Search Results (1,469)

Coronary artery disease (CAD) remains a major cause of mortality worldwide. Among the standard therapeutic approaches are percutaneous coronary interventions (PCI) employing stents. The main limitation of the procedure lies in the permanent stiffening of the vessel wall. The DynamX Bioadaptor, representing a new generation of vascular stents, combines the advantages of standard implants with a unique mechanism—“uncaging.” Its helical structure, linked by a biodegradable material, enables the restoration of the vessel’s natural functions. This breakthrough concept in interventional cardiology holds the potential to establish a new standard of care for patients suffering from CAD. In this work, we aim to synthesize the available evidence concerning the characteristics of the DynamX Bioadaptor and its impact on vascular physiology. We provide a comprehensive review and evaluation of current clinical reports on its use, analyzing the available literature in comparison with other stent technologies. Recognizing that the DynamX Bioadaptor is a relatively recent innovation, we also seek to identify existing gaps in the literature and propose future directions for research to fully assess its long-term clinical potential. Full article

Introduction: Twelve-lead electrocardiography (ECG) remains an essential diagnostic tool for patients presenting with chest pain. Timely recognition of specific electrocardiographic patterns is critical for guiding reperfusion strategies and predicting adverse outcomes. Among these, Wellens’ pattern is a high-risk marker of critical left anterior descending (LAD) artery stenosis and an impending anterior myocardial infarction. Although typically described in clinically stable patients without heart failure, its occurrence in the setting of acute decompensation is rare. Case Report: We report the case of a 66-year-old male with hypertension, obesity, and active smoking who presented with exertional chest pain, dyspnea, and signs of acute heart failure. Initial ECG revealed biphasic T waves in V2–V4, consistent with type A Wellens’ pattern. Laboratory evaluation demonstrated elevated troponin I, while point-of-care ultrasound (POCUS) identified systolic and diastolic dysfunction, lateral wall hypokinesia, pericardial effusion, and cardiogenic pulmonary edema. The patient received acute management with antiplatelet therapy, statins, diuretics, and anticoagulation, followed by referral for coronary angiography. This revealed critical stenosis (>90%) of the proximal LAD, successfully treated with percutaneous coronary intervention and drug-eluting stent implantation. The in-hospital course was uneventful, and guideline-directed medical therapy was optimized at discharge, including dual antiplatelet therapy, beta-blocker, renin–angiotensin system inhibitor, and SGLT2 inhibitor. Conclusions: This case highlights the need for early recognition of Wellens’ pattern, even in atypical contexts such as acute heart failure. Integrating ECG interpretation with bedside POCUS facilitated diagnostic accuracy and guided an early invasive strategy, preventing extensive myocardial infarction. In resource-limited settings, strengthening frontline diagnostic capabilities and referral networks is crucial to improving patient outcomes. Full article

Background and Objectives: To date, several machine learning (ML) prognostic prediction models have been investigated for patients with acute myocardial infarction (AMI). However, few studies have compared the prognostic performance of ML techniques in AMI patients who underwent percutaneous coronary intervention (PCI). We sought to compare the prognostic performance among various machine learning techniques to determine which one showed the best prediction ability. Materials and Methods: Using data from the large, multicenter COREA-AMI registry, this study analyzed 10,172 patients to predict major adverse cardiac events (MACEs) at 1 and 5 years. MACE was defined as a composite of cardiac death, myocardial infarction, or cerebrovascular accident. Results: Compared with the four other ML techniques and traditional logistic regression, the random forest (RF) model consistently demonstrated the highest predictive performance. At 5 years, the RF model achieved a superior area under the curve (AUC) of 0.822, an accuracy of 0.804, and an F1 score of 0.870. To ensure clinical interpretability, a SHapley Additive exPlanations analysis was performed on the RF model. It identified key independent predictors for MACEs. The top nonmodifiable predictors included age, renal function, and left ventricular ejection fraction, whereas modifiable risk factors included dual antiplatelet therapy, statin therapy, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy, and adherence to these optimal medical therapy. Conclusions: In this real-world patient cohort, the RF model provided modest improvements in long-term risk stratification, and our findings highlight the continuing importance of guideline-directed medical therapy in determining patient prognosis. Full article

Background: Coronary imaging is increasingly used in chronic total occlusion percutaneous coronary intervention (CTO-PCI), but the impact of different imaging strategies on procedural decisions and outcomes remains unclear. Methods: We retrospectively analyzed 171 consecutive patients undergoing CTO-PCI, stratified by imaging strategy into four groups: angiography-only (n = 48), IVUS-guided (n = 42), CT-guided (n = 40) and CT + IVUS-guided (n = 41). Procedural and in-hospital clinical outcomes were compared. A multivariable logistic regression identified predictors of intense debulking techniques (defined as the use of rotational atherectomy or intravascular lithotripsy). Results: Imaging guidance was associated with progressively longer procedural (p < 0.001) and fluoroscopic time (p = 0.007). Similarly, an increased number of guidewires (p = 0.005) and balloons (p = 0.003) was used in the imaging groups, with the CT + IVUS groups showing the highest features. Regarding stenting characteristics, higher stent length and diameter (p = 0.01) were observed in the imaging groups. In patients with J-CTO score > 2, procedural success rates significantly increased with the use of coronary imaging (p = 0.01). Multivariable analysis showed that both J-CTO score (OR 2.0; 95% CI 1.3–3.0; p = 0.001) and imaging strategies (OR 1.6; 95% CI 1.02–2.4; p = 0.04) independently predicted the use of intense debulking techniques. Importantly, no significant differences were observed in in-hospital complications across groups. Conclusions: The use of coronary imaging, particularly the combination of IVUS and CT, is associated with more complex CTO lesions and led to increased procedural time, fluoroscopic time and more extensive stenting, as well as higher debulking usage. In complex CTO cases, coronary imaging was associated with higher procedural success rates. Imaging strategies independently predicted the need for advanced lesion preparation, beyond anatomical complexity, without compromising safety. Despite higher procedural demands, coronary imaging enables a more tailored and successful approach to CTO-PCI, particularly in complex cases. These findings underscore the pivotal role of multimodal imaging in the procedural planning and optimization of CTO-PCI. Full article

Introduction: Posterior tibial tendon dysfunction (PTTD) is a progressive degenerative tendinopathy often unresponsive to conservative care, necessitating surgical interventions with significant postoperative risks. Wharton’s jelly (WJ) tissue allograft from the human umbilical cord, with its collagen-rich matrix homologous to tendon tissue, presents a potential alternative intervention. This study aims to report preliminary findings on the safety and efficacy of WJ allografts for the supplementation of degenerated tissue in patients with PTTD. Material and Methods: Twenty-six patients from the observational repository were identified with PTTD (Stages II-IV) and failed at least three months of conservative care. Patients received one or two ultrasound-guided percutaneous applications of the WJ allograft. Outcomes were tracked using the Numeric Pain Rating Scale (NPRS), the Western Ontario and McMaster University Arthritis Index (WOMAC), and the Quality-of-Life Scale (QOLS) at the initial, 30, 90, and 120-day follow-ups. Results: The cohort was 62% male (n = 16) and 38% female (n = 10), with a mean age predominantly in the 70–89 range. From the initial to final visit (90 days for single applications, 120 days for double applications), the single-application group (n = 22) showed a 48.32% improvement in NPRS and a 22.73% improvement in total WOMAC. The double-application group (n = 8) showed a 50% improvement in NPRS and a 27.86% improvement in total WOMAC. A statistically significant improvement in NPRS was observed in the single-application group (p = 0.042). No adverse events were reported. Discussion: This study provides preliminary evidence that WJ tissue allografts may be a safe and effective minimally invasive application for degeneration of the PTT, which is associated with improvements in pain, function, and quality of life. Key limitations include a lack of a control group and a small cohort size. Conclusions: The positive findings of this study warrant further research through randomized controlled trials to confirm efficacy, establish optimal dosage, and compare WJ to other conservative interventions. Full article

Tricuspid valve diseases are an increasing cause of cardiovascular mortality, peaking in the eighth decade of life. More than 75% of severe tricuspid regurgitations are recognized via functional mechanisms, often secondary to left heart disease and pulmonary hypertension. Surgical risk for isolated correction of tricuspid regurgitation, both repair or replacement, is associated with prohibitive risk mainly in elderly patients, with several comorbidities and right ventricular dysfunction. In the past decade, different percutaneous devices have been developed to treat a large group of high-surgical-risk patients. Early diagnosis and careful patient selection are essential to improving prognosis in severe TR. Potential treatment options may vary in different stages of disease. The current available results from present studies have proven the safety and effectiveness of these devices under proper clinical indications, although selection bias and non-randomization in most investigations at present do not allow for definite indications. Ideal anatomic and clinical parameters to predict interventional success are in continuous evolution and need definite standardization. We report three cases in which different percutaneous techniques were employed for treatment when surgery was not suitable. The literature is discussed for each condition. Despite promising results in terms of safety and success rate, further randomized studies are needed to better understand which patients may be subject to long-term effects on survival and quality of life. Full article

Acute myocardial infarction (AMI) remains the leading cause of death worldwide, with myocardial ischemia/reperfusion injury (MIRI) emerging as a significant factor influencing patient outcomes despite timely reperfusion therapy. MIRI refers to paradoxical myocardial damage that occurs upon restoration of coronary blood flow and is driven by complex inflammatory, oxidative, and metabolic mechanisms, which can exacerbate infarct size (IS), contributing to adverse outcomes. This review explores the molecular and cellular pathophysiology of MIRI, emphasizing both its clinical and forensic relevance. The principal mechanisms discussed include oxidative stress and mitochondrial dysfunction, calcium overload and ion homeostasis imbalance, inflammatory responses, with particular focus on the NLRP3 inflammasome and cytokine pathways, and multiple forms of cell death (apoptosis, necroptosis, pyroptosis, and autophagy). Additionally, the authors present original immunohistochemical findings from autopsy cases of patients who suffered ST-segment elevation myocardial infarction (STEMI) and underwent percutaneous coronary intervention (PCI), but subsequently died. These findings underscore that successful reperfusion does not completely prevent delayed complications, like arrhythmias, ventricular fibrillation (VF), and sudden cardiac death (SCD), often caused by secondary MIRI-related mechanisms. Moreover, the case series highlight the diagnostic value of inflammatory markers for pathologists in identifying MIRI as a contributing factor in such fatalities. Finally, immunotherapeutic strategies—including IL-1 and IL-6 inhibitors such as Canakinumab and Tocilizumab—are reviewed for their potential to reduce cardiovascular events and mitigate the effects of MIRI. The review advocates for continued multidisciplinary research aimed at improving our understanding of MIRI, developing effective treatments, and informing forensic investigations of reperfusion-related deaths. Full article

Contrast-induced encephalopathy (CIE) is a rare complication after percutaneous coronary intervention (PCI) that mimics intracranial hemorrhage (ICH). Its computed tomography (CT) findings (cortical contrast enhancement, sulci effacement) overlap with cerebrovascular conditions (e.g., cerebral infarction, subarachnoid hemorrhage). Dual-energy CT (DECT) differentiates blood/calcification from iodinated contrast medium (CM) extravasation via material decomposition, contributing to the accurate diagnosis of CIE. We report a CIE case highlighting DECT’s value. A 74-year-old woman underwent PCI. 50 min post-PCI, she had moderate headache (Numeric Rating Scale 4), dizziness, non-projectile vomiting (no seizures); vital signs were stable, no focal deficits, mannitol ineffective. Non-contrast CT demonstrated a left parietal 75 Hounsfield unit (HU) high-attenuation lesion, indistinguishable from acute intracerebral hemorrhage. Conventional non-contrast CT revealed a high-attenuation lesion (75 HU) in the left parietal lobe—indistinguishable from ICH. DECT clarified the diagnosis: virtual non-contrast maps showed CM extravasation, iodine concentration maps confirmed focal CM accumulation, and effective atomic number maps improved lesion visualization. The patient’s headache resolved within 5 h; follow-up non-contrast CT at 24 h showed complete disappearance of the lesion. She resumed clopidogrel, discharged day 3 without sequelae. This case underscores DECT’s role in distinguishing CIE (transient CM, normal neuro exam) from ICH (persistent hemorrhage), guiding safe post-PCI antiplatelet therapy. Full article

Acute pancreatitis (AP) is the most common cause of gastrointestinal-related hospitalizations in the United States, with gallstone disease and alcohol as the leading etiologies. Management is determined by disease severity, classified as interstitial edematous pancreatitis or necrotizing pancreatitis, with severity further stratified based on local complications and systemic organ dysfunction. Regardless of etiology, initial treatment involves aggressive intravenous fluid resuscitation with Lactated Ringer’s solution, pain and nausea control, early oral feeding in 24 to 48 h, and etiology-directed interventions when indicated. In gallstone pancreatitis, early endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is indicated in the presence of concomitant cholangitis or persistent biliary obstruction, with subsequent laparoscopic cholecystectomy as standard of care for stone clearance. The role of interventional therapy in uncomplicated AP is limited in the acute phase, except for biliary decompression or enteral feeding support with nasojejunal tube placement. However, in severe AP with complications, interventional radiology (IR) and endoscopic approaches play a pivotal role. IR facilitates early percutaneous drainage of symptomatic, acute fluid collections and infected necrosis, particularly in non-endoscopically accessible retroperitoneal or dependent collections, improving outcomes with a step-up approach. IR-guided angiographic embolization is the preferred modality for hemorrhagic complications, including pseudoaneurysms. In the delayed phase, walled-off necrosis (WON) and pancreatic pseudocysts are managed with endoscopic ultrasound (EUS)-guided drainage, with direct endoscopic necrosectomy (DEN) reserved for infected necrosis. Dual-modality drainage (DMD), combining percutaneous and endoscopic drainage, is increasingly utilized in extensive or complex collections, reflecting a collaborative effort between gastroenterology and interventional radiology comparable to that which exists between IR and surgery in institutions that perform video assisted retroperitoneal debridement (VARD). Peripancreatic fluid collections may fistulize into adjacent structures, including the stomach, small intestine, or colon, requiring transpapillary stenting with or without additional closure of the gut leak with over-the-scope clips (OTSC) or suturing devices. Additionally, endoscopic management of pancreatic duct disruptions with transpapillary or transmural stenting plays a key role in cases of disconnected pancreatic duct syndrome (DPDS). Comparative outcomes across interventional techniques—including retroperitoneal, laparoscopic, open surgery, and endoscopic drainage—highlight a shift toward minimally invasive approaches, with decreased morbidity and reduced hospital stay. The integration of endoscopic and interventional radiology-guided techniques has transformed the management of AP complications and multidisciplinary collaboration is essential for optimal patient outcomes. Full article

With the advancement of fractional flow reserve (FFR) derived from computed tomography (FFR_CT), virtual stenting technology has gradually developed. This study investigated the performance of virtual stenting based on FFR_CT in predicting post-percutaneous coronary intervention (PCI) FFR. Data from 75 patients (78 blood vessels) was collected retrospectively. We randomly allocated the participants to discovery (n = 26) and validation (n = 52) cohorts. The FFR_CT was calculated using pre-PCI coronary computed tomography angiography images. Virtual stent implantation was simulated using blinded and non-blinded virtual stenting methods to obtain post-virtual stenting FFR_CT. The median FFR_CT before PCI and invasive FFR were 0.70 (0.60–0.77) and 0.69 (0.63–0.76), respectively. The median FFR_CT were 0.91 (0.86–0.95) and 0.91 (0.87–0.94) in the blinded and non-blinded groups, respectively; the invasive post-PCI FFR was 0.90 (0.88–0.93). The difference between the FFR_CT after using the blinded/non-blinded method and the invasive post-PCI FFR were 0.010 (95% limits of agreement: −0.064 to 0.084) and 0.009 (−0.050 to 0.068) in the discovery cohort and −0.005 (−0.075 to 0.064) and −0.0002 (−0.064 to 0.064) in the validation cohort, respectively. Virtual stenting technology based on FFR_CT can effectively predict functional outcomes after PCI and could be a reliable tool for PCI procedural planning. Full article

Background: Three-dimensional (3D) printing technology has rapidly emerged as a transformative tool in medicine, enabling the conversion of two-dimensional scans into highly accurate 3D models. This technology, especially when combined with artificial intelligence (AI) and advanced materials, offers numerous applications in surgical planning, simulation-based training, and patient-specific care. Methods: This review examines current literature and case studies on the use of 3D printing technology in various fields of medicine, especially in surgical specialties. Key applications include surgical planning, mock surgeries, biopsy guide creation, and customized implant fabrication across various surgical fields. Results: 3D printing is transforming surgery by enabling precise visualization of tumors and critical structures, significantly enhancing preoperative planning for conditions such as bone, soft tissue (e.g., neuroblastomas), renal, and maxillofacial tumors. In reconstruction surgeries, patient-specific 3D-printed implants ensure better anatomical compatibility, particularly in maxillofacial, neurosurgical, and vascular applications. Puncture guides improve procedural accuracy in interventions like percutaneous nephrolithotripsy. Detailed anatomical models aid in simulation-based training, increasing preparedness for complex procedures. Additionally, patient-specific implants and AI-integrated decision support systems are paving the way for more personalized and efficient surgical care. Conclusions: 3D printing technology, especially when combined with AI, is reshaping modern surgery by improving both accuracy, safety, and personalized healthcare. Its applications extend across multiple specialties, offering new possibilities in surgical planning, training, and patient-specific treatments. As AI and bioprinting continue to evolve, the potential for real-time applications, such as live-printed tissue implants and enhanced decision support, could drive the next phase of innovation in various fields. Full article

Background: Post-procedural infection worsens outcomes in acute coronary syndrome (ACS). High-sensitivity cardiac troponin (hs-cTn) reflects myocardial injury, but its utility for infection risk prediction after percutaneous coronary intervention (PCI) is uncertain. Objective: This study aimed to evaluate whether high-sensitivity troponin (hs-cTn) levels are associated with the risk of infection and systemic inflammation. Methods: We performed an exploratory pilot study of consecutive ACS patients undergoing PCI (n = 181) at a tertiary interventional cardiology unit in Romania. Herein, hs-cTn was measured at 24- and 48-h post-PCI. The primary outcome was in-hospital infection (clinical and/or microbiological documentation), with the acknowledgment that nearly half were clinically diagnosed without microbiological confirmation. We assessed discrimination for hs-cTn48h using ROC analysis and explored associations with systemic markers (CRP, ESR, and leukocytes) and NT-proBNP using Spearman correlations. Results: Infections occurred in 9/181 patients (5.0%; 95% CI, 2.6–9.2). Notably, hs-cTn48h showed AUC = 0.49 (approx. 95% CI, 0.30–0.68) for infection discrimination. Correlations between hs-cTn48h and inflammatory markers were weak and non-significant (CRP ρ = 0.126, p = 0.091; ESR ρ = 0.119, p = 0.111; fibrinogen ρ = 0.134, p = 0.073), whereas hs-cTn48h correlated modestly with NT-proBNP (ρ = 0.232, p = 0.002). Conclusions: In this cohort, hs-cTn48h did not predict in-hospital infection after PCI in ACS. These negative findings highlight that troponin should be interpreted primarily as a marker of myocardial necrosis, not infectious risk. Larger multicenter studies with microbiological adjudication and broader biomarker panels are warranted. Full article

Acute appendicitis remains one of the most common surgical emergencies, with a lifetime incidence of approximately 7–8% in the USA and Europe. Despite the widespread adoption of the laparoscopic approach and advances made in perioperative care, post-operative infections—particularly intra-abdominal abscesses—continue to pose a substantial clinical challenge, with an overall probability that ranges from 5 to 15%. Nowadays, it is essential not only to improve patient outcomes by reducing these complications but also to promote responsible antibiotic use. This review provides an in-depth examination of post-appendectomy infections in adults, synthesizing research from the past decade. It explores the various risks involved, including those related to the patient, the disease itself, and the surgical techniques employed. There is particular emphasis on the impact of surgical approach, closure methods, timing of surgery, and intraoperative decisions such as drain placement, peritoneal lavage, and routine bacterial cultures. Part of the discussion is about emerging data regarding the use of antiseptic solutions and specimen retrieval techniques. Additionally, the review examines current approaches to managing postoperative intra-abdominal abscesses. It assesses when antibiotics are necessary, evaluates image-guided percutaneous drainage, and considers laparoscopic re-intervention as a possible solution. While recent studies offer valuable insights, the heterogeneity of available evidence highlights the pressing need for high-quality, standardized research. Ultimately, a deeper understanding of infection pathways and preventative strategies is vital—not only for reducing morbidity and hospital readmissions, but also for safeguarding the long-term efficacy of antibiotics and delivering safer, more effective surgical care. Full article

Background/Objectives: Existing data regarding the kinetics of cardiac troponin I (cTnI) are limited. The aim of the current study was to evaluate the kinetics of highly sensitive (hs) cTnI following acute myocardial infarction (MI) in a large-scale, real-world cohort. Methods: A prospective observational cohort study included all consecutive patients admitted to the intensive cardiovascular care unit (ICCU) with ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI) who underwent percutaneous coronary intervention (PCI) between January 2020 and April 2024. Hs-cTnI concentrations were measured at the time of presentation and daily thereafter. Results: A total of 1174 STEMI patients [191 females (16.3%)] with a mean age of 63 years and 767 NSTEMI patients [137 females (17.9%)] with a mean age of 66.7 years were enrolled. The average hs-cTnI peak levels were 77,937.99 ng/L and 24,804.73 ng/L for STEMI and NSTEMI patients, respectively. A single peak of hs-cTnI was observed in 83% and 78% of STEMI and NSTEMI patients, respectively, while two peaks were observed in 11% and 19% and three or more peaks were observed in 6% and 3% of STEMI and NSTEMI patients, respectively. A higher number of peaks was associated with a lower ejection fraction and more in-hospital complications. Additionally, a higher number of peaks correlated with a higher in-hospital mortality rate among NSTEMI patients. Conclusions: Most STEMI and NSTEMI patients displayed a monophasic kinetic pattern of hs-cTnI peak levels. However, a greater number of hs-cTnI peaks was linked to a higher incidence of clinical complications, lower ejection fraction, and increased mortality. Full article

Background and Clinical Significance: Atrial septal defects (ASDs), particularly the ostium secundum type, are congenital cardiac anomalies that can lead to serious complications if left untreated. Percutaneous closure using devices like the Amplatzer Septal Occluder (ASO) has become a widely accepted approach, although complications such as device embolization can occur. Case Presentation: We present a unique case of a 28-year-old woman who developed acute hemodynamic instability and arrhythmias following embolization of an Amplatzer device into the right ventricle during an ASD closure. Despite initial treatment with antiarrhythmic medication, the patient required urgent open-heart surgery for device retrieval and ASD closure. The surgery successfully involved pericardial patch closure of the ASD, device removal from the right ventricle, and the performance of the Kay procedure to address significant tricuspid regurgitation. Postoperative recovery was uneventful, with the patient stabilized and discharged in stable condition. Conclusions: This case highlights the critical need for rapid surgical intervention in cases of device embolization, and the importance of multidisciplinary coordination in managing such complex complications. The combination of ASD closure, device retrieval, and tricuspid valve repair led to a successful outcome, underscoring the importance of timely, decisive action in complex cardiovascular emergencies. Full article