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Interventional Cardiology: Current Challenges in Clinical Practice

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (15 August 2024) | Viewed by 9074

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Prof. Dr. Giuseppe De Luca

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Guest Editor

Division of Clinical and Experimental Cardiology, AOU Sassari, University of Sassari, 07100 Sassari, Italy
Interests: STEMI; platelet and antiplatelet therapies; coronary stenting; genetic polymorphisms; atherosclerosis
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Special Issue Information

Dear Colleagues,

Coronary heart disease (CAD) is the leading cause of mortality in developed countries. Great effort has been exerted in recent decades to improve the management of this disease, especially in the acute setting. Special attention has been focused on percutaneous revascularization and adjunctive antithrombotic therapies. The improvement of stent technology has certainly contributed to increasing both the efficacy (in terms of restenosis) and the safety (in terms of stent thrombosis, especially when premature discontinuation was clinically necessary) of these treatments. The availability of new devices (intravascular lithotripsy, high-pressure balloons) in addition to rotational atherectomy and the availability of mechanical support devices have contributed to further expanding the frontiers and indications of percutaneous revascularization. Special concerns still remain with regard to the optimal management of high-risk patients such as the elderly, diabetic patients, patients with multivessel disease/left main disease, severely calcified lesions, severely depressed left ventricular function, and cardiogenic shock, and those at high risk for major bleeding complications, the management of which is the focus of the current Special Issue. We welcome contributions on these and related topics, including original research and commentary to inform readers of the latest progress in the field.

Prof. Dr. Giuseppe De Luca
Guest Editor

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Keywords

drug-eluting balloon
drug-eluting stent
mechanical support devices
chronic total occlusion
antiplatelet therapy
thrombectomy
rotablator
IVUS
OCT
shockwave
STEMI
cardiogenic shock

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Published Papers (5 papers)

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Research

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14 pages, 1813 KiB

Open AccessArticle

Technically Challenging Percutaneous Interventions of Chronic Total Occlusions Are Associated with Enhanced Platelet Activation

by Ádám Illési, Zsolt Fejes, Marianna Pócsi, Ildikó Beke Debreceni, Katalin Hodosi, Béla Nagy Jr., János Kappelmayer, Zsolt Kőszegi, Zoltán Csanádi and Tibor Szük

J. Clin. Med. 2023, 12(21), 6829; https://doi.org/10.3390/jcm12216829 - 29 Oct 2023

Viewed by 1103

Abstract

Percutaneous coronary intervention (PCI) is a frequently performed treatment option for recanalization in patients with chronic total occlusion (CTO). As CTO-PCIs are often complicated and challenging for interventionalists, the stressful and damaging nature of the procedure can be remarkable, thus platelets can be easily activated. Our aim was to investigate the effect of CTO-PCI on platelet activation and the expression of selected circulating microRNAs (miR) of platelet and endothelium origin after CTO-PCI. In this study, 50 subjects after CTO-PCI were enrolled. Blood samples were obtained before PCI, at 2 days and 3–6 months after the procedure to measure the degree of platelet activation and the level of plasma miR-223, miR-181b, and miR-126. Patients were divided based on the characteristics of the intervention. Patients with higher Japanese CTO scores and longer duration of PCI showed significantly elevated platelet P-selectin positivity (p = 0.004 and p = 0.013, respectively) 2 days after the procedure compared to pre-PCI and increased concentration of soluble P-selectin 3–6 months after the intervention (higher Japanese CTO score: p = 0.028 and longer duration of PCI: p = 0.023) compared to baseline values. Shorter total stent length caused a significantly lower miR-181b expression at 3–6 months after the intervention (p = 0.031), while no difference was observed in miR-223 and miR-126. One stent thrombosis occurred during the follow-up period. Although these technically challenging CTO-PCIs may cause enhanced platelet activation right after the intervention and long-term endothelial cell dysfunction, these interventions are not associated with more adverse clinical events. Full article

(This article belongs to the Special Issue Interventional Cardiology: Current Challenges in Clinical Practice)

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16 pages, 1337 KiB

Open AccessArticle

Clinical Outcomes and Prognostic Factors in Complex, High-Risk Indicated Procedure (CHIP) and High-Bleeding-Risk (HBR) Patients Undergoing Percutaneous Coronary Intervention with Sirolimus-Eluting Stent Implantation: 4-Year Results

by Maciej Tyczyński, Adam Kern, Patryk Buller, Wojciech Wańha, Robert J. Gil and Jacek Bil

J. Clin. Med. 2023, 12(16), 5313; https://doi.org/10.3390/jcm12165313 - 15 Aug 2023

Cited by 2 | Viewed by 1521

Abstract

We aimed to characterize the performance and safety of percutaneous coronary intervention (PCI) in complex, high-risk indicated procedure (CHIP) and high-bleeding-risk (HBR) patients at a 4-year follow up. We included all consecutive patients who underwent PCI with the sirolimus-eluting coronary stent Alex Plus (Balton, Poland) between July 2015 and March 2016. We analyzed various baseline demographic and clinical characteristics, laboratory data, and clinical outcomes. We enrolled 232 patients in whom 282 stents were implanted, including 81 patients meeting the CHIP criteria and 76 patients meeting the HBR criteria. In the whole population, the mean age was 68 ± 11 years, and 23.7% were females. Most procedures were performed from radial access (83.2%) using a 6F guiding catheter (95.7%). The lesions were mostly predilated (61.6%), and postdilatation was performed in 37.9%. The device success was 99.6% (in one case, a second stent was required due to heavy calcifications). Additional stents were deployed in 39% of cases due to edge dissection (6.9%), side branch stenting (5.2%), or diffuse disease (26.9%). Myocardial infarction (MI) type 4a was revealed in 2.2% of cases. At 4 years, the MACE rates for the whole population and for CHIP and HBR patients were 23.3%, 29.6%, and 27.6%, respectively. CHIP patients had a higher risk of MACEs (29.6% vs. 19.9%, HR 1.69, p = 0.032) and cardiac death (11.1% vs. 4.6%, HR 2.50, p = 0.048). There were no differences for MI (7.4% vs. 6.6%, p = 0.826) and TLR (18.5% vs. 12.6%, p = 0.150). HBR patients were also characterized by a higher risk of MACEs (27.6% vs. 21.2%, HR 1.84, p = 0.049) and cardiac death (17.1% vs. 1.9%, HR 9.61, p < 0.001). There were no differences for MI (7.9% vs. 6.4%, p = 0.669) and TLR (11.8% vs. 16.0%, p = 0.991). PCI in CHIP and HBR patients is feasible with a low rate of periprocedural complications. Nevertheless, CHIP and HBR patients are at a high risk of future adverse events and require strict surveillance to improve outcomes. Full article

(This article belongs to the Special Issue Interventional Cardiology: Current Challenges in Clinical Practice)

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Review

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17 pages, 1147 KiB

Open AccessReview

Importance of Short-Term Neointimal Coverage of Drug-Eluting Stents in the Duration of Dual Antiplatelet Therapy

by Joanna Fluder-Wlodarczyk, Sławomir Pawłowski, Piotr J. Chuchra, Tomasz Pawłowski, Wojciech Wojakowski and Pawel Gasior

J. Clin. Med. 2024, 13(6), 1730; https://doi.org/10.3390/jcm13061730 - 17 Mar 2024

Viewed by 1443

Abstract

Dual antiplatelet therapy (DAPT) is mandatory after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation, but optimal DAPT duration remains a topic of intense discussion. The shorter regimen of DAPT might be especially beneficial for high-bleeding-risk (HBR) patients. Novel stent platforms have been designed with innovations that should facilitate vessel healing following stent implantation and enable short DAPT. This review aimed to summarize evidence of the neointimal coverage of short-term stents and their implications for DAPT duration. Results from histological and optical coherence tomography (OCT) studies confirm the significant role of uncovered struts after the implantation of a stent in patients presenting with late stent thrombosis. Several studies have shown favorable vessel healing at one month (with 83.2% of covered struts, on average) and three months following stent implantation (with 93.3% of covered struts, on average). Solely HBR patient trials have proven that one month of DAPT can be applicable and safe in this population. Three-month DAPT was tested in a more diverse population and remains effective and safe in comparison to a longer DAPT regimen. That evidence proves that short-term DAPT might be applicable, especially for HBR patients. Full article

(This article belongs to the Special Issue Interventional Cardiology: Current Challenges in Clinical Practice)

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16 pages, 8144 KiB

Open AccessFeature PaperReview

Percutaneous Treatment of Left Main Disease: A Review of Current Status

by Dario Pellegrini, Alfonso Ielasi, Maurizio Tespili, Giulio Guagliumi and Giuseppe De Luca

J. Clin. Med. 2023, 12(15), 4972; https://doi.org/10.3390/jcm12154972 - 28 Jul 2023

Cited by 6 | Viewed by 2126

Abstract

Percutaneous treatment of the left main coronary artery is one of the most challenging scenarios in interventional cardiology, due to the large portion of myocardium at risk the technical complexity of treating a complex bifurcation with large branches. Our aim is to provide un updated overview of the current indications for percutaneous treatment of the left main, the different techniques and the rationale underlying the choice for provisional versus upfront two-stent strategies, intravascular imaging and physiology guidance in the management of left main disease, and the role of mechanical support devices in complex high-risk PCI. Full article

(This article belongs to the Special Issue Interventional Cardiology: Current Challenges in Clinical Practice)

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11 pages, 5110 KiB

Open AccessSystematic Review

Clinical and Procedural Outcomes of IVUS-Guided vs. Angiography-Guided CTO-PCI: A Systematic Review and Meta-Analysis

by Giuseppe Panuccio, Youssef S. Abdelwahed, Nicole Carabetta, Nadia Salerno, David Manuel Leistner, Ulf Landmesser, Salvatore De Rosa, Daniele Torella and Gerald S. Werner

J. Clin. Med. 2023, 12(15), 4947; https://doi.org/10.3390/jcm12154947 - 27 Jul 2023

Cited by 6 | Viewed by 2101

Abstract

Chronic total occlusions (CTO) in coronary angiographies present a significant challenge nowadays. Intravascular ultrasound (IVUS) is a valuable tool during CTO-PCI, aiding in planning and achieving procedural success. However, the impact of IVUS on clinical and procedural outcomes in CTO-PCI remains uncertain. This meta-analysis aimed to compare IVUS-guided and angiography-guided approaches in CTO-PCI. The study included five studies and 2320 patients with stable coronary artery disease (CAD) and CTO. The primary outcome of major adverse cardiac events (MACE) did not significantly differ between the groups (p = 0.40). Stent thrombosis was the only secondary clinical outcome that showed a significant difference, favoring the IVUS-guided approach (p = 0.01). Procedural outcomes revealed that IVUS-guided procedures had longer stents, larger diameters, and longer procedure and fluoroscopy times (p = 0.007, p < 0.001, p = 0.03, p = 0.002, respectively). Stent number and contrast volume did not significantly differ between the approaches (p = 0.88 and p = 0.33, respectively). In summary, routine IVUS use did not significantly improve clinical outcomes, except for reducing stent thrombosis. Decisions in CTO-PCI should be individualized based on patient characteristics and supported by a multi-parametric approach. Full article

(This article belongs to the Special Issue Interventional Cardiology: Current Challenges in Clinical Practice)

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