Advanced Techniques for the Treatment of Complex Coronary Artery Disease

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

Deadline for manuscript submissions: 25 August 2024 | Viewed by 2584

Special Issue Editor


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Guest Editor
Department of Cardiology, San Paolo Hospital, Civitavecchia, Rome, Italy
Interests: coronary artery disease; antiplatelet therapy; intracoronary imaging; acute myocardial infarction; refractory angina; multivessel disease

Special Issue Information

Dear Colleagues,

Recently, there has been rapid progress in the device and strategies for the treatment of coronary artery disease. The complex coronary artery diseases represent the challenging in the interventional cardiologists.  Advanced techniques have changed our way of thinking about indications for coronary revascularization. In addition, the large sharing of operator experiences with several studies and international conferences, growing the operator skills advancing the limits of successful percutaneous procedures. These have also reduced the failure of percutaneous revascularization procedures, resulting in improved patient outcomes. Not least, the important knowledge about pharmacotherapy pathways in patients with coronary artery disease helped to solidify these results in short and long terms outcomes. In light of this evidences born the importance to share the investigation results on the treatment of complex coronary artery disease scenario to improve the revascularization and clinical outcomes.

I am pleased to invite you to contribute to this Special Issue on “Advanced Techniques for the Treatment of complex Coronary Artery Disease”. The aim is to present original research clinical studies as well as state-of-the-art reviews focused on complex coronary artery disease treatment.

We are mostly focused on invasive strategies, dedicated devices and pharmacotherapy for the coronary revascularization in complex scenario with percutaneous coronary interventions.

Dr. Simone Calcagno
Guest Editor

Manuscript Submission Information

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Keywords

  • coronary calcified lesion
  • IVUS
  • OCT
  • intravascular lithotripsy
  • bifurcation coronary lesions
  • left main
  • chronic total occlusions
  • multivessel disease
  • STEMI
  • NSTEMI

Published Papers (4 papers)

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Research

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11 pages, 1843 KiB  
Article
Acute Kidney Injury in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: The Role of Vascular Access Site
by Stefano Rigattieri, Ernesto Cristiano, Federica Tempestini, Luca Pittorino, Vincenzo Cesario, Matteo Casenghi, Francesca Giovannelli, Antonella Tommasino, Emanuele Barbato and Andrea Berni
J. Clin. Med. 2024, 13(8), 2367; https://doi.org/10.3390/jcm13082367 - 18 Apr 2024
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Abstract
Background: in patients undergoing percutaneous coronary interventions (PCI), radial access should be favoured over femoral access as it reduces the risk of vascular complications and bleeding. Furthermore, a preventive role of radial access in the occurrence of acute kidney injury (AKI), mainly mediated [...] Read more.
Background: in patients undergoing percutaneous coronary interventions (PCI), radial access should be favoured over femoral access as it reduces the risk of vascular complications and bleeding. Furthermore, a preventive role of radial access in the occurrence of acute kidney injury (AKI), mainly mediated by the reduction of bleeding and cholesterol crystal embolization into renal circulation, has been investigated in several studies, yielding conflicting results. Methods: we designed a retrospective study to appraise the effect of the use of a vascular access site on the occurrence of AKI in a cohort of 633 patients with acute myocardial infarction treated by PCI at our centre from 2018 to 2020. Results: after propensity score adjustment, radial access was associated with a reduced, albeit statistically not significant, incidence of AKI (14.7% vs. 21.0%; p = 0.06) and major bleeding (12.5% vs. 18.7%; p = 0.04) as compared to femoral access. At multivariate analysis, femoral access was an independent predictor of AKI, together with in-hospital occurrence of BARC 3–5 bleeding, Killip class >1 at presentation, female gender, baseline eGFR <60 mL/min, and baseline haemoglobin <12 g/dL. Conclusions: although limited by the observational design, our study supports the hypothesis that radial access may exert a protective role on the occurrence of AKI in patients with acute myocardial infarction undergoing PCI. Full article
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10 pages, 987 KiB  
Article
Comparison of Orbital Atherectomy and Rotational Atherectomy in Calcified Left Main Disease: Short-Term Outcomes
by Piotr Rola, Jan Jakub Kulczycki, Mateusz Barycki, Szymon Włodarczak, Łukasz Furtan, Michalina Kędzierska, Katarzyna Giniewicz, Adrian Doroszko, Maciej Lesiak and Adrian Włodarczak
J. Clin. Med. 2023, 12(12), 4025; https://doi.org/10.3390/jcm12124025 - 13 Jun 2023
Cited by 4 | Viewed by 1048
Abstract
Background: Coronary calcifications, particularly in left main disease (LMD), are independently associated with adverse outcomes of percutaneous coronary intervention (PCI). Adequate lesion preparation is pivotal to achieve favorable short- and long-term outcomes. Rotational atherectomy devices have been used in contemporary practice to obtain [...] Read more.
Background: Coronary calcifications, particularly in left main disease (LMD), are independently associated with adverse outcomes of percutaneous coronary intervention (PCI). Adequate lesion preparation is pivotal to achieve favorable short- and long-term outcomes. Rotational atherectomy devices have been used in contemporary practice to obtain adequate preparation of the calcified lesions. Recently, novel orbital atherectomy (OA) devices have been introduced to clinical practice to facilitate the preparation of the lesion. The objective of this study is to compare the short-term safety and efficacy of orbital and rotational atherectomy for LMD. Methods: we retrospectively evaluated a total of 55 consecutive patients who underwent the LM PCI supported by either OA or RA. Results: The OA group consisted of 25 patients with a median SYNTAX Score of 28 (26–36). The Rota group consisted of 30 patients with a median SYNTAX Score of 28 (26–33.1) There were no statistical differences in MACCE between the RA and OA subpopulations when recorded in-hospital (6.7% vs. 10.3% p = 0.619) as well as in a 1-month follow-up after the procedure (12% vs. 16.6% p = 0.261). Conclusion: OA and RA seem to be similarly safe and effective strategies for preparating the lesion in the high-risk population with calcified LMD. Full article
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Review

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15 pages, 1326 KiB  
Review
Coronary Chronic Total Occlusion Revascularization: When, Who and How?
by Elisabetta Ricottini, Federica Coletti, Annunziata Nusca, Nino Cocco, Andrea Corlianò, Alessandro Appetecchia, Rosetta Melfi, Fabio Mangiacapra, Paolo Gallo, Raffaele Rinaldi, Francesco Grigioni and Gian Paolo Ussia
J. Clin. Med. 2024, 13(7), 1943; https://doi.org/10.3390/jcm13071943 - 27 Mar 2024
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Abstract
Coronary chronic total occlusions (CTO) are an increasingly frequent entity in clinical practice and represent a challenging percutaneous coronary intervention (PCI) scenario. Despite data from randomized trials that have not yet demonstrated a clear benefit of CTO recanalization, the widespread of CTO-PCI has [...] Read more.
Coronary chronic total occlusions (CTO) are an increasingly frequent entity in clinical practice and represent a challenging percutaneous coronary intervention (PCI) scenario. Despite data from randomized trials that have not yet demonstrated a clear benefit of CTO recanalization, the widespread of CTO-PCI has substantially increased. The improvement in operators’ techniques, equipment, and training programs has led to an improvement in the success rate and safety of these procedures, which will represent an important field of future development of PCI. The present review will summarize clinical outcomes and technical and safety issues of CTO revascularization with the aim to guide clinical daily cath-lab practice. Full article
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11 pages, 576 KiB  
Review
A New Frontier for Drug-Coated Balloons: Treatment of “De Novo” Stenosis in Large Vessel Coronary Artery Disease
by Alessandro Sciahbasi, Tiziano Maria Mazza, Chiara Pidone, Simona Samperi, Edoardo Cittadini and Antonino Granatelli
J. Clin. Med. 2024, 13(5), 1320; https://doi.org/10.3390/jcm13051320 - 26 Feb 2024
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Abstract
Background: Drug-coated balloons (DCB) are a well-established option for treating in-stent restenosis endorsed by European Guidelines on myocardial revascularization. However, in recent years, a strategy of “leaving nothing behind” with DCB in de novo coronary stenosis has emerged as an appealing approach. [...] Read more.
Background: Drug-coated balloons (DCB) are a well-established option for treating in-stent restenosis endorsed by European Guidelines on myocardial revascularization. However, in recent years, a strategy of “leaving nothing behind” with DCB in de novo coronary stenosis has emerged as an appealing approach. Methods: We performed a systematic review to evaluate the current literature on the use of drug-coated balloons in the treatment of de novo stenosis in large vessel disease. Results: Observational studies, as well as randomized studies, demonstrated the safety of DCB percutaneous coronary interventions (PCI) in large vessel disease. The rate of major adverse cardiac events is even lower compared to drug-eluting stents in stable coronary artery disease. Conclusions: DCB PCI is feasible in large vessel disease, and future large, randomized studies are ongoing to confirm these results. Full article
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