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Precision Medicine in Vascular Disease
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Precision Medicine in Vascular Disease

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Clinical Medicine, Cell, and Organism Physiology".

Deadline for manuscript submissions: 25 May 2025 | Viewed by 3396

Special Issue Editors

Dr. Gaetano Lanza

E-Mail Website
Guest Editor
Department of Vascular Surgery, IRCCS Multimedica, 20099 Sesto San Giovanni, MI, Italy
Interests: vascular surgery; carotid pathology; guidelines; surgical registries
Prof. Dr. Carlo Setacci

E-Mail Website
Guest Editor
Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
Interests: CLTI; diabetic foot; abdominal and thoracic aneurysm

Special Issue Information

Dear Colleagues,

Over the last decades, evidence-based medicine (EBM) has emerged as a milestone for good clinical practice. Most recently, precision medicine (PM), which means the right medicine for the right patient at the right time, is overtaking the classic “one-size-fits-all” approach.

PM has been proposed as a new paradigm that supplements EBM rather than being in contrast with it. PM aims to consider the patient as an individual with specific characteristics within a predictive, preventive, personalized and participatory model. PM addresses each single patient, who often has comorbidities, with tailored indications, and can offer a valid solution. A patient with vascular disease, very often a comorbid condition, may benefit more than others from PM. Furthermore, PM is based on the observation that patients with apparently the same clinical diagnosis or symptoms often exhibit different responses to the same treatment. An increased understanding of the molecular and genetic mechanism of diseases and novel biomarkers can aid in selecting the patient who best benefits from a treatment.

In this Special Issue, we aim to publish a wide range of manuscripts on pathogenesis, diagnosis, genetics, omics and molecular study results, evaluation of biomarkers, predictive factors, potential therapies, indications for medical and surgical treatment in order to apply PM in the management of vascular diseases.

Dr. Gaetano Lanza
Prof. Dr. Carlo Setacci
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • precision medicine
  • vascular diseases
  • pathogenetics
  • diagnostics
  • genetics
  • omics
  • biomarkers
  • predictive factors
  • medical therapies
  • surgical indications

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Further information on MDPI's Special Issue polices can be found here.

Published Papers (3 papers)

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Research

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9 pages, 1227 KiB  
Article
Carotid Artery Geometry Modifications and Clinical Implications after Carotid Artery Stenting
by Edoardo Pasqui, Bruno Gargiulo, Leonardo Pasquetti, Elisa Lazzeri, Giuseppe Galzerano and Gianmarco de Donato
J. Pers. Med. 2024, 14(11), 1091; https://doi.org/10.3390/jpm14111091 - 4 Nov 2024
Viewed by 600
Abstract
Background: Carotid artery stenting (CAS) could lead to a modification of the carotid bifurcation geometry with possible clinical implications. This study aimed to clarify the geometrical impact of three carotid stents with different designs on the carotid bifurcation and its clinical consequences. Methods: [...] Read more.
Background: Carotid artery stenting (CAS) could lead to a modification of the carotid bifurcation geometry with possible clinical implications. This study aimed to clarify the geometrical impact of three carotid stents with different designs on the carotid bifurcation and its clinical consequences. Methods: This was a retrospective single-center study. We included all patients who underwent CAS in a 3-year period. Anatomical changes of the carotid bifurcation were evaluated by reviewing angiographic images. The population was divided into three groups based on the stent implanted: Group 1 (Carotid Wallstent), Group 2 (Roadsaver), and Group 3 (C-Guard). Results: A total of 226 patients were included. The mean age was 77.0 ± 7.4 years and 72.5% (164/226) were male. Three different stents were implanted into three groups: Group 1 (n = 131/226, 58%), Group 2 (n = 57/226, 25.2%), and Group 3 (n = 38/226, 16.8%). The mean pre-stent implantation CCA-ICA angle of the entire population was 155 ± 14.9°, and the post-CAS angle was 167.7 ± 8.7° (p = 0.0001). In every subgroup, the difference was statistically different, with the biggest difference registered in Group 2 (−16.1 ± 13.2°). Regarding stent oversizing, there was a significant relationship between CCA oversizing and CCA-ICA angle modification (p = 0.006). During follow-up, a total of 14 (6.2%) restenoses were registered. The mean CCA-ICA angle modification in the restenosis group was −9.5 ± 14.4° vs. −12.8 ± 11.9° in the no-restenosis group with no significant statistical differences were outlined (p = 0.3). Conclusions: Compared to the Carotid Wallstent and C-Guard, the Roadsaver stent appears to have a lower adaptability to the carotid vascular territory, resulting in a higher CCA-ICA angle modification after implantation, with no impact on the stent restenosis rate. Full article
(This article belongs to the Special Issue Precision Medicine in Vascular Disease)
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11 pages, 255 KiB  
Article
Sex as a Predictor of Outcomes for Symptomatic Carotid Stenosis: A Comparative Analysis between CAS and CEA
by Pasqualino Sirignano, Costanza Margheritini, Wassim Mansour, Francesco Aloisi, Carlo Setacci, Francesco Speziale, Eugenio Stabile, Maurizio Taurino and on behalf of the IRONGUARD-2 Study Investigators
J. Pers. Med. 2024, 14(8), 830; https://doi.org/10.3390/jpm14080830 - 5 Aug 2024
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Abstract
Purpose: Reporting gender-related outcomes for symptomatic carotid lesion revascularization after both endarterectomy (CEA) and carotid artery stenting (CAS) procedures in an unselected group of patients treated by Italian Vascular Specialists. Material and Methods: A retrospective study was conducted on patients presenting with recently [...] Read more.
Purpose: Reporting gender-related outcomes for symptomatic carotid lesion revascularization after both endarterectomy (CEA) and carotid artery stenting (CAS) procedures in an unselected group of patients treated by Italian Vascular Specialists. Material and Methods: A retrospective study was conducted on patients presenting with recently symptomatic carotid stenosis treated by CAS and by CEA. The primary endpoint was the 30 days any stroke occurrence rate; secondary endpoints were technical success, occurrence of transient ischemic attack (TIA), acute myocardial infarction (AMI) and death. Demographic, clinical and procedural data were all noted in order to identify the outcome’s determining factor. Results: A total of 265 patients (193 males and 72 females) were enrolled, and of these 134 (50.5%) underwent CEA and 131 CAS (49.5%). At 30 days, the overall new stroke rate was 3.4% (one fatal), and no TIA, AMI or deaths were observed. Among strokes, seven major and two minor strokes were reported, with six after CEA and three after CAS (p = 0.32; OR: 2; CI95%: 0.48–8.17). The timing of revascularization has been found to be slightly associated with new stroke occurrence: seven out nine strokes were observed in patients treated within 14 days from symptom onset (5.5% vs. 1.4%; p = 0.08, OR: 3.8, CI95%: 0.77–18.56). Lastly, female patients presented a significantly higher risk of post-operative stroke compared to male patients: 6.9% vs. 2.1% (p: 0.05; OR: 3.52; CI95%: 0.91–13.52). Conclusions: Our experience seems to suggest that both CEA and CAS provide safe and effective results in treating patients presenting with symptomatic carotid stenosis. Regardless of the type of revascularization, female sex is an independent risk factor for stroke recurrence after treatment. Full article
(This article belongs to the Special Issue Precision Medicine in Vascular Disease)

Review

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12 pages, 894 KiB  
Review
Physician-Modified Endografts for Repair of Complex Abdominal Aortic Aneurysms: Clinical Perspectives and Medico-Legal Profiles
by Giovanna Ricci, Filippo Gibelli, Ascanio Sirignano, Maurizio Taurino and Pasqualino Sirignano
J. Pers. Med. 2024, 14(7), 759; https://doi.org/10.3390/jpm14070759 - 17 Jul 2024
Cited by 1 | Viewed by 1350
Abstract
Standard endovascular aortic repair (EVAR) has become the standard of care for treating infrarenal abdominal aortic aneurysms (AAAs) in patients with favorable anatomies, while patients with challenging AAA anatomies, and those with suprarenal or thoraco-abdominal aneurysms, still need alternative, more complex, solutions, including [...] Read more.
Standard endovascular aortic repair (EVAR) has become the standard of care for treating infrarenal abdominal aortic aneurysms (AAAs) in patients with favorable anatomies, while patients with challenging AAA anatomies, and those with suprarenal or thoraco-abdominal aneurysms, still need alternative, more complex, solutions, including custom-made branched or fenestrated grafts, which are constrained by production delay and costs. To address urgent needs and complex cases, physicians have proposed modifying standard endografts by manually creating graft fenestrations. This allows for effective aneurysm exclusion and satisfactory patency of visceral vessels. Although physician-modified grafts (PMEGs) have demonstrated high technical success, standardized creation processes and long-term safety data are still lacking, necessitating further study to validate their clinical and legal standing. The aim of this article is to illustrate the state of the art with regard to this surgical technique, summarizing its origin, evolution, and the main clinical evidence supporting its effectiveness. The paper also aims to discuss the main medico-legal issues related to the use of PMEGs, with particular reference to the issue of safety related to the standardization of the surgical technique, medical liability profiles, and informed consent. Full article
(This article belongs to the Special Issue Precision Medicine in Vascular Disease)
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