Coronary Artery Aneurysm Post Drug-Coated Balloon Angioplasty.

Drug-coated balloons have emerged as effective therapy for treating in-stent restenosis and de novo lesions. The animal studies have shown the mechanism of action of paclitaxel-coated balloon in coronary arteries which leads to medial necrosis that may explain the better angiographic remodelling observed with paclitaxel- as compared to sirolimus-coated balloons. However, in some cases, paclitaxel may cause adverse remodelling resulting in coronary artery aneurysm.

What Have We Learned From Explanted Peripheral Stents Analysis?

Introduction: The behavior of endovascular devices used to treat peripheral artery obstructive disease (PAOD) is evaluated on in vitro and in vivo animal models that do not necessarily predict their behavior in humans. Direct in vivo analysis is not feasible; therefore, studying explanted stents might help the approach understand their in vivo behavior and their potential long-term complications. Consequently, studying their in vivo behavior in human diseased vessels is necessary to improve them.

Medial arterial calcification in ageing and disease: current evidence and knowledge gaps.

Medial arterial calcification (MAC) characterizes human arterial ageing, potentially remaining clinically silent for decades. However, in susceptible individuals and patients with diabetes mellitus and chronic kidney disease, it becomes a critical risk factor for cardiovascular morbidity and mortality, and it is a significant risk factor for chronic limb-threatening ischaemia and limb amputation. A key biological feature of MAC pathogenesis is the phenotype switching of vascular smooth muscle cells, ultimately responsible for the deposition of hydroxyapatite crystals and the progressive medial layer destruction associated with intimal thickening.

Pericoronary Adipose Tissue Attenuation in Patients with Future Acute Coronary Syndromes: The ICONIC Study.

Purpose Pericoronary adipose tissue attenuation (PCATa) measured at coronary CT angiography (CCTA) is an imaging biomarker of coronary inflammation associated with long-term adverse cardiac events. The authors hypothesized that PCATa may independently identify patients at risk for acute coronary syndromes (ACS). Materials and Methods The authors performed a retrospective substudy of the Incident Coronary Syndromes Identified by Computed Tomography (ICONIC) study, a propensity-matched case-control study of patients with CCTA followed by ACS.

An Absorbable Antibacterial Envelope Promotes Development of a Healthy Device Pocket: Results of the TYRX Pocket Health Study.

Introduction: Creation of a pocket and implant of a cardiac implantable electronic device (CIED) elicits a foreign body response in the presence of the normal wound healing process. An absorbable antibacterial envelope (TYRX™, Medtronic Inc.) was developed to stabilize CIEDs and reduce infections.

Feasibility of optical coherence tomography-guided primary percutaneous coronary intervention for STEMI: all-comer ATLAS-OCT trial.

Intravascular imaging for acute coronary syndrome is recommended in the guidelines; however, the actual rate of patients with ST-segment elevation myocardial infarction (STEMI) who successfully undergo optical coherence tomography (OCT)-guided primary percutaneous coronary intervention (PCI) is unclear. This study aimed to determine the feasibility of OCT-guided primary PCI and identify the patient population that would benefit most from OCT guidance in STEMI. The ATLAS-OCT trial was a prospective, single-arm, all-comers study conducted at 16 institutions.

Biomarkers Differentiating Plaque Erosion from Stable Plaque.

Purpose Of Review: Plaque erosion is the second most frequent cause of acute coronary syndrome, yet the biological processes and biomarkers associated with erosion remain incompletely understood. This review aims to examine the current understanding of plaque erosion, with a focus on identifying potential biomarkers.

Recent Findings: Recent studies have identified distinct pathophysiological characteristics associated with plaque erosion, including variations in inflammatory response and immune cell infiltration within the culprit lesions and thrombi.

Age Differences in Aortic Stenosis.

Aortic stenosis (AS) is a significant and growing concern, with a prevalence of 2-3% in individuals aged over 65 years. Moreover, with an aging global population, the prevalence is anticipated to double by 2050. Indeed, AS can arise from various etiologies, including calcific trileaflets, congenital valve abnormalities (e.

Role of Hemoglobin-Stimulated Macrophages and Intraplaque Hemorrhage in the Development of Vascular Diseases.

Intraplaque hemorrhage plays a critical role in the life of advancing atherosclerotic plaques, not only by triggering an acute increase in lesion size but also by attracting macrophages to the site. Lysis of erythrocytes in these areas is thought to be caused by oxidative stress, which induces the release of free Hb (hemoglobin), which is quickly bound by haptoglobin to form Hb-haptoglobin complexes. Macrophages are the only cells in the body capable of scavenging these complexes through the CD (cluster of differentiation) 163 scavenger receptor, which mediates Hb-haptoglobin ingestion, driving their differentiation.

CTA-Derived Plaque Characteristics and Risk of Acute Coronary Syndrome in Patients With Coronary Artery Calcium Score of Zero: Insights From the ICONIC Trial.

. Coronary artery calcium (CAC) scoring is used to stratify acute coronary syndrome (ACS) risk. Nonetheless, patients with a CAC score of zero (CAC) remain at risk from noncalcified plaque components.

Sex related coronary plaque progression patterns among patients with family history as the sole cardiovascular risk factor: A PARADIGM sub-study.

Background And Aims: How sex may influence the prevalence and progression of coronary atherosclerosis in patients with positive family history for CAD is still unclear. Aim of the present study was to explore the role of family history of CAD in coronary atherosclerosis expression and progression in male and female subjects.

Methods: A total of 2252 patients who underwent clinically indicated serial CCTAs at an interscan interval of more than 2 years were enrolled in the PARADIGM Study.

An In Situ Curing, Shear-Responsive Biomaterial Designed for Durable Embolization of Microvasculature.

Endovascular embolization is a minimally-invasive technique whereby blood vessels supplying pathological structures are selectively occluded with various embolic agents. In many scenarios, it is desirable for the embolic to distally penetrate to the level of the microvasculature, which maximizes devascularization. Existing agents exhibit inconsistent distal penetration and have other limitations including tendency for proximal reflux, patient pain during infusion, lack of fluoroscopic radiopacity, potential for catheter adhesion, susceptibility to recanalization, and other usability challenges.

Vascular Response, Downstream Effect, and Pharmacokinetics After Sirolimus- and Paclitaxel-Coated Balloons in Porcine Coronary Arteries.

Background: Paclitaxel (PCB) and sirolimus-coated balloons (SCB) are major therapeutic options for coronary artery disease, but there is no direct head-to-head histological comparison of their effects during the percutaneous coronary intervention (PCI).

Aims: We aimed to investigate the vascular and downstream effects and drug pharmacokinetics in a porcine coronary model treated with MagicTouch-SCB (MT-SCB), Selution-SRL-SCB (SEL-SCB), Agent PCB, and plain old balloon angioplasty (POBA).

Methods: Twenty-eight coronary arteries from 10 pigs were treated with one of three drug-coated balloons (DCBs) (n = 7 for each) or POBA (n = 7) with 28 days follow-up.

Histological assessment of a novel restorative coronary artery bypass graft in a chronic ovine model.

Background: Although prosthetic conduits for coronary artery bypass grafting (CABG) are increasingly needed because of the limited availability and patency of autologous conduits, no alternatives have succeeded.

Methods: Sixteen sheep underwent CABG. Thirteen received a bioabsorbable polymer graft with an incorporated nitinol microskeleton (Xeltis coronary artery bypass graft [XABG]), and three received autologous saphenous vein grafts (SVG).

Pathology of Self-Expanding Transcatheter Aortic Bioprostheses and Hypoattenuated Leaflet Thickening.

Background: Hypoattenuated leaflet thickening (HALT) is believed to reflect leaflet thrombosis; however, no systematic histological examination of HALT has ever been performed. The aim of this study was to evaluate histological findings of explanted self-expanding transcatheter aortic bioprosthetic valves from clinical trials and to compare microCT findings of suspected HALT with histology findings of valve thrombosis and its characterization over time.

Methods: A total of 123 self-expanding transcatheter aortic valves were collected through autopsy (n=89) or surgical explant (n=34) from 11 CoreValve/Evolut clinical trials.

Carotid artery atherosclerosis: mechanisms of instability and clinical implications.

Cardiovascular disease remains a prominent cause of disability and premature death worldwide. Within this spectrum, carotid artery atherosclerosis is a complex and multifaceted condition, and a prominent precursor of acute ischaemic stroke and other cardiovascular events. The intricate interplay among inflammation, oxidative stress, endothelial dysfunction, lipid metabolism, and immune responses participates in the development of lesions, leading to luminal stenosis and potential plaque instability.

Risk Factors Favoring Plaque Erosion.

Purpose Of Review: Plaque erosion is the second leading cause of coronary thrombosis following plaque rupture and represents a key pathophysiological process underlying acute coronary syndromes that can culminate in sudden coronary death. While the precise mechanisms and risk factors driving plaque rupture are well-established, those for erosion have only recently been explored. This review summarizes current literature on the characteristics and risk factors favoring plaque erosion.