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Percutaneous Coronary Intervention (PCI): Past, Present and Future
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Percutaneous Coronary Intervention (PCI): Past, Present and Future

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (30 September 2024) | Viewed by 12667

Special Issue Editors

Prof. Dr. Giuseppe Gargiulo

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Guest Editor
Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy
Interests: percutaneous coronary intervention; coronary artery disease; peripheral artery disease; antithrombotic therapy
Dr. Mario Enrico Canonico

E-Mail Website
Guest Editor
1. Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
2. CPC Clinical Research, Department of Medicine, University of Colorado, Aurora, CO 80045, USA
Interests: clinical cardiology; heart failure; coronary artery disease; antithrombotic therapy; peripheral arterial disease
Dr. Marisa Avvedimento

E-Mail Website
Guest Editor
1. Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
2. Quebec Heart and Lung Institute, Laval University, Quebec City, QC G1V0A6, Canada
Interests: transcatheter aortic valve replacement; transcatheter aortic valve implantation; percutaneous coronary intervention; coronary artery disease; antithrombotic therapy

Special Issue Information

Dear Colleagues,

Percutaneous coronary intervention (PCI) represents the most common strategy to manage flow-limiting coronary artery stenoses. According to the latest evidence from large randomized or observational studies, PCI continues to improve with an ever-broadening indication in light of the newer devices and procedural techniques, which has led higher rates of successful procedures and improved clinical outcomes over time. PCI has also been offered to more complex patients including those at high-risk or with cardiogenic shock, eventually through devices for mechanical support. Hence, a PCI strategy guided by physiology, imaging, and optimal lesion management should be pursued to obtain complete revascularization and sustained long-term results. In addition, the refinement of antithrombotic therapy in patients undergoing PCI has contributed to further improving patient outcomes; however, its optimization remains a matter of ongoing debate in order to balance ischemic and bleeding risks.

The aim of the present Special Issue is to offer insights into the implementation of diagnosis and treatment of patients with coronary artery disease (CAD), covering several aspects of interventional cardiology from procedural techniques to peri-procedural management. The intended primary target audience consists of clinicians who are involved in the care of patients for whom revascularization is indicated. The Editors hope that this Special Issue will be of interest to interventional cardiologists as well as a broader range of clinicians that encounter CAD. Therefore, we invite researchers and clinicians to submit their works, including original clinical research studies, meta-analyses, and reviews, related to the PCI field.

Prof. Dr. Giuseppe Gargiulo
Dr. Mario Enrico Canonico
Dr. Marisa Avvedimento
Guest Editors

Manuscript Submission Information

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

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

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

Keywords

  • coronary revascularization
  • percutaneous coronary intervention (PCI)
  • coronary artery disease
  • acute coronary syndrome
  • chronic coronary syndrome
  • antithrombotic therapy

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Published Papers (5 papers)

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Research

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11 pages, 1328 KiB  
Article
The Usefulness of Coregistration with iFR in Tandem or Long Diffuse Coronary Lesions: The iLARDI Randomized Clinical Trial
by Francisco Hidalgo, Rafael Gonzalez-Manzanares, Javier Suárez de Lezo, Ignacio Gallo, Marco Alvarado, Jorge Perea, Luis Carlos Maestre-Luque, Adriana Resúa, Miguel Romero, María López-Benito, Armando Pérez de Prado, Soledad Ojeda and Manuel Pan
J. Clin. Med. 2024, 13(15), 4342; https://doi.org/10.3390/jcm13154342 - 25 Jul 2024
Viewed by 919
Abstract
Background. Despite technical advancements, patients with sequential or diffuse coronary lesions undergoing percutaneous coronary intervention (PCI) have an increased risk of cardiovascular events at follow-up. We aimed to analyze the utility of a SyncVision/iFR (S-iFR)-guided PCI strategy versus an angiography-guided strategy in [...] Read more.
Background. Despite technical advancements, patients with sequential or diffuse coronary lesions undergoing percutaneous coronary intervention (PCI) have an increased risk of cardiovascular events at follow-up. We aimed to analyze the utility of a SyncVision/iFR (S-iFR)-guided PCI strategy versus an angiography-guided strategy in patients with this type of lesions. Methods. Randomized, multicenter, controlled, and open-label trial to compare S-iFR versus angiography-guided PCI in patients with sequential or diffuse angiographic coronary stenosis (ClinicalTrials.gov identifier: NCT04283734). The primary endpoint was the implanted stent length. The main secondary endpoint was targeting vessel failure (TVF) at one year. Results. A total of 100 patients underwent randomization, with 49 patients assigned to the S-iFR group and 51 to the angiography-guided PCI group. There were no differences between groups regarding clinical and anatomical characteristics. The baseline iFR was 0.71 ± 0.16 vs. 0.67 ± 0.19 (p = 0.279) in the S-iFR and angiography group, respectively. The mean lesion length was 42.3 ± 12 mm and 39.8 ± 12 (p = 0.297). The implanted stent length was 32.7 ± 17.2 mm in the S-iFR group and 43.1 ± 14.9 mm in the angiography group (mean difference, −10.4 mm; 95% confidence interval [CI], −16.9 to −4.0; p = 0.002). At one year, target vessel failure (TVF) occurred in four patients: three (6.1%) in the S-iFR group vs. one (1.9%) in the angiography group (p = 0.319). Conclusions. Among patients with sequential or long diffuse coronary lesions, a S-iFR-guided PCI strategy resulted in a reduction of the total stent length compared to an angiography-guided PCI strategy. A nonsignificant increase in TVF was observed in the S-iFR group. Full article
(This article belongs to the Special Issue Percutaneous Coronary Intervention (PCI): Past, Present and Future)
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Review

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14 pages, 834 KiB  
Review
Mechanical Circulatory Support with Impella: Principles, Evidence, and Daily Practice
by Giulia Masiero, Federico Arturi, Andrea Panza and Giuseppe Tarantini
J. Clin. Med. 2024, 13(16), 4586; https://doi.org/10.3390/jcm13164586 - 6 Aug 2024
Viewed by 2705
Abstract
The Impella (Abiomed, Danvers, MA, USA) microaxial pump is a percutaneous mechanical circulatory support (MCS) that has been shown to increase coronary perfusion, reduce myocardial oxygen demand, and improve peripheral organ perfusion. Therefore, indications for the Impella device include emergency use for cardiogenic [...] Read more.
The Impella (Abiomed, Danvers, MA, USA) microaxial pump is a percutaneous mechanical circulatory support (MCS) that has been shown to increase coronary perfusion, reduce myocardial oxygen demand, and improve peripheral organ perfusion. Therefore, indications for the Impella device include emergency use for cardiogenic shock (CS) and pre-emptive implantation during high-risk percutaneous coronary intervention (HR-PCI). However, despite their exponential use in cardiovascular practice over the past decade, there is limited randomized evidence to support the benefits of this therapy and growing concern regarding complication rates. In this review, we summarize the principles, evidence, and practical considerations of the most widely used Impella CP percutaneous left ventricular support in both CS and HR-PCI settings, moving from the historical background to current issues and future expectations for this device. Full article
(This article belongs to the Special Issue Percutaneous Coronary Intervention (PCI): Past, Present and Future)
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18 pages, 1017 KiB  
Review
Antiplatelet Therapy for Elderly Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
by Vincenzo Fioretti, Luca Sperandeo, Donato Gerardi, Aldo Di Fazio and Eugenio Stabile
J. Clin. Med. 2024, 13(14), 4229; https://doi.org/10.3390/jcm13144229 - 19 Jul 2024
Viewed by 1112
Abstract
The elderly represent an increasing proportion of patients presenting with acute coronary syndrome (ACS). Various data have shown that the benefits of percutaneous coronary revascularization are maintained in elderly patients presenting with ACS. Conversely, the management of antiplatelet therapy remains challenging and controversial, [...] Read more.
The elderly represent an increasing proportion of patients presenting with acute coronary syndrome (ACS). Various data have shown that the benefits of percutaneous coronary revascularization are maintained in elderly patients presenting with ACS. Conversely, the management of antiplatelet therapy remains challenging and controversial, because older patients are usually at a high risk of both ischemia and bleeding. Moreover, the recommended ischemic and bleeding risk scores in patients with ACS were developed from studies with a low representation of older patients. New antiplatelet strategies have been developed, but their evidence in elderly patients is limited because they are usually underrepresented in randomized clinical trials due to their clinical complexity. The aim of this review is to summarize the different factors associated with increased ischemic and/or bleeding risk and the scientific evidence about the different antiplatelet strategies in elderly patients presenting with ACS and undergoing percutaneous coronary revascularization. Full article
(This article belongs to the Special Issue Percutaneous Coronary Intervention (PCI): Past, Present and Future)
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22 pages, 5904 KiB  
Review
Current Management of In-Stent Restenosis
by Daniele Giacoppo, Placido Maria Mazzone and Davide Capodanno
J. Clin. Med. 2024, 13(8), 2377; https://doi.org/10.3390/jcm13082377 - 19 Apr 2024
Cited by 2 | Viewed by 2583
Abstract
In-stent restenosis (ISR) remains the primary cause of target lesion failure following percutaneous coronary intervention (PCI), resulting in 10-year incidences of target lesion revascularization at a rate of approximately 20%. The treatment of ISR is challenging due to its inherent propensity for recurrence [...] Read more.
In-stent restenosis (ISR) remains the primary cause of target lesion failure following percutaneous coronary intervention (PCI), resulting in 10-year incidences of target lesion revascularization at a rate of approximately 20%. The treatment of ISR is challenging due to its inherent propensity for recurrence and varying susceptibility to available strategies, influenced by a complex interplay between clinical and lesion-specific conditions. Given the multiple mechanisms contributing to the development of ISR, proper identification of the underlying substrate, especially by using intravascular imaging, becomes pivotal as it can indicate distinct therapeutic requirements. Among standalone treatments, drug-coated balloon (DCB) angioplasty and drug-eluting stent (DES) implantation have been the most effective. The main advantage of a DCB-based approach is the avoidance of an additional metallic layer, which may otherwise enhance neointimal hyperplasia, provide the substratum for developing neoatherosclerosis, and expose the patient to a persistently higher risk of coronary ischemic events. On the other hand, target vessel scaffolding by DES implantation confers relevant mechanical advantages over DCB angioplasty, generally resulting in larger luminal gain, while drug elution from the stent surface ensures the inhibition of neointimal hyperplasia. Nevertheless, repeat stenting with DES also implies an additional permanent metallic layer that may reiterate and promote the mechanisms leading to ISR. Against this background, the selection of either DCB or DES on a patient- and lesion-specific basis as well as the implementation of adjuvant treatments, including cutting/scoring balloons, intravascular lithotripsy, and rotational atherectomy, hold the potential to improve the effectiveness of ISR treatment over time. In this review, we comprehensively assessed the available evidence from randomized trials to define contemporary interventional treatment of ISR and provide insights for future directions. Full article
(This article belongs to the Special Issue Percutaneous Coronary Intervention (PCI): Past, Present and Future)
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15 pages, 809 KiB  
Review
Antithrombotic Therapy Optimization in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention
by Felice Gragnano, Antonio Capolongo, Antonio Micari, Francesco Costa, Victoria Garcia-Ruiz, Vincenzo De Sio, Fabrizia Terracciano, Arturo Cesaro, Elisabetta Moscarella, Silvio Coletta, Pasquale Raucci, Fabio Fimiani, Leonardo De Luca, Giuseppe Gargiulo, Giuseppe Andò and Paolo Calabrò
J. Clin. Med. 2024, 13(1), 98; https://doi.org/10.3390/jcm13010098 - 23 Dec 2023
Cited by 2 | Viewed by 4718
Abstract
The antithrombotic management of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) poses numerous challenges. Triple antithrombotic therapy (TAT), which combines dual antiplatelet therapy (DAPT) with oral anticoagulation (OAC), provides anti-ischemic protection but increases the risk of bleeding. Therefore, TAT is [...] Read more.
The antithrombotic management of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) poses numerous challenges. Triple antithrombotic therapy (TAT), which combines dual antiplatelet therapy (DAPT) with oral anticoagulation (OAC), provides anti-ischemic protection but increases the risk of bleeding. Therefore, TAT is generally limited to a short phase (1 week) after PCI, followed by aspirin withdrawal and continuation of 6–12 months of dual antithrombotic therapy (DAT), comprising OAC plus clopidogrel, followed by OAC alone. This pharmacological approach has been shown to mitigate bleeding risk while preserving adequate anti-ischemic efficacy. However, the decision-making process remains complex in elderly patients and those with co-morbidities, significantly influencing ischemic and bleeding risk. In this review, we discuss the available evidence in this area from randomized clinical trials and meta-analyses for post-procedural antithrombotic therapies in patients with non-valvular AF undergoing PCI. Full article
(This article belongs to the Special Issue Percutaneous Coronary Intervention (PCI): Past, Present and Future)
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