TCT 2026: Late-Breaking Trials and Clinical Science to Watch
Preview the TCT 2026 late-breaking trials most likely to matter in the cath lab, from CT- and physiology-guided PCI to drug-coated balloons, transcatheter valve intervention, cerebral protection during TAVR, and renal denervation.
Preview the TCT 2026 late-breaking trials most likely to matter in the cath lab, from CT- and physiology-guided PCI to drug-coated balloons, transcatheter valve intervention, cerebral protection during TAVR, and renal denervation.
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The Transcatheter Cardiovascular Therapeutics (TCT) 2026 meeting will be held October 31-November 3 in San Diego, California. The meeting will feature late-breaking data in areas including:
• Percutaneous coronary intervention (PCI) guidance
• Drug-coated balloons
• Heparin dosing
• Coronary physiology
• Transcatheter valve intervention
• Cerebral protection during transcatheter aortic valve replacement
• Renal denervation
Several of these studies address questions that could directly influence lesion assessment, procedural strategy, and patient selection in the cath lab. Below, CLD highlights a selection of TCT 2026 late-breaking trials with particular relevance to interventional cardiology (not a comprehensive list of all studies being presented).
PCI Guidance and Procedural Strategy
Among the coronary trials, Carlos Collet is scheduled on Sunday, November 1st, to present the randomized P4 trial, comparing coronary computed tomography (CT) angiography-guided PCI with intravascular ultrasound (IVUS)-guided PCI. P4 sets a high bar by using IVUS rather than angiography alone as the comparator, asking whether a comprehensive CCTA-guided strategy can achieve outcomes comparable to IVUS-guided PCI while moving much of the procedural planning upstream of the cath lab.
Also on Sunday, November 1st, Bernardo Cortese is scheduled to present TRANSFORM II, comparing sirolimus-coated balloons with drug-eluting stents (DES) in native coronary vessels. The trial addresses a key question for drug-coated balloon PCI: whether effective antiproliferative therapy can be delivered without leaving a permanent implant. A head-to-head randomized comparison with DES should help define how far a stent-free strategy can extend in de novo native-vessel disease.
Another trial with immediate relevance is HD-PCI, scheduled to be presented on Sunday, November 1st, by Sanjit Jolly. The randomized study compares higher- versus lower-dose unfractionated heparin during elective PCI. Despite the routine use of heparin, the optimal dose remains uncertain, particularly in balancing protection from ischemic events against bleeding risk. HD-PCI should help clarify whether 70 U/kg or 100 U/kg provides the better net clinical benefit in contemporary elective PCI.
Coronary Physiology
Coronary physiology will be a major theme. Patrick Serruys is scheduled to present the final results of PIONEER IV on Tuesday, November 3rd, comparing an angiography-derived FFR strategy using quantitative flow ratio (QFR) for lesion selection and PCI optimization with routine local practice in an all-comers PCI population. Nicolas Majunke is scheduled to present LIPSIA-STRATEGY on Monday, November 2nd, directly comparing angiography-derived FFR with wire-based FFR to guide coronary revascularization. A related analysis from AIR STEMI, presented by Simone Biscaglia on Monday, November 2nd, will examine how nonculprit lesion severity affects the utility of functional coronary angiography in patients with STEMI and multivessel disease. Taken together, these studies should help further define the role of angiography-derived physiology in coronary revascularization.
Structural Heart Intervention
Structural heart disease may produce some of the meeting’s most closely watched results. Philippe Généreux is scheduled to present the primary results of the PROGRESS randomized trial on Monday, November 2nd, comparing early transcatheter aortic valve replacement (TAVR) with guideline-directed clinical surveillance in patients with moderate aortic stenosis and at-risk features, such as symptoms or evidence of cardiac damage or dysfunction. The study addresses whether selected patients may benefit from intervention before aortic stenosis progresses to the severe stage. Whatever the result, PROGRESS should help clarify whether selected patients with moderate aortic stenosis and at-risk features benefit from earlier intervention.
Tricuspid intervention will also receive significant attention. Charles Davidson and Suzanne Arnold are scheduled to present clinical and health-status outcomes from CLASP II TR on Monday, November 2nd, comparing transcatheter tricuspid edge-to-edge repair (T-TEER) with the Pascal system (Edwards Lifesciences) against medical therapy in patients with severe symptomatic tricuspid regurgitation. Junbo Ge is scheduled to present TRAVEL III on Sunday, November 1st, a randomized comparison of transcatheter tricuspid valve replacement (TTVR) with the LuX-Valve Plus system (Jenscare Scientific) versus medical therapy for severe tricuspid regurgitation. Together, the studies reflect the rapid movement toward randomized evidence for transcatheter treatment of a disease that historically had limited procedural options.
Also notable is a randomized study scheduled to be presented by Xiaoping Peng on Tuesday, November 3rd, comparing TAVR with surgical aortic valve replacement (SAVR) for symptomatic severe aortic regurgitation. Native aortic regurgitation remains a challenging transcatheter indication, and a randomized TAVR-versus-SAVR comparison could help define whether TAVR is ready for a broader role in patients with symptomatic severe aortic regurgitation.
TAVR procedural strategy will receive additional scrutiny in the randomized PROTEMBO IDE trial, with Susheel Kodali scheduled on Tuesday, November 3rd, to present final results evaluating the ProtEmbo cerebral protection system (Protembis) during TAVR. The findings should help clarify whether cerebral embolic protection meaningfully reduces neurologic risk and whether routine use is justified.
Renal Denervation
Beyond coronary and valve intervention, David Kandzari is scheduled on Tuesday, November 3rd, to present U.S. primary results from SPYRAL AFFIRM, a prospective, single-arm post-approval study evaluating the safety and effectiveness of radiofrequency renal denervation in clinical practice. The study is particularly relevant as renal denervation moves into broader use. The findings should provide important insight into the safety and effectiveness of the Symplicity Spyral renal denervation system (Medtronic) outside the setting of randomized clinical trials.
From PCI guidance and drug-coated balloons to TAVR, tricuspid intervention, and renal denervation, TCT 2026 will put several evolving cath lab strategies to the test. Explore the full TCT 2026 late-breaking program here for additional trials and clinical science presentations.
