Wrap Up

In this Redcliffe Cardiology NVM reflections episode, Prof Nicolas Van Mieghem cuts through the noise from TCT 2025. Tune in to hear what the SELUTION trials mean for drug-coated balloons in de novo disease and ISR, why cost and sizing matter in calcium modification, how PE thrombectomy stacks up against anticoagulation alone, and what 7-year PARTNER 3 and 10-year NOBLE data signal for TAVR and left main PCI. Practical takeaways you can use on your next case. Drug-coated balloons (DCB): SELUTION-ISR and the large SOLUTION DeNovo RCT show non-inferiority vs contemporary care,with ~80% of DCB cases avoiding a stent. How to size, when to escalate to DES, and why 5-year data will be decisive. We also contrast these results with CAGE-FREE-1 three-year outcomes and discuss “not all DCBs are created equal.” Calcium strategies: SHORT-CUT and VICTORY pit cutting/high-pressure balloons against intravascular lithotripsy. Similar luminal results—but very different costs and workflow. We outline a toolbox and imaging-first algorithm for nodular/annular calcium and where atherectomy still fits. Pulmonary embolism: STORM-PE shows catheter thrombectomy on top of anticoagulation cuts RV/LV ratio fast along with real-world procedure times, blood loss, and complications you should counsel up front. Valves & MR: PARTNER 3 at 7 years TAVR vs surgery outcomes remain similar with reassuring valve durability; mild PVL not tied to mortality. ENCIRCLE (Sapien M3 TMVR) shows strong MR elimination but flags stroke and leaflet thrombosis prompting a rethink of antithrombotic strategy. Coronary trials: NOBLE 10-year left main results, PROCTOR (native CTO vs SVG PCI), I-MODERN (iFR-guided complete revasc vs deferred CMR), iCABG (physiology-guided grafting), INFINITY SWEDEHEART (bioadaptor stent signals), and ANDES (post-LAAO DOAC vs DAPT). Expect pragmatic thresholds, device selection tips, and critical review of the latest evidence with Prof Nicolas Van Mieghem.