Prof Nicolas Van Mieghem takes viewers through his EuroPCR 2026 reflections from Paris in a structured, case‑oriented way. He focuses on late‑breaking data in three main areas: coronary calcium modification in complex PCI, high‑risk PCI with and without mechanical circulatory support, and contemporary approaches to secondary prevention and structural heart interventions.

He starts by unpacking results from a large registry of patients with heavily calcified coronary disease treated with a new laser‑based intravascular lithotripsy catheter, explaining how lesion preparation, pulse delivery and intravascular imaging interact to keep complication rates low while achieving good stent expansion. He then moves on to comparative data for different calcium tools—lithotripsy, cutting balloons, rotational and orbital atherectomy—showing how device performance varies with calcium morphology, arc and lesion complexity, and what that means for day‑to‑day device selection.

In the high‑risk PCI segment, he reviews outcome data in patients with poor LV function undergoing complex PCI, and discusses how this informs the selective use of mechanical circulatory support rather than routine implantation. He also dedicates time to long‑term prevention after PCI, walking through large datasets on intensive LDL‑cholesterol lowering with PCSK9 inhibition and how these translate into fewer myocardial infarctions, repeat revascularisations and deaths over follow‑up.

Finally, he covers structural highlights, including transcatheter valve implantation in small annuli and tricuspid intervention registries. He outlines how differences in valve hemodynamics, prosthesis–patient mismatch, right‑ventricular function and afterload should be interpreted when choosing devices and defining procedural targets. The overall aim is to give interventional cardiologists and fellows a detailed, trial‑grounded overview that can be mapped directly onto real‑world coronary and structural cases.

Studies included:

00:30 – FFRacture trial
Coronary intravascular lithotripsy for severely calcified coronary artery disease and impact on PCI outcomes.

03:35 – SHORT‑CUT trial
Randomized comparison of cutting balloon angioplasty versus intravascular lithotripsy for calcified coronary lesions prior to DES implantation.

06:13 – iCARE study
iCARE coronary intervention study: contemporary intracoronary imaging and physiology‑guided PCI strategy.

08:13 – ORACLE study
ORACLE trial: optimisation of revascularisation strategy using physiologic assessment and imaging in complex coronary artery disease.

10:48 – PROTECT‑EU Registry
Real‑world outcomes with contemporary coronary and structural heart interventions in European practice

13:15 – VESALIUS‑CV trial
PCSK9 inhibitor evolocumab in high‑risk patients without prior ASCVD events: long‑term prevention of first major cardiovascular events.

16:08 – SMART trial
SMART study: optimising secondary prevention and event reduction in high‑risk cardiovascular patients on intensive lipid‑lowering therapy.

19:40 – TriValve Registry
Transcatheter tricuspid interventions in the TriValve Registry: patient selection, procedural strategies and clinical outcomes in advanced TR.

21:58 – Mechanical thrombectomy vs catheter‑directed thrombolysis for pulmonary embolism
Head‑to‑head comparison of contemporary mechanical thrombectomy systems versus catheter‑directed thrombolysis in high‑ and intermediate‑risk acute PE.