Polydopamine is one of the simplest and most versatile approaches to functionalizing material surfaces, having been inspired by the adhesive nature of catechols and amines in mussel adhesive proteins. Since its first report in 2007, a decade of studies on polydopamine molecular structure, deposition conditions, and physicochemical properties have ensued. During this time, potential uses of polydopamine coatings have expanded in many unforeseen directions, seemingly only limited by the creativity of researchers seeking simple solutions to manipulating surface chemistry.

Polydopamine (PDA) formed by the oxidation of dopamine is an important polymer, in particular, for coating various surfaces. It is composed of dihydroxyindole, indoledione, and dopamine units, which are assumed to be covalently linked. Although PDA has been applied in a manifold way, its structure is still under discussion.

Vascular and cardiovascular diseases are leading causes of mortality globally. Despite significant progress in elucidating the molecular and cellular mechanisms involved in these conditions, some critical aspects, including complex intercellular interactions and therapeutic efficacy, require further investigation to be fully understood and predicted. This lack of knowledge motivates the development of advanced research methodologies, where bioengineering has contributed significantly. Technological advances in bioengineering have evolved into powerful tools that replicate the molecular and cellular microenvironment of human vascular and cardiac tissues with unprecedented fidelity in vitro and ex vivo. The evolution of conventional 2-dimensional, monocultured cell models into 3-dimensional and mechanically dynamic models that also possess tissue-level cellular and molecular sophistications enables studying vascular pathologies and therapies with promising predictability. Various techniques, such as microphysiological systems, organoids, and bioprinting, are increasingly used and further improved through numerous studies to reconstruct human vascular microenvironment and the associated diseases such as atherosclerosis and thrombosis in vitro.

The assessment of coronary lesion functional significance remains central to contemporary percutaneous coronary intervention (PCI). Although wire-based fractional flow reserve (FFR) is supported by strong evidence, its global adoption remains limited by cost, procedural complexity, hyperaemia, and operator preference1. Angiography-derived physiological indices such as quantitative flow ratio (QFR) have therefore emerged as attractive alternatives. Beyond eliminating the pressure wire and pharmacological hyperaemia, angiography-derived FFR enables virtual pullback analysis, allowing discrimination between focal and diffuse disease and supporting PCI planning without intracoronary instrumentation2. If rigorously validated, this technology could expand the use of physiology-guided revascularisation, particularly in laboratories where pressure wire adoption is low. Its evaluation is thus not merely a device comparison but a test of whether physiology can be made more accessible without compromising outcomes.

The DAPT-MVD trial, published in the New England Journal of Medicine in July 2026, evaluated extended dual antiplatelet therapy in patients with multivessel coronary disease. This open-label, assessor-blinded randomized study enrolled 8,250 patients across 97 Chinese centers who had successfully completed 12 months of dual antiplatelet therapy (DAPT) with drug-eluting stents. Eligible participants had multivessel disease defined as stenosis of at least 50% in two major epicardial vessels. At mean 379 days post-intervention, patients were randomized to receive either an additional 12 months of clopidogrel plus aspirin or aspirin monotherapy alone. The trial demonstrated that extended DAPT with clopidogrel and aspirin significantly reduced ischemic events compared to aspirin monotherapy, with no detectable increase in adjudicated bleeding complications. These findings challenge current guidelines that designate extended DAPT as only a conditional Class 2b option, suggesting multivessel patients may represent an important exception where prolonged dual therapy provides meaningful clinical benefit without excess hemorrhagic risk.

A recent study from Mass General Brigham reveals a significant gap between current cholesterol levels and newly released 2026 American guidelines. Nearly one-third of U.S. adults without heart disease and almost four-fifths of those with prior cardiovascular events have LDL cholesterol above recommended targets. Notably, approximately three-quarters of at-risk adults without heart disease receive no cholesterol-lowering medication despite eligibility. The 2026 guidelines introduced stricter LDL goals based on cardiovascular risk assessment, with lower targets for higher-risk patients. Researchers analyzed national data representing 178 million Americans, highlighting a substantial treatment gap that represents missed prevention opportunities for millions of individuals at risk for heart attacks and strokes.

Administration of antiplatelet drugs significantly improves outcomes in patients with CAD, and DAPT is the current standard regimen in patients undergoing PCI. However, continuous procedural, technical, and pharmacological improvements, along with the recognition that bleeding events have significant drawbacks for overall patient prognosis, have significantly reduced the need for long-term DAPT in favor of antiplatelet monotherapy. In the context of post-procedural management, there is mounting evidence supporting the use of P2Y12 inhibitor monotherapy rather than aspirin monotherapy after a short course of DAPT, as this strategy has been shown to reduce bleeding without any trade-off in ischemic events. P2Y12 inhibitor monotherapy is gaining attention compared to aspirin monotherapy for long-term secondary prevention of ischemic events. However, data are still limited, and aspirin still remains the cornerstone of long-term treatment in patients with CAD who have previously undergone PCI.

In vitro data showed that the PDA-coated Zn encouraged EC adhesion, spreading, proliferation, and phenotype maintenance on its surfaces. VEGF functionalization on PDA coatings further enhanced the biocompatibility of Zn to ECs. Implantation of PDA-coated Zn wires into rat aortas didn’t cause thrombosis and showed a faster blood flow than pure Zn or the Zn wires coated with VEGF alone. In addition, the PDA coating didn’t affect the degradation of Zn wires in vivo. Besides, the PDA-coated Zn wires reduced neointimal formation, increased EC coverage, decreased macrophage infiltration, and declined aggrecan accumulation in ECM. VEGF immobilization onto PDA coatings didn’t cause thrombosis and affect Zn degradation in vivo as well, and further increased the endothelization percentage as compared to PDA coating alone, thus resulting in thinner neointimas.

Dual antiplatelet therapy (DAPT) for 12 months has historically been the standard of care following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS); however, prolonged DAPT carries a cumulative, time-dependent risk of major bleeding. We aimed to determine whether a short DAPT duration (≤6 months) followed by single antiplatelet therapy reduces bleeding events without compromising ischemic safety compared with standard 12-month DAPT in ACS patients.

The sirolimus DEB was noninferior to a usual care control strategy including 80% repeat DES but not noninferior to DES for single-layer ISR for TLF at 12 months. There was significant interaction on the basis of operator selection of DES vs BA. (SELUTION SLR 014 In-stent Restenosis [SELUTION4ISR]; NCT04280029)

Pressure-wire-based fractional flow reserve (FFR) is the gold standard for physiological assessment of intermediate coronary stenoses but remains underutilized owing to procedural complexity, cost, and the need for hyperemic agents. Angiography-derived physiology (ADP) platforms offer a wire-free, adenosine-free alternative. This systematic review and meta-analysis compared the clinical outcomes of ADP-guided versus FFR-guided revascularization in patients with coronary artery disease.

In patients with intermediate coronary lesions, revascularisation guided by vFFR was noninferior to FFR-guided revascularisation in terms of a composite of death, myocardial infarction, or revascularisation at 1 year.

Patients undergoing complex PCI are often at increased bleeding risk, challenging, therefore, the decision-making process. In this setting, the optimal antithrombotic treatment is still a matter of debate and has become a field of intensive research. In this state-of-the-art review, we analyse the evidence related to the different approaches regarding the periprocedural and long-term antithrombotic management of patients undergoing complex PCI. Since a “one-size-fits-all” approach cannot be justified in this clinical setting, our aim is to tailor the antithrombotic strategy to each patient’s profile and PCI complexity. We discuss the type and duration of antithrombotic regimens that can be selected for patients undergoing complex PCI, with a focus on prolonged dual antiplatelet therapy, P2Y12 receptor inhibitor monotherapy, and dual pathway inhibition.

This clinical study demonstrates the utility of optical coherence tomography (OCT) imaging in identifying biological mechanisms underlying in-stent restenosis (ISR) across three distinct cases with varying temporal presentations. By visualizing neoatherosclerotic plaque formation and neointimal hyperplasia patterns, OCT enabled mechanism-based treatment selection rather than uniform repeat stent implantation. The cases illustrate both early and very late restenosis despite optimal initial stent expansion and excellent medication adherence, highlighting that biological factors drive failure even in well-expanded devices. OCT findings supported targeted interventions, including drug-coated balloon therapy for biologically driven ISR and repeat drug-eluting stents when structural scaffolding was warranted. This imaging-guided approach aligns with contemporary recommendations and demonstrates superior outcomes compared to conventional angiographic assessment alone in managing complex restenosis cases.

Explore the UK consensus on the role of intravascular ultrasound in percutaneous coronary interventions, including guidelines and best practices.

The FAVOR III Europe trial presents two-year follow-up data comparing quantitative flow ratio (QFR) and fractional flow reserve (FFR) guided approaches for coronary revascularization in patients with intermediate stenoses. This prospective, multicenter randomized study enrolled 2,000 patients from 34 European centers to evaluate whether QFR, an angiography-derived physiological assessment method, could match the clinical outcomes of FFR, the current invasive reference standard. QFR offers significant practical advantages by eliminating the need for pressure wires and hyperemic agents, thereby reducing procedural time and costs. The trial results contribute valuable evidence regarding the clinical equivalence of these two physiological assessment strategies for guiding coronary intervention decisions in routine clinical practice.

by AS Triantafyllis · 2026 — The FFR is calculated as FFR = (Pd − Pv)/(Pa − Pv), where Pd is the distal coronary pressure measured by a pressure guidewire placed distal to the stenosis, Pa ...

Atherosclerosis is a systemic disease of the arterial tree that often assumes variable forms across vascular territories. As a result, atherosclerotic plaques in different vascular beds differ in frequency, composition, stability and propensity to rupture. Here, we argue that this territorial variability is a manifestation of partially predictable principles. Embryological origin and developmental programming create regionally distinct smooth muscle cell lineages and extracellular matrix architectures, predisposing vascular segments to characteristic modes of injury and repair. Local hemodynamic processes and vessel structures further influence this architecture, leading to distinct atherosclerotic plaque evolution. Microvascular and macrovascular calcification contribute to these processes by amplifying local signals, including inflammation and environmental cues, and by driving the chondrogenic and osteogenic transformation of vascular cells. By synthesizing evidence on divergent atherosclerotic and calcification patterns across vascular beds, the concept of territory-adapted imaging and therapy may improve prevention and risk stratification.

Luca Saba, Dean of the University of Cagliari's School of Medicine, presents a groundbreaking perspective on atherosclerosis heterogeneity published in Nature Cardiovascular Research. Building upon established concepts of vulnerable plaques and vulnerable patients, Saba and colleague Jagat Narula introduce the novel concept of "vulnerable territory." They argue that the arterial system comprises biologically distinct vascular territories with unique embryologic origins, hemodynamic environments, and structural characteristics. These territorial differences fundamentally influence how systemic risk factors manifest and progress, meaning identical calcification patterns in different arteries carry distinct biological and clinical significance. This framework resolves why atherosclerosis operates systemically yet remains nonuniform, offering profound implications for cardiovascular research and clinical practice.

The curcumin-conjugated PLA/PCL biodegradable stent (Cur-PLA/PCL) exhibited excellent hemocompatibility by significantly reducing fibrinogen adsorption, inhibiting platelet adhesion, and preventing thrombus formation simultaneously. Released curcumin showed strong antioxidant and anti-inflammatory effects by downregulating TNF-α, IL-1β, and IL-6, thereby fostering a regenerative microenvironment for endothelial cells. Furthermore, curcumin promoted cholesterol efflux from foam cells, resulting in ~ 70% reduction in intracellular lipid accumulation by day 7 through upregulation of ABCA1 and ABCG1 transporters. In addition, curcumin promoted selective apoptosis of foam cells via increased expression of FAS and BAX pathways. These findings demonstrate the potential of natural compound-functionalized stents as a promising platform for targeted and sustained atherosclerosis therapy.