Key takeaways for interventional cardiology from TCT 2025
At TCT 2025 in San Francisco, interventional cardiology delivered a slate of late-breaking clinical trials that could reshape practice patterns across coronary, structural and vascular interventions.
B. Hadley Wilson, MD, executive vice chair of Atrium Health's Sanger Heart and Vascular Institute and clinical professor of medicine at Wake Forest University School of Medicine, said this year’s presentations felt “particularly exciting” and were among the most impactful in recent years.
“A lot of these trials were started just before or during the pandemic and are just now coming to fruition,” Wilson, a former American College of Cardiology president, told Cardiovascular Business during the conference. “We’re seeing the results of several years of work finally pay off.”
Drug-coated balloons return to the spotlight
Among the most closely watched studies were multiple drug-coated balloon (DCB) trials, including the SELUTION and the SELUTION4ISR trials focused on a sirolimus-coated balloon.
Wilson said the results showed one-year outcomes comparable to what clinicians see with drug-eluting stents (DES), suggesting that the field might be entering a “back-to-the-future” era where balloons, rather than stents, could again be used to deliver drugs without leaving behind permanent metal scaffolds.
"After these series of trials, we may actually see drug-eluting balloons being used where right now we're seeing drug-coated stents as the standard. That has the potential of using less metal in patients and still have good results, but it remains to be seen," Wilson explained.
While about 20% of cases in the trial still required bailout stenting, Wilson said the data could shift how interventionalists think about managing small vessels, side branches and in-stent restenosis (ISR). ISR is currently the only FDA-approved use for DCBs in the U.S.
Read more on the drug-coated balloon late-breakers.
Simplifying the treatment for calcified lesions
Another group of late-breaking studies—including the SHORTCUT and VICTORY trials—compared lower-cost, lower-complexity technologies such as traditional cutting balloons and high-pressure balloons against intravascular lithotripsy (IVL) for treating calcified lesions.
“IVL has been the darling of the last few years,” Wilson said. “But these trials suggest that in some cases, a high-pressure or scoring balloon could achieve comparable results.”
That could have major implications for cost and procedural simplicity, especially in resource-limited settings.
Long-term TAVR durability confirmed for low-risk patients
On the structural heart side, the seven-year results from the PARTNER 3 trial drew significant attention. The data showed that the Edwards Lifesciences Sapien 3 transcatheter aortic valve replacement (TAVR) device in low-risk patients remained comparable to surgical valve replacement in both outcomes and valve durability.
"The PARTNER 3 trial seven-year results look very good in the low-risk patients. They were showing the valve quality of the TAVR valves are were holding up well compared to surgical valves, so that's also very encouraging," Wilson explained.
He added that the findings could help further expand TAVR into lower-risk and younger populations, provided durability continues to hold up in future follow-up.
Surgical valves tend to start seeing durability issues within about seven to 10 years of implant. It was widely expected TAVR valves, originally developed for very old and sicker patients with a lower life expectancy, would have a a shorter life span. This is partly due to the additional stresses these valves undergo to fold them into small delivery catheters.
Read more on the PARTNER 3 Results.
Tricuspid valve repair and replacement studies also demonstrated strong results, further advancing the field of structural intervention.
Device therapy better than drugs for pulmonary embolism
A major highlight in peripheral intervention was the STORM-PE trial, which tested a thrombectomy device for evacuating clots in patients with intermediate-risk pulmonary embolism (PE).
The trial showed superiority over anticoagulation alone, marking one of the first strong comparative datasets in over a decade for device-based PE therapy in intermediate-risk patients.
“This was the evidence interventionalists have been waiting for,” Wilson said. “It’s the first trial to really show device therapy outperforming medical therapy in this group.”
AI-powered ECGs help lower false positives
In a forward-looking presentation, an AI-powered ECG algorithm developed by Power Medical showed superior accuracy to both cardiologists and traditional ECG software in detecting acute myocardial infarction and occluded arteries.
"It essentially is superior to both previous computerized ECG reports and to cardiologists in detecting acute myocardial infarction and occluded arteries. It's amazing seeing some of the examples, where it can see very subtle changes on the ECG. It's better than humans," Wilson said.
The AI model could reduce false positives while accelerating treatment for true emergencies, potentially transforming acute cardiac care triage. This includes lower the number of cath lab activation's that turn out not to be ST-elevated myocardial infarctions (STEMI).
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]