The 2026 Society for Cardiovascular Angiography and Interventions (SCAI) Scientific Sessions and CAIC-ACCI Summit, held in Montréal, Canada, highlighted the continuing evolution of interventional cardiology through the presentation of several important late-breaking clinical trials. This year's meeting focused on improving outcomes in cardiogenic shock, expanding coronary revascularization options, advancing structural heart therapies, and refining peripheral and pulmonary vascular interventions.

Collectively, these studies reinforced the ongoing shift toward less invasive therapies, less invasive therapies, individualized treatment strategies and multidisciplinary cardiovascular care. The following review summarizes my picks as the most important interventional and structural heart studies presented during the meeting.

Coronary Intervention

CERAMICS: Advancing Care For AMI-Related Cardiogenic Shock

Among the most important presentations at SCAI 2026 was the CERAMICS trial, which evaluated a protocol-driven approach for patients presenting with acute myocardial infarction (AMI) complicated by cardiogenic shock. The study builds upon prior work from the National Cardiogenic Shock Initiative and examined outcomes among 124 patients treated across 20 experienced shock centers.

The treatment strategy emphasized early identification of shock, rapid coronary revascularization, routine invasive hemodynamic monitoring, prompt initiation of Impella-supported circulatory assistance when appropriate, and predefined escalation pathways for patients demonstrating persistent hemodynamic compromise.

The study population represented an exceptionally high-risk cohort. Nearly 90% of patients presented with STEMI, while approximately 40% had experienced cardiac arrest prior to intervention. Despite these adverse baseline characteristics, survival to hospital discharge reached 71%, a figure that compares favorably with historical outcomes in cardiogenic shock.

Importantly, outcomes were superior among patients treated earlier in the progression of shock, reinforcing the concept that timing remains critical in shock management. The findings provide additional support for regionalized shock systems of care, multidisciplinary shock teams and early mechanical circulatory support strategies.

SELUTION DeNovo: Expanding the "Leave-Nothing-Behind" Strategy

The acute coronary syndrome (ACS) substudy of the SELUTION DeNovo trial generated significant interest among interventional cardiologists. Investigators evaluated a sirolimus-eluting drug-coated balloon (DCB) strategy compared with conventional drug-eluting stent implantation in patients presenting with NSTEMI and unstable angina.

More than 1,000 ACS patients were included in the analysis. At one-year follow-up, target vessel failure rates were low and comparable between the two treatment groups. Rates of cardiac death, myocardial infarction and repeat revascularization remained similar, while procedural safety was maintained.

These findings support growing enthusiasm for the "leave-nothing-behind" approach in coronary intervention. Avoiding permanent metallic implants may reduce long-term complications such as stent thrombosis, neoatherosclerosis and challenges associated with future revascularization. Although longer-term follow-up remains necessary, the study suggests that DCBs may become increasingly utilized in carefully selected coronary lesions.

Clopidogrel Vs. Aspirin Monotherapy Following PCI

Another noteworthy presentation focused on optimizing antiplatelet therapy after coronary stenting. Investigators compared long-term clopidogrel monotherapy with aspirin monotherapy following completion of dual antiplatelet therapy.

Across multiple patient populations, including individuals at high bleeding risk and those undergoing complex PCI, clopidogrel monotherapy demonstrated favorable net clinical outcomes. These results add to a growing body of evidence supporting P2Y12 inhibitor monotherapy strategies and may further influence future guideline recommendations regarding long-term secondary prevention after PCI.

Lipoprotein(a): Identifying Residual CV Risk

A secondary prevention analysis presented during the late-breaking sessions examined the impact of elevated lipoprotein(a) [Lp(a)] levels on cardiovascular outcomes.

Investigators demonstrated that patients with Lp(a) levels exceeding 175 mg/dL experienced event rates approaching those observed among active smokers despite receiving contemporary guideline-directed therapies.

These findings underscore the importance of screening for elevated Lp(a), particularly among patients with premature coronary artery disease, recurrent cardiovascular events or strong family history of atherosclerotic disease. With several novel Lp(a)-lowering therapies currently undergoing evaluation, this biomarker continues to emerge as a potentially important therapeutic target.

Structural Heart Disease

AltaValve Early Feasibility Study: A Promising Future For TMVR

The most anticipated structural heart presentation at SCAI 2026 was the one-year follow up from the AltaValve Early Feasibility Study.

AltaValve is a novel transcatheter mitral valve replacement (TMVR) system that utilizes atrial fixation technology rather than traditional ventricular anchoring. This design aims to minimize left ventricular outflow tract obstruction (LVOT), one of the major challenges limiting widespread adoption of TMVR.

The study enrolled 30 high-risk patients with severe symptomatic mitral regurgitation (MR) who were not candidates for surgical intervention or alternative transcatheter therapies.

At one year, investigators reported durable reduction in MR, sustained symptomatic improvement, preservation of LV function and low rates of device-related complications.

Most importantly, the incidence of clinically significant LVOT obstruction remained minimal, addressing a major concern associated with existing TMVR technologies. The encouraging results support ongoing evaluation in the ATLAS pivotal trial and position AltaValve as one of the most promising next-generation mitral valve replacement platforms currently under development.

Mitral TEER in Patients With Mitral Annular Calcification

Another important structural heart study evaluated outcomes of transcatheter edge-to-edge repair (TEER) in patients with significant mitral annular calcification (MAC).

Historically, severe MAC has presented substantial challenges for both surgical and transcatheter therapies. Investigators demonstrated that procedural success rates and MR reduction were comparable between patients with and without MAC.

However, patients with severe MAC experienced higher rates of heart failure hospitalization and mortality during follow-up.

These findings suggest that TEER remains a valuable treatment option in this complex patient population while highlighting the prognostic significance of advanced annular calcification.

DETECT AS: Improving Detection of Severe AS

The DETECT AS study focused on improving recognition and referral patterns for severe aortic stenosis (AS). Investigators implemented an electronic provider notification system designed to alert clinicians when echocardiographic findings suggested severe AS requiring further evaluation.

The intervention significantly improved referral rates to structural heart programs and reduced age-related disparities in treatment. These findings demonstrate how relatively simple digital health interventions may improve access to lifesaving therapies such as TAVR.

Peripheral and Pulmonary Vascular Intervention

PROMISE III: Deep Vein Arterialization For No-Option CLTI

Peripheral vascular intervention also received considerable attention at SCAI 2026. The PROMISE III study evaluated transcatheter deep vein arterialization among patients with chronic limb-threatening ischemia (CLTI) who lacked conventional surgical or endovascular revascularization options.

Six-month outcomes demonstrated encouraging rates of limb salvage, improved wound healing and enhanced quality of life. These findings continue to support deep vein arterialization as an important therapeutic option for patients who otherwise face major amputation.

CARPOOL: Radial Access For Peripheral Intervention

The CARPOOL study compared radial-to-peripheral access with traditional femoral access for lower extremity peripheral arterial interventions.

Although procedural success rates were similar between treatment groups, radial access was associated with higher rates of major adverse limb events at six months, primarily driven by repeat revascularization. While radial peripheral intervention remains technically feasible and attractive from an access-site perspective, additional refinement may be necessary before it can routinely replace femoral access in complex peripheral procedures.

ENGULF: Advancing PE Thrombectomy

Pulmonary embolism (PE) intervention continues to represent one of the fastest-growing areas within interventional cardiology. The ENGULF study evaluated continuous aspiration mechanical thrombectomy using the Hēlo Blood Return System.

Investigators demonstrated reduced blood loss while maintaining procedural efficacy and safety. These findings are particularly relevant given concerns regarding blood loss during large-bore aspiration thrombectomy procedures. The technology may help improve procedural efficiency while reducing transfusion requirements and procedural complications.

Conclusion

SCAI 2026 underscored how quickly the interventional field is moving from concept to clinical application. Coronary intervention remained at the forefront, highlighted by CERAMICS, which reinforced the value of organized shock care pathways, and SELUTION DeNovo, which further validated DCB therapy as part of the growing "leave-nothing-behind" PCI movement. Structural heart disease continued its rapid evolution with encouraging one-year outcomes from the AltaValve TMVR platform and expanding evidence supporting TEER in complex mitral valve disease. Meanwhile, peripheral and pulmonary vascular studies demonstrated continued innovation in limb salvage and thrombectomy technologies.

The key takeaway: earlier recognition, more precise patient selection and continued technology refinement are likely to define the next phase of interventional cardiology

This article was authored by M. Chadi Alraies, MD, FACC, medical director of the cardiac catheterization laboratory, cardiac rehabilitation and interventional cardiology research at Detroit Medical Center, Harper University Hospital, in Michigan.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Interventions and ACS

Keywords: Cardiology Magazine, ACC Publications, CM-Jul-Aug-2026, Percutaneous Coronary Intervention, Acute Coronary Syndrome, Interventional Cardiology