Search Results (126)

Background/Objectives: To determine the optimal reconstruction parameters for accurate visualization of peripheral in-stent restenosis using photon-counting detector CT (PCD-CT), and to evaluate its potential advantages over energy-integrated detector CT (EID-CT). Methods: Endovascular peripheral stents with varying degrees of in-stent restenosis were scanned in a custom-made phantom using EID-CT (Somatom Force) and PCD-CT (Naeotom Alpha) under clinical acquisition protocols. EID-CT images were reconstructed with Bv40 and Bv59 kernels at 512 matrices. PCD-CT data were acquired in standard-resolution (SR) and ultra-high-resolution (UHR) modes. In both modes, images were reconstructed with multiple kernels (Bv40, Bv56 and Bv72) and matrix sizes (512 and 1024 matrix). In SR mode, additional virtual monoenergetic images (40–100 keV) were generated, while UHR mode included only polychromatic reconstructions. Quantitative image quality (noise, contrast, contrast-to-noise ratio [CNR]) was measured, and two blinded readers performed qualitative assessments of restenosis visualization. Results: PCD-CT with SR mode at VMI 40 keV achieved the highest image contrast and CNR, significantly outperforming EID-CT and PCD-CT_UHR under matched conditions (all p < 0.05). The sharper reconstruction kernel further enhanced the image contrast and improved subjective visualization despite increased image noise. Both readers ranked PCD-CT_{SR-Bv72-40keV} at 1024 matrix highest for detecting all degrees of restenosis, with excellent inter-reader agreement (ρ > 0.80). Conclusions: PCD-CT in SR mode at VMI 40 keV, specifically using the Bv72 kernel with a 1024 matrix, optimizes the visualization of peripheral in-stent restenosis. Compared to EID-CT, PCD-CT provides superior image quality and detectability of restenosis. Full article

Background/Objectives: Commercially available drug-eluting stents still suffer from poor blood compatibility, polymer coating delamination, polymer cracking and lack of stability during and after stent implantation that led to adverse events such as stent thrombosis and in-stent restenosis. This article highlights the advantages of using silicon nanofilament (SiNf) as an interface between stent surface and drug-in-polymer coating or bloodstream. Methods: Thin layer of SiNf was successfully formed on the surface of Co-Cr substrate via one-step simple method. For stent applications, sirolimus-in-poly(D,L-lactide) (PDLLA/SRL) matrix was coated on control and SiNf-modified Co-Cr substrates and the stability, cracking, and long-term degradation was compared. Blood compatibility studies were also compared between control and SiNf-modified Co-Cr substrates. Results: The morphology of the filaments showed nanosized structures with nano-gaps between the filaments which support mechanical interlocking of PDLLA/SRL coating and enhanced the coating stability with no coating delamination whereas, the control substrate presented 97% of coating delamination. The PDLLA/SRL coating on stent platform demonstrates smooth and uniform morphology without webbing between stent struts. After stent ballooning, the control stent presented cracking and peeling of the polymer coating from the surface whereas, the SiNf-modified stent did not show any signs of these unfavorable defects. Moreover, SiNf-modified surface showed reduced fibrinogen adsorption and lower number of platelet adhesion with round shape morphology. Conclusions: Overall, this suggests that modifying the metallic substrates with SiNf could act as a universal coating for reinforcing the polymer coating stability, prevent coating defects that accompany stent ballooning, and improve the blood compatibility of the material surfaces that could have various applications to medical implants and devices. Full article

Background and Objectives: Percutaneous coronary intervention (PCI) has markedly improved outcomes in coronary artery disease through the implantation of bare-metal stents (BMS) or drug-eluting stents (DES). However, in-stent restenosis (ISR) remains a significant complication, often necessitating repeat interventions. This study aimed to identify risk factors associated with ISR in patients with ST-elevation myocardial infarction (STEMI) who underwent PCI. Materials and Methods: We conducted a retrospective, non-randomized observational study of 107 STEMI patients treated with PCI between January 2016 and December 2019 who subsequently underwent clinically indicated (predominantly symptom-driven) follow-up coronary angiography within 12 months. ISR was defined as ≥50% luminal narrowing at follow-up angiography. Time-to-event analysis was performed using Cox regression models, incorporating clinical, biochemical, and angiographic variables. Results: In this selected cohort of patients undergoing follow-up angiography, ISR of any degree was identified in 87% of patients, and 52% had restenosis >70%. Advanced age, prior cardiovascular events, diabetes mellitus, chronic kidney disease, and history of stroke significantly increased the hazard of ISR. Smoking, dyslipidemia, and hypertension were prevalent in patients with severe ISR. Women presented with more severe clinical profiles (higher Killip class and troponin levels). DES showed slightly better TIMI flow than BMS, but stent type, dimensions, and number did not significantly impact restenosis risk. Thrombolytic therapy was associated with a significantly reduced ISR hazard. Mortality was 6% in patients with severe ISR. The highest restenosis incidence occurred in the LAD and RCA territories. Conclusions: ISR is a multifactorial process influenced by demographic, clinical, and procedural factors. Despite technological advances, ISR remains a prevalent issue, particularly in high-risk groups undergoing clinically indicated follow-up angiography. Secondary prevention strategies, optimized stent deployment, and targeted therapies addressing inflammation and vascular remodeling are essential to improving long-term PCI outcomes. Full article

The use of excimer laser atherectomy (ELA) has significantly evolved from the mid-1990s to the present, showing substantial improvements in both coronary and peripheral artery interventions. Initially associated with suboptimal outcomes due to low-energy settings and limited techniques, advancements such as high-energy delivery, improved catheter designs, contrast injection protocols, and refined procedural approaches have greatly enhanced clinical efficacy. In coronary applications, ELA has become an established technique for treating intracoronary thrombus, under-expanded stents, in-stent restenosis, and heavily calcified lesions, offering favorable procedural and clinical outcomes with low complication rates. The excimer laser operates through photochemical, photothermal, and photomechanical mechanisms, enabling precise plaque ablation with minimal collateral damage. In peripheral interventions, especially in critical limb ischemia (CLI), ELA has emerged as a viable option for complex, non-crossable lesions and in-stent restenosis, demonstrating high technical success, improved patency, and promising limb salvage rates. Multiple clinical trials and registries support the safety and effectiveness of ELA, particularly in high-risk patient populations. This narrative review summarizes current evidence and practical considerations on the use of excimer laser atherectomy in coronary and peripheral interventions. Full article

Background: The Inflammatory Prognostic Index (IPI) is a novel biomarker integrating C-reactive protein (CRP), albumin, and white blood cell-derived ratios, reflecting systemic inflammation and nutritional status. Inflammation is central to in-stent restenosis (ISR). This study investigated the prognostic value of IPI in predicting ISR after drug-eluting stent (DES) implantation. Methods: We retrospectively analyzed 571 patients who underwent DES implantation and follow-up angiography at a median of 12 months (IQR 12–24) for recurrent angina or ischemia. Patients were grouped as ISR (+) (n = 218) and ISR (−) (n = 353). IPI was calculated as (CRP × neutrophil-to-lymphocyte ratio)/albumin. Logistic regression and ROC analyses assessed the predictive role of IPI. Results: ISR occurred in 38.1% of patients. The ISR (+) group showed a higher prevalence of hypertension and active smoking, as well as higher CRP, glucose, and neutrophil levels, but lower albumin and lymphocytes (all p < 0.05). Elevated IPI independently predicted ISR (OR = 2.90; 95% CI = 2.35–3.57; p < 0.001). ROC analysis showed an optimal cutoff of 1.275 (sensitivity 84.4%, specificity 74.5%). Conclusions: IPI, derived from routine laboratory tests, independently predicts ISR after DES implantation and may serve as a simple, inexpensive biomarker for coronary artery disease risk stratification. Full article

In-stent restenosis (ISR) remains a clinically relevant cause of recurrent ischemia and repeat revascularization despite progressive refinements in stent design and implantation technique. Contemporary data indicate that restenosis-related target lesion revascularization (TLR) has declined from bare-metal stent (BMS) to early- and newer-generation drug-eluting stents (DESs), yet ISR continues to accumulate over long-term follow-up and is associated with worse outcomes than PCI for de novo lesions. Mechanistically, ISR is a time-dependent, heterogeneous process dominated early by neointimal hyperplasia—triggered by mechanical endothelial injury, delayed re-endothelialization, inflammation/oxidative stress, vascular smooth muscle cell phenotypic switching, and extracellular matrix deposition—and later by in-stent neoatherosclerosis, which may confer a higher-risk plaque substrate and overlap with thrombotic complications. Clinically, ISR frequently presents as an acute coronary syndrome (ACS) rather than stable symptoms, underscoring the prognostic relevance of prompt recognition and mechanism-informed management. Patient-level risk determinants repeatedly reported across cohorts include diabetes mellitus, chronic kidney disease, dyslipidemia, hypertension, and smoking, while lesion/procedural factors include small vessel caliber, long/complex or bifurcation lesions, multiple stent layers, and suboptimal stent expansion. Intravascular imaging (OCT/IVUS) is central to phenotyping ISR mechanisms (e.g., underexpansion, calcific neoatherosclerosis, stent fracture, homogeneous hyperplasia) and can guide targeted prevention and therapy. This review synthesizes current evidence on ISR biology and risk factors to support risk stratification, preventive strategies, and individualized management. Full article

Background: Autologous arteriovenous fistula (AVF) is the most commonly used vascular access for end-stage renal disease patients. However, during the maturation process following AVF surgery, insufficient initial venous diameter often results in inadequate blood flow, leading to fistula maturation failure. Studies have indicated that implanting stents can enlarge the initial venous diameter and improve the success rate of AVF surgeries. However, stents made from metallic materials remain permanently in the body after implantation, posing risks such as in-stent restenosis. Methods: Our development and testing of magnesium alloy stents with a layered double hydroxide (LDH) coating to assist AVF maturation is presented in this paper. Firstly, AZ31 alloy was used as a benchmark to screen coating technologies, including anodizing, alkaline films, and LDH coatings. ZM21 tubes were then utilized to verify the transferability of optimized parameters across different substrates. Finally, the optimized coating was applied to ZM21 stents, followed by validation through in vitro degradation tests and biochemical simulations. Results: The results showed that LDH-coated AZ31 samples exhibited a 95% reduction in average corrosion rate compared to untreated samples. Additionally, the anion exchange property of the LDH layer effectively reduced the pH of the saline solution. Subsequently, LDH coatings were applied to ZM21 magnesium alloy stents, followed by in vitro degradation and biochemical simulation. Compared to untreated ZM21 stents, LDH-coated stents demonstrated a 94.9% reduction in average corrosion rate and significantly reduced the generation of soluble magnesium chloride, maintaining the solution pH below 8.0 and the Mg²⁺ concentration below 300 μg/mL. Conclusions: The results show LDH is the most effective corrosion-resistant coating and can control the degradation rate of magnesium alloy stents to enhance their support duration and biocompatibility. Full article

Restenosis after carotid endarterectomy and carotid artery stenting remains the main complication after both surgical and endovascular treatment of carotid stenosis, with a 2-year restenosis rate of 6–12%. Complex inflammation processes are the cause of early (<2 years) and late (>2 years) restenosis and principal systemic risk factors are female gender, hypertension, diabetes, dyslipidemia, and smoking. Non-procedural treatment includes lifestyle modifications and best medical therapy. The procedural treatment, considered mostly for symptomatic patients, includes different open and endovascular techniques. The management should be personalized according to patient and plaque characteristics. Full article

Excimer Laser Coronary Atherectomy (ELCA) has re-emerged as a valuable adjunctive modality in percutaneous coronary intervention (PCI), particularly in the context of increasingly complex coronary anatomy and rising procedural expectations. By delivering pulsed ultraviolet energy at 308 nm through flexible fiber-optic catheters, ELCA enables precise photochemical, photothermal, and photomechanical ablation of atherosclerotic, fibrotic, calcified, and thrombotic tissue while minimizing thermal injury to surrounding structures. Recent technical refinements, simplified catheter designs, and improved safety profiles have enhanced its feasibility and utility across a range of challenging lesion subsets. This review summarizes the fundamental principles underlying excimer laser–tissue interaction, discusses available equipment and key procedural considerations, and examines the expanding clinical evidence supporting ELCA in contemporary practice. Data from observational studies and multicenter registries suggest that ELCA may enhance device crossability, restore coronary flow, and reduce distal embolization in thrombus-rich lesions, particularly during primary PCI. In device-uncrossable lesions, ELCA facilitates plaque modification and improves procedural success, including in chronic total occlusions. Furthermore, ELCA—especially when performed with simultaneous contrast injection—has demonstrated efficacy in treating stent underexpansion refractory to high-pressure balloon dilation, improving minimal stent area and enabling optimal post-dilatation. As lesion complexity continues to increase, ELCA is gaining recognition as an important tool within the interventional armamentarium. While generally safe in experienced hands, ELCA carries a risk of procedural complications that must be carefully considered. Ongoing investigations are expected to further define its optimal use and reinforce its relevance in modern interventional cardiology. Full article

Drug-coated balloons (DCBs) have emerged as an alternative to drug-eluting stents (DESs) in percutaneous coronary intervention, delivering antiproliferative drugs without leaving a permanent implant. This review provides a comparative analysis of sirolimus-coated DCBs (DCB-S), paclitaxel-coated DCBs (DCB-P), and DESs across key scenarios: de novo coronary lesions in chronic coronary syndrome (CCS), acute coronary syndromes (ACS), and in-stent restenosis (ISR). We discuss late lumen loss (LLL), target lesion/vessel revascularization (TLR/TVR), vessel patency, and major adverse cardiac events (MACE) outcomes, along with current guidelines and emerging indications for DCB-S. We also examine pharmacological differences between sirolimus and paclitaxel (mechanisms of action, tissue uptake, and healing profiles), trial methodologies, and recent innovations in DCB technology. Across stable de novo lesions (especially small vessels and high bleeding-risk patients), multiple trials show DCB-P can achieve non-inferior clinical outcomes to DES. Early data suggest newer DCB-S may likewise match DES outcomes in broader populations. In ACS, DCB-only strategies have demonstrated feasibility and safety in carefully selected lesions without heavy thrombus, with randomized studies like REVELATION (STEMI) showing non-inferior fractional flow reserve and low revascularization rates compared to DES. For ISR, DCB-P is an established Class I treatment in both BMS-ISR and DES-ISR, yielding similar or lower TLR rates than repeat stenting. DCB-S are now being evaluated as an alternative in ISR, aiming to avoid additional stent layers. Contemporary guidelines endorse DCB use in ISR and small vessels, and experts anticipate expanding indications as evidence grows. Sirolimus and paclitaxel differ in antiproliferative mechanisms and pharmacokinetics—sirolimus (cytostatic, mTOR inhibition) may offer faster endothelial recovery, whereas paclitaxel’s high lipophilicity ensures sustained arterial wall retention. Technological advances (e.g., phospholipid micro-reservoirs for sirolimus) are enhancing drug transfer and addressing prior limitations. In summary, DCB-P and DCB-S now represent viable alternatives to DES in specific scenarios, especially where “leaving nothing behind” could reduce long-term complications. Ongoing large randomized trials, such as SELUTION DeNovo, currently available as conference-presented data, together with longer-term follow-up will further clarify the optimal niches for DCB-S versus DCB-P and DES. Full article

Background: Coronary artery disease (CAD) remains a significant health challenge, placing a heavy burden on people and healthcare systems worldwide. Objectives: This narrative review aims to provide a comprehensive overview of recent advancements in the diagnosis, intervention, and pharmacological management of CAD, with a focus on emerging technologies shaping its future. Methods: This is a narrative review that synthesises information from diverse sources, including clinical trials, systematic reviews, meta-analyses, and preclinical studies, to provide a comprehensive overview of the current landscape and emerging trends in CAD management. The literature included in this review was sourced from original research articles and review papers published between January 2010 and December 2025. Results: Early detection has been transformed by non-invasive imaging, such as PCAT, and the addition of invasive and non-invasive FFR technology enables quicker and more accurate diagnoses. Biomarkers, such as high-sensitivity troponin, have further improved the precision of acute coronary syndrome detection, enhancing early intervention. In interventional cardiology, new-generation drug-eluting stents (DESs) have lowered restenosis rates, whereas robotic-assisted percutaneous coronary intervention (PCI) offers precision and reduced operator radiation exposure. Furthermore, the efficacy of drug-coated balloons (DCBs) has been established in the management of in-stent restenosis, and their application in de novo coronary lesions and bifurcation anatomy remains promising. Looking ahead, nanomedicine promises targeted plaque reduction and vascular repair, while 3D-bioprinted blood vessels offer durable, biocompatible grafts for surgical applications. Pharmacological developments, including modern cholesterol-lowering drugs, have also been crucial in achieving cholesterol targets. Conclusions: Despite significant advancements in diagnosis, intervention, and pharmacotherapy, several critical challenges remain, including the need for validated biomarkers and imaging modalities to identify vulnerable atheroma before symptoms arise. Continued research is essential to improve patient outcomes and address the global burden of CAD. Full article

Calcified coronary lesions remain a challenge in percutaneous coronary intervention (PCI) in both situations of acute myocardial infarction (MI) and stable coronary syndrome. It significantly increases the risk of procedural complications due to difficulty in equipment delivery, balloon expansion, and stent delivery. Furthermore, stent thrombosis, dissection, perforation, and future in-stent restenosis occur more frequently in calcified coronary lesions, impacting repeat target vessel revascularization and increasing the risk of future MI. With intracoronary imaging (intravascular ultrasound and optical coherence tomography), peri-procedural success for treating calcified lesions has increased significantly. Different modalities of calcium modification techniques have since been introduced. This review will discuss the pathophysiology and phenotypes of calcium deposition in the coronary vessels, including eccentric calcified plaques and calcified nodules. We will also focus on calcium modification techniques and their mechanisms: (1) Balloon escalation technique, (2) intravascular lithotripsy, (3) orbital atherectomy, and (4) rotational atherectomy. We will focus on the strengths and limitations of each technique, based on current recommendations and expert consensus from SCAI. We will also provide contemporary evidence of each modality for treating different phenotypes of calcified lesions. In summary, this article provides a comprehensive review of current guidelines for optimizing the treatment of calcified coronary lesions in PCI. Full article

Percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) is the most used revascularization strategy in current clinical practice. However, this approach is still associated with a non-negligible risk of adverse events, including late and very late in-stent restenosis (ISR) and stent thrombosis, even with newer-generation DESs. Notably, long stents and the use of overlapping stents have been consistently identified as independent predictors of both ISR and stent thrombosis. Drug-coated balloons (DCBs) have emerged as a viable alternative to DESs. Initially evaluated in specific clinical settings, such as small-vessel disease and ISR, DCBs have demonstrated promising results in the treatment of more complex coronary lesions and higher-risk patient populations, including elderly, diabetics and those at high bleeding risk. Their main advantage lies in avoiding permanent implantation of metallic struts and polymer coatings, thereby preserving coronary vasomotor function and promoting positive vessel remodeling and late lumen enlargement. As a result, a hybrid or blended revascularization strategy combining DESs and DCBs has gained increasing interest, offering the potential to harness the complementary benefits of both DESs and DCBs, while minimizing stent overlap and total stent length. Some studies have explored this approach, particularly for the treatment of diffuse coronary artery disease and bifurcation lesions. This narrative review aims to outline the pathophysiological rationale underlying a blended DCB/DES approach and to summarize the currently available clinical evidence. Furthermore, we discuss future perspectives for optimizing the combination DCB and DES PCI in real-world practice. Full article

Background: Drug-coated balloons (DCBs) have transformed percutaneous coronary intervention (PCI) by delivering antiproliferative drugs without leaving a permanent scaffold. DCB is initially indicated for in-stent restenosis (ISR) and now has expanded indication for treating small vessel disease and bifurcation lesions. However, there is a heterogeneity in the patient and lesion selection, lesion preparation techniques, and the optimal duration of dual antiplatelet therapy after DCB angioplasty. The Cardiovascular Intervention Association of Thailand (CIAT) developed a consensus statement on DCB use in coronary interventions. Methods: The CIAT expert panel systematically reviewed randomized controlled trials, meta-analyses, and real-world studies evaluating DCB therapy. Procedural strategies, imaging guidance, physiologic assessment, and antiplatelet therapy protocols were appraised. The recommendations were developed and put to an online vote. Consensus was defined when the recommendation reached 80% of votes in support of “agree” or “neutral”. Results: Clinical evidence demonstrates that DCBs achieve comparable outcomes to drug-eluting stents (DESs) in selected lesions while enabling shorter durations of dual antiplatelet therapy (DAPT), particularly beneficial for high-bleeding-risk patients. Optimal outcomes require meticulous lesion preparation, appropriate balloon sizing, and controlled vessel dissection. Intravascular imaging and physiologic assessment further refine procedural precision, while hybrid strategies combining DCBs and DESs address complex lesions and multivessel disease. The final document presents 15 consensus statements addressing indications, procedural techniques, imaging and physiologic guidance, and antiplatelet therapy recommendations. Conclusions: DCB angioplasty can be an alternative or complement to therapeutic options to DESs across multiple clinical and anatomical scenarios. The CIAT consensus provided structured recommendations to support DCB therapy in contemporary practice. Full article

Background: Vascular calcification has been highlighted as a prognostic factor for perioperative thrombosis but a protective factor for late restenosis in lower limb peripheral artery disease (LLPAD). The aim of this study was to investigate the association between calcification and twelve-month primary patency in patients with stenting of the common femoral artery (CFA) and its bifurcation for atheromatous stenosis. Materials/Methods: This single-center retrospective study analyzed consecutive limbs (n = 90) that underwent CFA stenting for symptomatic lesions between January 2018 and January 2023. Calcification was assessed using dedicated computed tomography angiography analysis software (EndoSize; Therenva), with blinded evaluation of volume (mm³) and density (Hounsfield Units) across three anatomically distinct zones: proximal CFA (Zone 1); distal CFA (Zone 2); and bifurcation segments (Zone 3). The primary endpoint was twelve-month primary patency, defined as a peak systolic velocity ratio (PSVR) < 2.4 on duplex ultrasound without target lesion revascularization. Secondary endpoints included predictors of restenosis using multivariable logistic regression. Results: Ninety cases of CFA stenting for LLPAD (lower limb peripheral artery disease) were analyzed. A total of 78.9% of CFA lesions were treated for claudication and 21.1% for critical limb-threatening ischemia (CLTI). Lesions were distributed as Azema types I (1%), II (43%), and III (56%). At twelve-month follow-up, primary patency (PSVR < 2.4) was achieved in 77.4% of limbs. Patent CFA stenting demonstrated significantly higher median calcification density in Zone 2 compared to those with restenosis (1122 [IQR: 903–1248] vs. 858 [788–987] HU; p = 0.006; q = 0.021 after false discovery rate correction). ROC curve analysis identified a density threshold of 800 HU with a 76% reduction in restenosis risk (OR 0.24; 95% CI: 0.08–0.72; p = 0.011). Bootstrap validation (1000 replications) confirmed threshold stability at 821 HU (95% CI: 656–990 HU). Conclusions: In this exploratory study, dense calcification (≥800 HU) in the distal CFA appears to be protective against twelve-month restenosis following stenting. These findings suggest that calcification density may serve as a valuable predictor for patient selection and procedural planning in CFA interventions. Full article