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Purpose of review: Drug-eluting stent (DES) technology has greatly enhanced the safety and effectiveness of percutaneous coronary interventions (PCI). The aim of the present paper is to provide a comprehensive review of in-stent restenosis (ISR), focusing on the contemporary DES era, including its incidence, mechanisms, and imaging characterization. Recent findings: Despite the widespread use of DES and numerous improvements, recent clinical data indicate that ISR still occurs in 5–10% of PCI procedures, posing a considerable public health issue. Summary: The incidence, morphology, and clinical implications of ISR are determined by a complex interplay of several factors: the patient, stent, procedure, and vessel and lesion-related factors. Advancements in intracoronary imaging have provided greater insight into its patterns and underlying causes. Over time, treatment strategies have evolved, and current guidelines recommend an individualized approach using intracoronary imaging to characterize ISR's underlying substrate. [ABSTRACT FROM AUTHOR]

Background and Aims There was no previous trial comparing aspirin monotherapy with a P2Y12 inhibitor monotherapy following short dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stents. Methods In the STOPDAPT-3, patients with acute coronary syndrome or high bleeding risk (HBR) were randomly assigned to either 1-month dual antiplatelet therapy with aspirin and prasugrel followed by aspirin monotherapy (aspirin group) or 1-month prasugrel monotherapy followed by clopidogrel monotherapy (clopidogrel group). This secondary analysis compared aspirin monotherapy with clopidogrel monotherapy by the 30-day landmark analysis. The co-primary endpoints were the cardiovascular endpoint defined as a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischaemic stroke and the bleeding endpoint defined as Bleeding Academic Research Consortium 3 or 5. Results Of the 6002 assigned patients, 5833 patients (aspirin group: N = 2920 and clopidogrel group: N = 2913) were included in the 30-day landmark analysis. Median age was 73 (interquartile range 64–80) years, women 23.4%, acute coronary syndrome 74.6%, and high bleeding risk 54.1%. The assigned monotherapy was continued at 1 year in 87.5% and 87.2% in the aspirin and clopidogrel groups, respectively. The incidence rates beyond 30 days and up to 1 year were similar between the aspirin and clopidogrel groups for both cardiovascular endpoint [4.5 and 4.5 per 100 person-year, hazard ratio 1.00 (95% confidence interval.77–1.30), P =.97], and bleeding endpoint [2.0 and 1.9, hazard ratio 1.02 (95% confidence interval.69–1.52), P =.92]. Conclusions Aspirin monotherapy compared with clopidogrel monotherapy was associated with similar cardiovascular and bleeding outcomes beyond 1 month and up to 1 year after percutaneous coronary intervention with drug-eluting stents (STOPDAPT-3 ClinicalTrials.gov number, NCT04609111). [ABSTRACT FROM AUTHOR]

The document discusses the selection of stent types in high bleeding risk patients undergoing percutaneous coronary intervention (PCI) for myocardial revascularization. It highlights the importance of stent selection based on factors like technical features and lesion characteristics to mitigate stent-related complications. Clinical trials comparing different stents in high bleeding risk patients receiving short dual antiplatelet therapy (DAPT) provide evidence for stent-type selection at the time of PCI when a short DAPT duration is anticipated. Stents like BioFreedom, Resolute Onyx, Synergy, and Xience are indicated for use in high bleeding risk patients, while upcoming trials will provide further insight into this topic. [Extracted from the article]

Abstract Coronary artery calcium (CAC) scoring CT is a useful tool for screening coronary artery disease and for cardiovascular risk stratification. However, its efficacy in patients with coronary stents, who had pre-existing coronary artery disease, remains uncertain. Historically, CAC CT scans of these patients have been manually excluded from the CAC scoring process, even though most of the CAC scoring process is now fully automated. Therefore, we hypothesized that automating the filtering of patients with coronary stents using artificial intelligence could streamline the entire CAC workflow, eliminating the need for manual intervention. Consequently, we aimed to develop and evaluate a deep learning-based coronary stent filtering algorithm (StentFilter) in CAC scoring CT scans using a multicenter CAC dataset. We developed StentFilter comprising two main processes: stent identification and false-positive reduction. Development utilized 108 non-enhanced echocardiography-gated CAC scans (including 74 with manually labeled stents), and for false positive reduction, 2063 CAC scans with significant coronary calcium (average Agatston score: 523.8) but no stents were utilized. StentFilter’s performance was evaluated on two independent internal test sets (Asan cohort- and 2; n = 355 and 396; one without coronary stents) and two external test sets from different institutions (n = 105 and 62), each with manually labeled stents. We calculated the per-patient sensitivity, specificity, and false-positive rate of StentFilter. StentFilter demonstrated a high overall per-patient sensitivity of 98.8% (511/517 cases with stents) and a false-positive rate of 0.022 (20/918). Notably, the false-positive ratio was significantly lower in the dataset containing stents (Asan cohort-1; 0.008 [3/355]) compared with the dataset without stents (Asan cohort-2; 0.043 [17/396], p = 0.008). All false-positive identifications were attributed to dense coronary calcifications, with no false positives identified in extracoronary locations. The automated StentFilter accurately distinguished coronary stents from pre-existing coronary calcifications. This approach holds potential as a filter within a fully automated CAC scoring workflow, streamlining the process efficiently.

Purpose: We assessed the safety of general thoracic surgery in patients with prior coronary stents undergoing lung resection, based on differences in perioperative antiplatelet therapy management. Methods: We retrospectively examined 150 patients with coronary artery stents who underwent pulmonary resection between July 2009 and July 2018. The impact of the antiplatelet agent on thoracic surgery safety was assessed by comparing perioperative outcomes, including major adverse cardiac and cerebrovascular events, among the discontinued antiplatelet therapy (group D), heparin bridging (group H), and continuous antiplatelet therapy (group C) groups. Results: Groups D, H, and C included twenty-four, eighty-four, and forty-two patients, respectively. Second-generation drug-eluting stents were used in > 50% of the patients. No significant differences were found in the estimated blood loss, transfusion rate, or operative duration. Major adverse cardiac and cerebrovascular events occurred in four (2.7%) patients, which was comparable among the groups. In group H, postoperative heart failure and transient ischemic attack with stroke occurred in one patient each. Major bleeding occurred in two (4.7%) patients in group C. Conclusions: Pulmonary resection surgical outcomes in patients with coronary artery stents were feasible regardless of antiplatelet therapy continuation. However, discontinuing dual-antiplatelet or single-antiplatelet therapy in such patients may be reasonable because this generation of drug-eluting stents has a higher safety profile than bare-metal and first-generation drug-eluting stents. [ABSTRACT FROM AUTHOR]

Polymeric coating is one of the most used surface modification techniques on stents to reduce late stent thrombosis and restenosis. Coating process parameters must need to be rigorously controlled in biomedical applications. Spray coating is one of the most promising process used to recover commercial coronary stents, wherein uniform surfaces must be achieved. A novel low-cost spray coating machine was developed constructed using an airbrush with adjustable pressure (30 psi to 45 psi). Additionally, time and distance control systems were adapted for tubular samples, and a motor controlled their rotation. Polylactic acid (PLA) was deposited on 316L stainless steel tubes, using a spray coating technique for coronary stents purposes in order to achieve optimal film characteristics. Scanning electron microscopy was used to analyze the coating homogeneity. Other physical characteristics such as weight and surface roughness were measured to assess the feasibility of the proposed system. [ABSTRACT FROM AUTHOR]

To investigate the effect of heart rate and virtual monoenergetic image (VMI) on coronary stent imaging in dual-source photon-counting detector computed tomography (PCD-CT). A dynamic cardiac phantom was used to vary the heart rate at 50 beats per minute (bpm), 70 bpm, and 90 bpm. Five types of stents (4.0 mm, 3.5 mm, 3.0 mm, 2.75 mm, and 2.5 mm diameter) were scanned at three different locations and reconstructed VMI at 70 keV. In addition, 50% stenosis was assessed for 3.0 mm and 4.0 mm stents. To assess in-stent stenosis, 40 keV, 70 keV, and 100 keV images were compared. Measurable lumen and contrast to noise ratio (CNR) from lumen to stenosis were evaluated quantitatively. A-4-point scale was used for the qualitative image quality of in-stent stenosis. The measurable lumen had no significant differences among heart rates in patent stents (p = 0.55). In-stent stenosis, the residual lumen was significantly larger in 40 keV [27.5% (20.8–32.3%)] than in 70 keV [11.5% (10.0–23.0%), p < 0.05] and 100 keV [0% (0–5.2%), p < 0.05]. The CNR was higher in 40 keV [12.5 (7.5–18.2)] than in 70 keV [5.3 (2.9–7.7), p < 0.05] and 100 keV [1.3 (0.5–2.7), p < 0.05]. The image quality was better in 40 keV (3.4 ± 0.7) than in 70 keV [(2.6 ± 0.8), p < 0.05] and 100 keV [(1.3 ± 0.4), p < 0.05]. Dual-source PCD-CT maintains a measurable lumen even at high heart rates. Adjusting the VMI can be helpful in visualizing the in-stent stenosis. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the impact of super-resolution deep learning reconstruction (SR-DLR) on coronary CT angiography (CCTA) image quality and blooming artifacts from coronary artery stents in comparison to conventional methods, including hybrid iterative reconstruction (HIR) and deep learning-based reconstruction (DLR). Methods: A retrospective analysis included 66 CCTA patients from July to November 2022. Major coronary arteries were evaluated for image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Stent sharpness was quantified using 10%-90% edge rise slope (ERS) and 10%-90% edge rise distance (ERD). Qualitative analysis employed a 5-point scoring system to assess overall image quality, image noise, vessel wall, and stent structure. Results: SR-DLR demonstrated significantly lower image noise compared to HIR and DLR. SNR and CNR were notably higher in SR-DLR. Stent ERS was significantly improved in SR-DLR, with mean ERD values of 0.70 ± 0.20 mm for SR-DLR, 1.13 ± 0.28 mm for HIR, and 0.85 ± 0.26 mm for DLR. Qualitatively, SR-DLR scored higher in all categories. Conclusions: SR-DLR produces images with lower image noise, leading to improved overall image quality, compared with HIR and DLR. SR-DLR is a valuable image reconstruction algorithm for enhancing the spatial resolution and sharpness of coronary artery stents without being constrained by hardware limitations. Advances in knowledge: The overall image quality was significantly higher in SR-DLR, resulting in sharper coronary artery stents compared to HIR and DLR. [ABSTRACT FROM AUTHOR]

Longitudinal stent deformation (LSD) is an infrequent complication of percutaneous coronary intervention. While the occurrence of gross LSD is a rare phenomenon, minor changes in length are common and have been recognized as accepted behavior of stents during implantation. Due to the proximity of the guide catheter, ostial or ostio-proximal lesions are prone to stent deformation either by the guide or other devices during navigation. Moreover, to satisfy the fractal geometry of coronary bifurcation, the proximal optimization technique is commonly performed during different bifurcation procedures, which can subject the stent to extreme overexpansion resulting in structural deformation. We describe two cases of longitudinal stent elongation during ostial deployment and try to analyze the factors behind this rare, yet complicated behavior of the latest-generation drug-eluting stent.

There was no study evaluating the effects of an aspirin-free strategy in patients undergoing complex percutaneous coronary intervention (PCI). The authors aimed to evaluate the efficacy and safety of an aspirin-free strategy in patients undergoing complex PCI. We conducted the prespecified subgroup analysis based on complex PCI in the STOPDAPT-3 (ShorT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent-3), which randomly compared low-dose prasugrel (3.75 mg/d) monotherapy to dual antiplatelet therapy (DAPT) with low-dose prasugrel and aspirin in patients with acute coronary syndrome or high bleeding risk. Complex PCI was defined as any of the following 6 criteria: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation with 2 stents implanted, total stent length >60 mm, or a target of chronic total occlusion. The coprimary endpoints were major bleeding events (Bleeding Academic Research Consortium 3 or 5) and cardiovascular events (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic stroke) at 1 month. Of the 5,966 study patients, there were 1,230 patients (20.6%) with complex PCI. Regardless of complex PCI, the effects of no aspirin relative to DAPT were not significant for the coprimary bleeding (complex PCI: 5.30% vs 3.70%; HR: 1.44; 95% CI: 0.84-2.47; P = 0.18 and noncomplex PCI: 4.26% vs 4.97%; HR: 0.85; 95% CI: 0.65-1.11; P = 0.24; P for interaction = 0.08) and cardiovascular (complex PCI: 5.78% vs 5.93%; HR: 0.98; 95% CI: 0.62-1.55; P = 0.92 and noncomplex PCI: 3.70% vs 3.10%; HR: 1.20; 95% CI: 0.88-1.63; P = 0.25; P for interaction = 0.48) endpoints without significant interactions. The effects of the aspirin-free strategy relative to standard DAPT for the cardiovascular and major bleeding events were not different regardless of complex PCI. (ShorT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent-3 [STOPDAPT-3]; NCT04609111) [Display omitted] [ABSTRACT FROM AUTHOR]

We present with full and proper consent of the patient, the case of a 64-year-old man with severe peripheral arterial disease and a known chronic infrarenal aortic occlusion causing severe short-distance claudication. Preoperative computed tomography angiography was significant for a new “cylindrical” calcified lesion. During the elective surgery, the lesion was confirmed to be a coronary stent. The coronary stent was confirmed to be from the patient's prior percutaneous coronary intervention to the left anterior descending artery 1 year prior. The stent was removed without complications by the surgical team. To the best of our knowledge, this is the first such case to be described in current literature. This patient is currently alive, and a revision of his left anterior descending artery intervention was found to be unwarranted on repeat coronary angiography.

Objective: This study aimed to evaluate the rate of major adverse cardiac events (MACEs; the sum of death, myocardial infarction, and revascularization rates) according to interventional strategies guided by invasive physiological methods in both sexes in a Brazilian population during long-term follow-up for an average of 2 years. Methods: This retrospective single-center study included 151 consecutive patients (232 lesions) between January 2018 and January 2022. The participants were divided into two groups: the female group (FG), comprising 59 patients with 88 lesions, and the male group (MG), comprising 92 patients with 144 lesions. Results: The FG had a greater mean age (FG: 67.96???13.12 vs. MG: 62.36???12.01 years, p?=?0.009) and lower mean creatinine clearance (FG: 79.35???38.63 vs. MG: 92.02???38.62?mL/min, p?=?0.02) than did the MG. The percentage of lesions in the left main coronary artery was higher in the FG than in the MG (12.5% vs. 2.78%, p?=?0.006). The mean follow-up time was longer in the MG than in the FG (795.61???350 vs. 619.19???318 days, respectively; p?=?0.001). MACE occurred in 11.86% and 13.04% of patients in the FG and MG, respectively (p?=?0.850). Secondary outcomes, such as death, reinfarction, and the need for new revascularization, showed no significant between-sex differences. Conclusions: Our study demonstrated the safety of invasive physiological methods to determine coronary revascularization in both male and female patients in a Brazilian population, as evidenced by the low rates of adverse cardiac events and death after a long-term follow-up.

Over the last few decades, cardiovascular stents have emerged as crucial biomedical devices. Stents undergo cyclic physiological loading, which can lead to progressive accumulation of structural damage over time eventually resulting in a stent fracture. Considering the critical role of stents, it is necessary to assess their fatigue endurance and predict a potential premature failure due to fatigue loading. This paper presents a comprehensive analysis of coronary stent design based on both fatigue failure and damage-tolerant approaches. Employing the fatigue failure approach, S-N analysis was conducted to pinpoint the critical zones of the stent. Initial resistance to fatigue was evaluated using Goodman's and Soderberg's criteria. These criteria were applied to principal and effective stresses obtained using the Finite Element Method. Susceptibility to fatigue damage was performed by simulating the initial crack growth, and it was assessed through the Paris power law. The damage-tolerant approach yields more conservative fatigue stress ranges compared to fatigue failure criteria, ensuring safety under standard physiological loading conditions. The presented approach offers reliable insights into stent durability, with potential for further enhancement. [ABSTRACT FROM AUTHOR]

Objective To research the effect of centralized procurement of coronary stent on total hospitalization expenses and structural expenses, explore the possible changes in treatment behavior and provide basis for the formulation of relevant operation management focus after the centralized procurement of coronary stent. Methods We collected the data of patients who underwent coronary stent implantation from January 2019 to December 2022 in a 3A hospital, using the interrupted time series analysis, descriptive analysis method, chi - square test and Welch' s ANOVA test to analyze the data at 48 time - observation points before and after centralized procurement. Results Centralized procurement immediately reduced the average hospitalization expenses of coronary stent implantation by 19 954. 38 Yuan (0, = -19 954. 381, 95% CI: - 21 546. 085 ~ - 18 362. 676) and medical materials cost dropped most (侯=-16 410. 418, 95% CI: - 17 548. 630 ~ -15 272. 206), other categories expenses had also varying degrees decrease (P <0.05). After centralized procurement, the average hospitalization expense of coronary stent implantation was gradually rising (艮=315. 605, 95% CI: 198. 061 -433. 148), mainly due to the rise in the expenses of medical examination (角=110. 484, 95% CI: 95.525 -125.443) and materials (民=265.433, 95% CI: 181. 378 - 349. 487), the proportion of medical service fees was gradually decreasing (P < 0. 05). Conclusion The centralized procurement of coronary stent reduces the total hospitalization expenses of related patients. However, the cost of medical examination and materials continues growth after the centralized procurement of coronary stent, so hospital managers should strengthen supervision to avoid unreasonable recovery of expenses. [ABSTRACT FROM AUTHOR]

The use of invasive physiology methods in patients with renal dysfunction is not well elucidated. Our objective was to evaluate the in-hospital and long-term results of using intracoronary physiology to guide revascularization in patients with chronic kidney disease. In this retrospective study, we evaluated 151 patients from January 2018 to January 2022, divided into 2 groups: CKD (81 patients [114 lesions]) and non-CKD (70 patients [117 lesions]). The mean age was higher (p < 0.001), body mass index was lower (p = 0.007), contrast volume used was lower (p = 0.02) and the number of ischemic lesions/patients was higher (p = 0.005) in the CKD group. The primary outcomes (rate of major adverse cardiac events during follow-up, defined as death, infarction, and need for new revascularization) in the CKD and non-CKD groups were 22.07% and 14.92%, respectively (p = 0.363). There was a significant difference in the target lesion revascularization (TLR) rate (11.68%, CKD group vs. 1.49%, non-CKD group, p = 0.02), this initial statistical difference was not significant after adjusting for variables in the logistic regression model. There was no difference between the rates of death from all causes (6.49%, CKD group vs. 1.49%, non-CKD group, p = 0.15), reinfarction (3.89%, CKD group vs. 1.49%, non-CKD group, p = 0.394), and need for new revascularization (11.68%, CKD group vs. 5.97%, non-CKD group, p = 0.297). As there was no difference in the endpoints between groups with long-term follow-up, this study demonstrated the safety of using intracoronary physiology to guide revascularization in patients with CKD.

[Display omitted] [ABSTRACT FROM AUTHOR]

In‐stent restenosis and thrombosis remain to be long‐term challenges in coronary stenting procedures. The objective of this study was to evaluate the in vitro biological responses of trimethylsilane (TMS) plasma nanocoatings modified with NH3/O2 (2:1 molar ratio) plasma post‐treatment (TMS + NH3/O2 nanocoatings) on cobalt chromium (CoCr) alloy L605 coupons, L605 stents, and 316L stainless steel (SS) stents. Surface properties of the plasma nanocoatings with up to 2‐year aging time were characterized by wettability assessment and x‐ray photoelectron spectroscopy (XPS). It was found that TMS + NH3/O2 nanocoatings had a surface composition of 41.21 ± 1.06 at% oxygen, 31.90 ± 1.08 at% silicon, and 24.12 ± 1.7 at% carbon, and very small but essential amount of 2.77 ± 0.18 at% nitrogen. Surface chemical stability of the plasma coatings was noted with persistent O/Si atomic ratio of 1.292–1.413 and N/Si atomic ratio of ~0.087 through 2 years. The in vitro biological responses of plasma nanocoatings were studied by evaluating the cell proliferation and migration of porcine coronary artery endothelial cells (PCAECs) and smooth muscle cells (PCASMCs). 3‐(4,5‐Dimethylthiazol‐2‐yl)‐2,5‐diphenyltetrazolium (MTT) assay results revealed that, after 7‐day incubation, TMS + NH3/O2 nanocoatings maintained a similar level of PCAEC proliferation while showing a decrease in the viability of PCASMCs by 73 ± 19% as compared with uncoated L605 surfaces. Cell co‐culture of PCAECs and PCASMCs results showed that, the cell ratio of PCAEC/PCASMC on TMS + NH3/O2 nanocoating surfaces was 1.5‐fold higher than that on uncoated L605 surfaces, indicating enhanced selectivity for promoting PCAEC growth. Migration test showed comparable PCAEC migration distance for uncoated L605 and TMS + NH3/O2 nanocoatings. In contrast, PCASMC migration distance was reduced nearly 8.5‐fold on TMS + NH3/O2 nanocoating surfaces as compared to the uncoated L605 surfaces. Platelet adhesion test using porcine whole blood showed lower adhered platelets distribution (by 70 ± 16%), reduced clotting attachment (by 54 ± 12%), and less platelet activation on TMS + NH3/O2 nanocoating surfaces as compared with the uncoated L605 controls. It was further found that, under shear stress conditions of simulated blood flow, TMS + NH3/O2 nanocoating significantly inhibited platelet adhesion compared to the uncoated 316L SS stents and TMS nanocoated 316L SS stents. These results indicate that TMS + NH3/O2 nanocoatings are very promising in preventing both restenosis and thrombosis for coronary stent applications. [ABSTRACT FROM AUTHOR]

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Yan Chen,1,2,&ast; Ya-Fang Gao,3,&ast; Yun-Fan Wang,2 Cheng-Jian Wang,1 Ying Du,1 Ya-Hui Ding1,2 1The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China; 2Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China; 3Graduate Department, Bengbu Medical College, Bengbu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ya-Hui Ding, Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), No.158 Shangtang Road, Hangzhou, 310014, People’s Republic of China, Email dyh@zjheart.comPurpose: A longer stent is associated with adverse events after percutaneous coronary intervention (PCI). However, little information is available on the relationship between stent length and periprocedural prognosis in patients with ST segment elevation myocardial infarction (STEMI). We aimed to assess the target vessel stent length influence on angiographic outcomes and in-hospital major adverse cardiovascular event (MACE) during primary PCI in patients with STEMI.Patients and Methods: This single-center retrospective observational study included 246 patients with STEMI admitted to the Zhejiang Provincial People’s Hospital between January 2019 and December 2021, who underwent primary PCI and successful stent implantation. The exclusion criteria included left main lesion, multiple diseased vessel-stenting, bleeding disorders, contrast allergy, and incomplete data. Patients were divided into two groups based on the median stents length: group A (≤ 29 mm, n=125) and group B (> 29mm, n=121). Periprocedural outcomes were slow flow/no-reflow (SF-NR) and in-hospital MACE, which included acute heart failure, malignant arrhythmia, cardiovascular death, non-fatal stroke, non-fatal myocardial infarction, and urgent revascularization. Multivariate logistic analyses were used to explore the correlation between stent length and SF-NR.Results: A total of 246 patients (82.9% males) with a mean age of 59.9± 12.6 years were included in the analysis. The incidence of SF-NR was significantly higher in group B than in group A (36.4% vs 23.2%, p=0.024). However, the in-hospital MACE incidence rate was similar between the two groups (7.2% vs 7.4%, p=0.943). Multivariate logistic regression analysis showed that stent length and diameter, and peak troponin I level were independent risk factors for SF-NR.Conclusion: Excessive stent length is an independent risk factor for SF-NR, without any significant influence on the risk of MACE during hospitalization.Keywords: coronary stent, ST segment elevation myocardial infarction, primary percutaneous coronary intervention, slow flow/no-reflow, major adverse cardiovascular event

Objectives: Bypassing a patently stented coronary artery has a risk of flow competition, and leaving it ungrafted has a high risk of stent restenosis. This study determines the fate of patently stented coronary arteries bypassed and left ungrafted. Materials and Methods: Patients undergoing isolated coronary artery bypass grafting (CABG) with previous percutaneous coronary intervention (PCI) were retrospectively scanned between January 1, 2015, and January 1, 2020. Patients undergoing surgery with a patently stented coronary artery were identified. Postoperative coronary angiography was performed in 52 of these patients. Results: There were 24 patients whose patently stented coronary artery was bypassed and 28 whose patently stented coronary artery was not bypassed. The median follow-up time was 49 months in the non-bypass group and 53.5 months in the bypass group. Twenty (71.4%) patently stented coronary arteries remained open in the non-bypass group, and 23 (95.8%) vessels were open in the bypass group (p=0.02). The estimated open rate of vessels was 56% in the non-bypass group and 95% in the bypass group at five years (log-rank p=0.01). Major adverse cardiac events were developed in 12 (42.8%) patients in the non-bypass group and 6 (25%) patients in the bypass group. Conclusion: Patients with an open stented vessel that was not bypassed during CABG have a risk of in-stent restenosis and major adverse cardiac events during the mid-and long-term periods. It may not be safe to leave patently stented coronary arteries ungrafted, particularly those with bare metal stents. [ABSTRACT FROM AUTHOR]

Objective(s): Bioresorbable scaffolds have been advocated as the new generation in interventional cardiology because they could provide temporary scaffolds and then disappear with resorption. Although, the available stents in clinical trials exhibited biosafety, efficacy, no death, and no apparent thrombosis, Mg-substrate degradation on drug release has not been investigated.Materials and Methods: Therefore, more research has been needed to legitimize the replacement of current stents with Mg-based stents. UV-Vis spectrophotometer, scanning electron microscope (SEM), X-ray diffraction (XRD), pH measurement, H₂ evolution, and corrosion tests determined the change in hybrid properties and drug release rate. Results: The effect of Mg degradation on drug release from poly-L-lactide (PLLA) specimen was much higher than that of the L605/PLLA sample. Hydrogen evolution caused by magnesium degradation compelled everolimus out without significant PLLA decomposition during the first 100 days, while formation of Mg(OH)2 caused the PLLA to deform and crack. Conclusion: A combined mechanism of lattice/hole diffusion-dissolution governed the release of everolimus with the activation energies of 5.409 kJ/mol and 4.936 kJ/mol for the first 24 hr and diffusion coefficients 6.06×10-10 and 3.64×10-11cm2/s for the 50th to 100th days. Prolonged suppression of hyperplasia within the smooth muscle cells by hybrid stent insertion could bring about the cessation of restenosis.

Background: Repeat drug-eluting stenting is superior to balloon angioplasty for prevention of recurrent in-stent restenosis (ISR), but carries a potential disadvantage of multiple layers of stent. The safety and effectiveness of a sirolimus drug-eluting balloon as an alternative has not been assessed., Study Design and Methods: The SELUTION4ISR trial is a prospective, multi-center, single-blinded, randomized, controlled trial. A total of 418 subjects with bare metal or drug-eluting stent (DES) ISR with up to 2 previous stent procedures at the target lesion, lesion length <26 mm and reference diameter ≥2.0 mm - ≤4.5 mm will be randomized 1:1 to treatment with either the SELUTION SLR™ DEB (SLR DEB) or standard of care (SOC), which includes either repeat DES or balloon angioplasty without drug coating. A subset of subjects will undergo planned angiographic and optical coherence tomography follow-up. The primary endpoint will be target lesion failure, defined as cardiac death, target vessel myocardial infarction, or clinically-driven target lesion revascularization at 12 months follow-up. The study will sequentially assess non-inferiority of the SLR DEB to SOC in the overall cohort, followed by non-inferiority then superiority of the SLR DEB to DES in the cohort with only 1 previous stent at the target lesion., Trial Registration: The trial is registered at Clinicaltrials.gov (NCT04280029)., Current Status: The trial completed enrollment in July 2024., Conclusion: The SELUTION4ISR study will evaluate the safety and effectiveness of SLR DEB in a prospective, randomized, international, multi-center trial for treatment of coronary ISR., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025. Published by Elsevier Inc.)

Aims: Safety of aspirin-free strategy immediately after percutaneous coronary intervention (PCI) for cardiovascular events in patients with diabetes was unknown., Methods and Results: We conducted the prespecified subgroup analysis on diabetes in the STOPDAPT-3 trial, which randomly compared prasugrel (3.75 mg/day) monotherapy (2984 patients) to dual antiplatelet therapy (DAPT) with prasugrel and aspirin (2982 patients) in patients with acute coronary syndrome or high bleeding risk. The co-primary endpoints were major bleeding events (Bleeding Academic Research Consortium 3 or 5) and cardiovascular events (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) at 1 month. Of 5966 study patients, there were 2715 patients (45.5%) with diabetes. Patients with diabetes more often had chronic coronary syndrome, heart failure or cardiogenic shock, and comorbidities than those without. Patients with diabetes compared to those without had higher incidences of major bleeding and cardiovascular events. Regardless of diabetes, the effect of no-aspirin relative to DAPT was not different for the co-primary bleeding (diabetes: 5.05% vs. 5.47%; HR, 0.92; 95%CI, 0.66-1.28 and non-diabetes: 3.99% vs. 4.07%; HR, 0.98; 95%CI, 0.69-1.38; P for interaction = 0.81) and cardiovascular (diabetes: 5.54% vs. 5.15%; HR, 1.08; 95%CI, 0.78-1.49 and non-diabetes: 2.95% vs. 2.47%; HR, 1.20; 95%CI, 0.79-1.82; P for interaction = 0.70) endpoints. The incidences of subacute definite or probable stent thrombosis and any coronary revascularization were higher in the no-aspirin group than in the DAPT group regardless of diabetes., Conclusions: The effects of an aspirin-free prasugrel monotherapy (3.75 mg/day) relative to DAPT for major bleeding and cardiovascular events were not different regardless of diabetes., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background and Aims: Drug-eluting stents (DES) are not designed for overexpansion to supra-nominal diameters or intentional stent fracture (ISF). The optimal dilation technique to minimize stent shortening (SS) and achieve ISF to accommodate pediatric somatic growth has not been described., Methods: Three sizes of two commonly used DES were implanted within a silicone model to simulate blood vessels. Each stent was serially dilated in 1 mm increments under fluoroscopy using three techniques: 2 cm length, semi-compliant balloons (Technique 1), 2 cm, noncompliant balloons straddling the entire stent (Technique 2), or noncompliant balloons in an "inside-out" manner (balloon shorter than stent or 2 cm balloon aligned with distal end of stent (no straddle); (Technique 3). Technique 1 crossed over to noncompliant balloons once stent "napkin-ringed" (NR). Percent SS = (L nominal  - L final )/L nominal  * 100., Results: Technique 1 resulted in the greatest SS (median 85%, IQR 82, 87) and universal napkin ringing. Technique 2 caused less SS (median 14%, IQR 7, 15), and Technique 3 caused the least SS (median 7%, IQR 3, 11). ISF was achieved in all, however, the inside-out technique caused ISF at smaller stent diameters (median 114% recommended postdilation limit vs. 122%-131%) and lower inflation pressures (median 15 vs. 28-29 ATM). ISF was achieved in Technique 1 after napkin ringing but required larger noncompliant balloons than other techniques (median 8.5 vs. 7 mm)., Conclusion: Inside-out dilation resulted in less SS and fracture at smaller diameters with lower inflation pressures. This technique may improve the ISF success rate of DES in pediatric patients., (© 2025 Wiley Periodicals LLC.)

Aims: There were no previous studies comparing aspirin versus P2Y12 inhibitor monotherapy following short dual antiplatelet therapy (DAPT) after complex percutaneous coronary intervention (PCI)., Methods and Results: We conducted a prespecified subgroup analysis based on complex PCI in the 1-year results of the STOPDAPT-3 trial, which randomly compared 1-month DAPT followed by aspirin monotherapy (aspirin group) to 1-month prasugrel monotherapy followed by clopidogrel monotherapy (clopidogrel group). The main analysis in the present study was the 30-day landmark analysis. The co-primary endpoints were cardiovascular events (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) and major bleeding (Bleeding Academic Research Consortium 3 or 5). In the 30-day landmark analysis (N = 5833), there were 1415 patients (24.3%) who underwent complex PCI. There was a significant interaction between complex PCI and the effect of aspirin group relative to clopidogrel group for cardiovascular events (complex PCI: 3.3% versus 5.2%, non-complex PCI, 4.3% versus 3.6%, interaction P = 0.04) and net adverse clinical events (complex PCI: 4.8% versus 7.2%, non-complex PCI: 5.3% versus 4.4%, interaction P = 0.02), but not for bleeding events (complex PCI: 2.1% versus 2.7%, non-complex PCI: 1.7% versus 1.4%, interaction P = 0.35)., Conclusions: There was a significant interaction between complex PCI and the effect of aspirin monotherapy relative to clopidogrel monotherapy beyond 1 month and up to 1 year for cardiovascular events due to numerically lower risk of aspirin monotherapy in patients with complex PCI, while the effect of aspirin monotherapy relative to clopidogrel monotherapy was not different for bleeding regardless of complex PCI. Clinical trial registration: ShorT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent-3 [STOPDAPT-3]; NCT04609111., (© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Existing biodegradable Magnesium Alloy Stents (MAS) have several drawbacks, such as high restenosis, hasty degradation, and bulky cross-section, that limit their widespread application in a current clinical practice. To find the optimum stent with the smallest possible cross-section and adequate scaffolding ability, a 3D finite element model of 25 MAS stents of different cross-sectional dimensions were analysed while localized corrosion was underway. For the stent geometric design, a generic sine-wave ring of biodegradable magnesium alloy (AZ31) was selected. Previous studies have shown that the long-term performance of MAS was characterized by two key features: Stent Recoil Percent (SRP) and Stent Radial Stiffness (SRS). In this research, the variation with time of these two features during the corrosion phase was monitored for the 25 stents. To find the optimum profile design of the stent subjectively (without using optimization codes and with much less computational costs), radial recoil was limited to 27 % (corresponding to about 10 % probability of in-stent diameter stenosis after an almost complete degradation) and the stent with the highest radial stiffness was selected. The comparison of the recoil performance of 25 stents during the heterogeneous corrosion phase showed that four stents would satisfy the recoil criterion and among these four, the one having a width of 0.161 mm and a thickness of 0.110 mm, showed a 24 % – 49 % higher radial stiffness at the end of the corrosion phase. Accordingly, this stent, which also showed a 23.28 % mass loss, was selected as the optimum choice and it has a thinner cross-sectional profile than commercially available MAS, which leads to a greater deliverability and lower rates of restenosis.

In obstructing left-sided colonic or rectal cancer, endoscopic stent placement with the purpose of decompression and bridge to elective colon resection has been widely utilized and accepted. However, in malignant right-sided colonic obstruction, stent placement prior to colectomy is still highly controversial, due to lower clinical success and high anastomotic leak. We report a case of malignant right-sided colonic obstruction based on the radiological findings of irregular thickening of ascending colon wall and dilation of proximal large bowel on enhanced computed tomography scan. The 72-year-old woman presented with obvious abdominal distension. Due to concerning cardiovascular complications as intermittent chest pain and a long history of type 2 diabetes, a three-step therapeutic plan was instigated. Initially, a self-expandable metallic stent was placed palliatively to relieve the bowel obstruction. Consecutively, coronary angiography was performed, and two coronary stents were implanted to alleviate more than 80% stenosis of two main coronary arteries. One month later, laparoscopic radical resection of right colon and lymphadenectomy were successfully performed, with a blood loss less than 50 millimeters and a harvest of 29 lymph nodes, 1 being positive. The patient was discharged one week postoperatively with no complications, and received adjuvant chemotherapy one month later. During a follow-up of more than one year, the patient was in complete remission with no recurrence and cardiovascular events. In patients presenting with malignant right-sided colonic obstruction and peril of high cardiovascular risks, we propose colonic and coronary stent-first strategy to emergency surgery as a potential approach so as to ensure sufficient cardiovascular preparation improving perioperative safety. Moreover, the anatomical location of the tumor would be significantly achievable thus granting high-quality radical colon resection and lymphadenectomy.

The use of chemically modified nanocomposites for atherosclerotic plaques can open up new opportunities for studying their effect on changing the structure of the plaque itself. It was shown on the model of the greater omentum of two groups of experimental animals (rats n = 30), which were implanted with Fe@C NPs nanocomposites of 10–30 Nm size into the omentum area. Group 1 (n = 15) consisted of animals that were implanted with chemically modified Fe@C NPs nanocomposites and control group 2 (n = 15) was with non-modified Fe@C NPs nanocomposites. After 1, 2 and 3 weeks we conducted the morphological study of changes in the structure of the omentum using two dyes (Nile Blue and Sudan III), which are specific for adipose tissue. Chemically modified nanocomposites have demonstrated, in contrast to non-modified nanoparticles, to cause morphological changes in the structure of the greater omentum accompanied by the probable release of a similar antiatherogenic factor. The model of the greater omentum of rats showed that chemically modified nanocomposites cause intravital changes in its structure. Considering that the omentum itself in its qualitative composition is as close as possible to the human atherosclerotic plaque, these morphological changes were described as a "fringing phenomenon", which manifests itself in the omental tissues directly adjacent to the modified nanocomposites. The option of applied use of nanocomposites for the manufacture of a new generation of coronary stents is being considered. [Display omitted] [ABSTRACT FROM AUTHOR]

The high mortality rate caused by atherosclerosis makes it necessary to constantly search for new and better treatments. In previous reports, chemically modified carbon-coated iron nanoparticles (Fe@C NPs) have been demonstrated a high biocompatibility and promising anti-plaque properties. To further investigate these effects, the interaction of these nanoparticles with the adipose tissue of Wistar rats (in vivo) and human atherosclerotic plaques (ex vivo) was studied. For the in vivo study, cobalt–chromium (CoCr) alloy tubes, which are used for coronary stent manufacturing, were prepared with a coating of polylactic acid (PLA) which contained either modified or non-modified Fe@C NPs in a 5% by weight concentration. The tubes were implanted into an area of subcutaneous fat in Wistar rats, where changes in the histological structure and functional properties of the surrounding tissue were observed in the case of coatings modified with Fe@C NPs. For the ex vivo study, freshly explanted human atherosclerotic plaques were treated in the physiological solution with doses of modified Fe@C NPs, with mass equal to 5% or 25% relative to the plaques. This treatment resulted in the release of cholesterol-like compounds from the surface of the plaques into the solution, thus proving a pronounced destructive effect on the plaque structure. Chemically modified Fe@C NPs, when used as an anti-atherosclerosis agent, were able to activate the activity of macrophages, which could lead to the destruction of atherosclerotic plaques structures. These findings could prove the fabrication of next-generation vascular stents with built-in anti-atherosclerotic agents. [ABSTRACT FROM AUTHOR]

This research shows how expansion ratio gets affected by the different input parameters of fiber laser. In this research all input parameters were studied and scrutinize the final parameters which affects or influence the mechanical properties of the stent. In this research the input parameters were selected after performing pilot experiments. ANOVA analysis is used to finding out the percentage contribution of each factors on expansion ratio. Mathematical model has also been derived for prediction of expansion ratio without performing actual experiments. It is observed less effect of gas pressur, contributed 10.36%, Percentage contribution of laser power is 61.88 % and frequency is contributing 26.64%. Software developed featured with which can predict expansion ratio of stent without performing actual performance. [ABSTRACT FROM AUTHOR]

Introduction: Severe haemophilia A is characterized by serious factor VIII deficiency (biological activity

Objective: We report carotid artery stenting (CAS) using balloon-expandable coronary (BECo) stent. The materials in this study consist of 15 cases of high-grade stenosis in internal carotid artery (ICA) in which self-expanding carotid (SECa) stent was not utilized. There were two groups why BECo stent was used instead of SECa stent: alternative group and intentional group. The alternative group was subdivided into two groups: access difficulty of guiding catheter and access difficulty of SECa stent. Case Presentation: The alternative group included 11 cases (access difficulty of guiding catheter in 10 and access difficulty of SECa stent in 1), and the intentional group included 4 cases. There were four cases using transbrachial approach. All the intentional group cases were the first stage of staged angioplasty (SAP). The second stage of SAP was PTA in two and SECa stent over the BECo stent in two. There was no complication related to CAS. Conclusion: CAS using BECo stent is one of the choices for the first stage of SAP, if stent placement instead of PTA is required at the first stage. It is also the useful alternative for the patient having difficulty of SECa stent.