New Evidence for Iliac Vein Stenting: The C-TRACT Trial

For years, clinicians have utilized iliac vein stenting to treat Postthrombotic Syndrome (PTS) based largely on clinical intuition. However, high-level evidence has been scarce—until now.

Data from the C-TRACT trial, recently published in the New England Journal of Medicine, provides the validation needed to refine our endovascular approach to obstructed iliac veins.

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Key Clinical Findings

The study randomized 225 patients with moderate-to-severe PTS to either endovascular therapy (stenting plus enhanced antithrombotics) or standard care. At 6 months, the interventional arm demonstrated:

• Symptom Reduction: Significantly improved scores on the Venous Clinical Severity Score (VCSS), showing a 2-point benefit over control (P = 0.001).

• Quality of Life: A robust 14.5-point increase in VEINES-QOL scores, indicating a meaningful impact on daily functionality.

• Device Performance: The benefits appear to be a class effect across approved venous stents, including Abre and Venovo.

The Trade-off: Bleeding Risk

The primary complication was a higher rate of bleeding events (11.6% vs. 3.6%; $P = 0.03$). These were predominantly nonmajor and likely linked to the intensified antithrombotic therapy required post-procedure, rather than the stenting procedure itself.

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Practice Implications

The C-TRACT results move the needle toward evidence-based intervention. However, success hinges on individualized care. Shared decision-making is essential to balance substantial quality-of-life gains against bleeding risks and the need for long-term surveillance.

Women are less likely to take heart medications after a cardiac event — and socioeconomics may be why

A new analysis of the TEXTMEDS trial reveals meaningful gaps in how men and women manage cardiovascular health after acute coronary syndromes.

After a heart attack or other acute coronary syndrome (ACS), sticking to medications is critical — but a new study shows women are doing so at notably lower rates than men. The finding, published in Open Heart, comes from a secondary analysis of TEXTMEDS, a randomized clinical trial that tested whether text-message reminders could improve medication adherence after ACS in Australian patients.

The numbers

Among 1,379 participants tracked for 12 months, just 46% of women reported taking all five recommended heart medications — compared to 54% of men. The gap held across a range of drugs, including statins, beta-blockers, aspirin, ACE inhibitors, and P2Y12 inhibitors.

Women fully adherent

46%

Men fully adherent

54%

Women reaching LDL target

39%

Women were also less likely to meet the recommended LDL-cholesterol target of under 70 mg/dL (39% vs. nearly 50% of men), and less likely to achieve regular physical activity goals (50% vs. 63%). On one measure, however, women came out ahead: they were more likely than men to maintain a healthy body mass index.

Socioeconomics as the hidden variable

One of the study's most important findings was what happened when researchers adjusted for socioeconomic factors like income and education: the adherence gap between men and women largely disappeared. The one exception was statins, where women remained significantly less likely to adhere even after full adjustment.

"When we accounted for socioeconomic factors like income and education, the difference between men and women largely disappeared, suggesting socioeconomic factors explain this relationship to some extent," said lead investigator Shiva Raj Mishra, PhD, of the University of Sydney.

As for the statin gap specifically, researchers point to several possible explanations: side-effect concerns, an underestimation of personal cardiac risk, and competing social priorities such as caregiving responsibilities.

A broader problem — for everyone

The study also underscores that medication adherence after ACS is low across the board. Overall, just over half of all patients — men and women combined — were consistently taking all five cardioprotective medications at 6 and 12 months. Patients with more comorbidities fared even worse, likely because managing multiple conditions simultaneously makes complex medication regimens harder to follow.

"Just knowing and having a serious cardiac event alone is clearly not sufficient as an intervention," said Mishra. "More is needed to address this."

"Medical adherence is important and difficult to achieve for many patients, and even more so for women compared to men. We should always be asking about medical adherence after ACS, especially among our patients with socioeconomic barriers to care."

— Clara Chow, MBBS, PhD, University of Sydney

Sources

Mishra SR et al. Open Heart, 2026. TEXTMEDS randomized clinical trial.

O'Riordan M. "Women Less Likely Than Men to Adhere to Post-ACS Medications: TEXTMEDS." TCTMD, April 13, 2026.

CTO Intervention via PCI Leads to Better Symptom Relief and Quality of Life

A new meta‑analysis published in JACC provides strong evidence that percutaneous coronary intervention (PCI) for a chronic total occlusion (CTO) significantly improves symptoms, functional capacity, and quality of life compared with optimal medical therapy (OMT) alone. By focusing exclusively on patients with a single CTO lesion, the analysis resolves longstanding uncertainty created by earlier trials with mixed designs and confounding from multivessel disease.

Why This Matters

CTO lesions are present in 15–20% of patients with chronic coronary syndrome, yet guideline recommendations for CTO PCI remain cautious. This hesitancy reflects:

• Variability in earlier trial designs

• Lower historical procedural success rates

• Higher complication risks

• Confounding from non‑CTO PCI in medical‑therapy arms of prior studies

The new meta‑analysis eliminates these issues by isolating patients with one CTO and no other significant coronary lesions, allowing a clearer assessment of the true therapeutic benefit of CTO PCI.

Key Findings From the Meta‑Analysis

The combined dataset included 518 patients with stable angina and a single CTO. Across all domains of the Seattle Angina Questionnaire (SAQ)—including angina frequency, physical limitation, and quality of life—patients treated with CTO PCI experienced significantly greater improvements than those treated with OMT.

Additional highlights:

• Benefits were consistent across age, sex, diabetes status, and lesion complexity

• Patients with more severe baseline symptoms experienced the largest improvements

• Procedural success exceeded 92% after a second attempt

• Long‑term safety outcomes were similar between PCI and OMT

• OMT‑treated patients were more likely to require subsequent revascularization

These findings align with earlier evidence from the ORBITA‑CTO, EUROCTO, and DECISION‑CTO trials.

Meta‑Analysis Summary Table

Included Trials and Key Characteristics

Trial	Design	Population Included	Key Features	Original Findings
EUROCTO	Randomized	272 patients with single CTO	Compared CTO PCI vs OMT	PCI improved angina, physical limitations, and quality of life
DECISION‑CTO	Randomized	246 patients with single CTO (multivessel disease excluded for this analysis)	Original design allowed PCI of non‑CTO lesions	No difference between PCI and OMT due to cross‑over PCI in OMT arm

Meta‑Analysis Findings (518 Patients)

Outcome	PCI Group	OMT Group	Key Takeaway
Angina Frequency (SAQ)	Significant improvement	Less improvement	PCI provides superior angina relief
Quality of Life (SAQ QoL)	Significant improvement	Less improvement	PCI leads to better QoL gains
Physical Limitation (SAQ PL)	Improved (P < 0.01)	Less improvement	PCI improves functional capacity
SAQ Summary Score	Larger improvement	Smaller improvement	Overall health status benefit
Clinically meaningful improvement	More patients met thresholds	Fewer met thresholds	PCI more likely to produce clinically important changes
CTO PCI Success Rate	88.7% first attempt; 92.2% after second	N/A	High procedural success
Cross‑over to PCI	N/A	6.7%	Some OMT patients required PCI
Complications	Low (1% non‑Q‑wave MI; 0.7% silent cerebral ischemia)	N/A	Acceptable safety profile
Long‑term outcomes (3.1 years)	Cardiac death or nonfatal MI: 2.7%	5.1%	No significant difference
Revascularization	Lower	Higher	OMT patients more likely to need later PCI

Guideline Implications

Current US guidelines assign CTO PCI a class IIb recommendation, while European guidelines provide a class IIa recommendation for patients with persistent angina despite OMT. The new findings suggest:

• CTO PCI is effective

• CTO PCI is safe

• CTO PCI provides meaningful improvements in daily functioning and symptom burden

However, CTO PCI remains a technically demanding procedure, and outcomes depend heavily on operator experience, which likely explains the continued caution in guideline language.

Looking Ahead

Further clarity is expected from the ongoing ISCHEMIA‑CTO trial, which is evaluating PCI versus OMT in patients with varying degrees of ischemia, including those without symptoms. Results are anticipated in the coming years.

For now, the evidence is converging: In patients with a single CTO and persistent symptoms, PCI offers substantial improvements in quality of life, physical function, and angina relief.

Multifaceted Intervention Controls BP in Low‑income Hypertension Patients

 A new analysis from the IMPACTS‑BP trial shows that intensive blood pressure (BP) control is achievable even in resource‑limited primary‑care settings in the United States. Conducted across federally qualified health centers (FQHCs) in Louisiana and Mississippi, the study demonstrated that a systematic, team‑based intervention can significantly reduce systolic BP among low‑income adults.

A Real‑World Strategy With Real Impact

The intervention combined several coordinated components:

• Protocol‑driven medication management
• Team‑based care with regular auditing
• Health coaching
• Home BP monitoring

Among the 1,272 adults enrolled—most earning under $25,000 annually—those receiving the multifaceted intervention achieved a 6.4 mm Hg greater reduction in systolic BP at 18 months compared with usual care. Even modest reductions of this size are associated with meaningful decreases in long‑term cardiovascular risk, including stroke, coronary disease, heart failure, and mortality.

Nearly 22% of patients in the intervention arm reached a systolic BP below 120 mm Hg, and almost 48% achieved levels below 130 mm Hg—demonstrating that intensive BP targets can be met outside controlled research environments.

Why This Matters

Hypertension remains one of the most common and undertreated conditions in the United States, with low‑income communities facing disproportionate burdens. The IMPACTS‑BP findings show that structured, scalable care models can help close this gap.

While the results did not fully match the dramatic BP reductions seen in the landmark SPRINT trial, the comparison is limited by differences in setting. SPRINT operated under tightly controlled conditions, whereas IMPACTS‑BP took place in busy clinics serving patients with significant social and economic challenges. The fact that the intervention still produced substantial improvements underscores its real‑world value.

Looking Ahead

Experts agree that the next step is broader implementation. Success will require:

• Policy support and reimbursement pathways for health coaching and home monitoring
• System‑level commitment to team‑based care
• Ensuring affordable access to antihypertensive medications

If scaled effectively, the IMPACTS‑BP model could transform hypertension control in underserved communities and bring intensive BP management into everyday practice.

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References & Further Reading

• Multifaceted strategies for hypertension control in low‑income patients. New England Journal of Medicine, 2026.
  https://www.nejm.org
• SPRINT Research Group. A randomized trial of intensive versus standard blood‑pressure control. New England Journal of Medicine, 2015.
  https://www.nejm.org/doi/full/10.1056/NEJMoa1511939 (nejm.org in Bing)
• TCTMD Coverage of IMPACTS‑BP Trial
  https://www.tctmd.com