In this Redcliffe Cardiology NVM reflections episode, Prof Nicolas Van Mieghem cuts through the noise from TCT 2025. Tune in to hear what the SELUTION trials mean for drug-coated balloons in de novo disease and ISR, why cost and sizing matter in calcium modification, how PE thrombectomy stacks up against anticoagulation alone, and what 7-year PARTNER 3 and 10-year NOBLE data signal for TAVR and left main PCI. Practical takeaways you can use on your next case. Drug-coated balloons (DCB): SELUTION-ISR and the large SOLUTION DeNovo RCT show non-inferiority vs contemporary care,with ~80% of DCB cases avoiding a stent. How to size, when to escalate to DES, and why 5-year data will be decisive. We also contrast these results with CAGE-FREE-1 three-year outcomes and discuss “not all DCBs are created equal.” Calcium strategies: SHORT-CUT and VICTORY pit cutting/high-pressure balloons against intravascular lithotripsy. Similar luminal results—but very different costs and workflow. We outline a toolbox and imaging-first algorithm for nodular/annular calcium and where atherectomy still fits. Pulmonary embolism: STORM-PE shows catheter thrombectomy on top of anticoagulation cuts RV/LV ratio fast along with real-world procedure times, blood loss, and complications you should counsel up front. Valves & MR: PARTNER 3 at 7 years TAVR vs surgery outcomes remain similar with reassuring valve durability; mild PVL not tied to mortality. ENCIRCLE (Sapien M3 TMVR) shows strong MR elimination but flags stroke and leaflet thrombosis prompting a rethink of antithrombotic strategy. Coronary trials: NOBLE 10-year left main results, PROCTOR (native CTO vs SVG PCI), I-MODERN (iFR-guided complete revasc vs deferred CMR), iCABG (physiology-guided grafting), INFINITY SWEDEHEART (bioadaptor stent signals), and ANDES (post-LAAO DOAC vs DAPT). Expect pragmatic thresholds, device selection tips, and critical review of the latest evidence with Prof Nicolas Van Mieghem.