Percutaneous coronary intervention (PCI), also known as percutaneous transluminal coronary angioplasty (PTCA), is a minimally invasive procedure used to treat coronary artery disease with or without stent insertion. The procedure addresses stable ischemic heart disease with refractory angina and acute coronary syndromes including unstable angina, NSTEMI, and STEMI. For STEMI patients, stent placement within 90 minutes of symptom onset represents optimal treatment. Elective PCI is appropriate for post-MI patients with recurrent angina or those remaining symptomatic despite medical management. The procedure is typically performed via femoral, radial, or brachial artery puncture, with the radial approach now preferred due to reduced patient discomfort, faster ambulation, and decreased bleeding complications. A guiding catheter is threaded to the coronary artery, followed by inflation of a balloon-tipped catheter guided by fluoroscopy or intravascular ultrasound to disrupt atherosclerotic plaque and dilate the artery. A stent is usually placed to maintain vessel patency, with post-procedure angiography confirming successful revascularization.

Fractional flow reserve (FFR) is an established technique for guiding coronary interventions by identifying lesion-level ischaemia, though its application in acute coronary syndrome (ACS) remains controversial. This comprehensive review examines FFR efficacy in both non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) settings. The analysis confirms FFR as a reliable tool for lesion-level decision-making in NSTEMI, though with specific limitations. For STEMI, evidence remains limited, but FFR shows potential value in assessing non-culprit lesions in stabilized patients post-intervention. Notably, the index of myocardial resistance (IMR), measured in the culprit artery, demonstrates predictive value for long-term clinical outcomes in STEMI patients. The review addresses multivessel disease, present in 30-50% of STEMI presentations with associated worse prognosis. The findings support an increasing evidence base for FFR-guided revascularization and IMR-based outcome prediction in ACS patients, while acknowledging concerns about microvascular pathophysiology affecting maximal hyperaemia induction and plaque instability considerations.

The GINGER trial evaluated the efficacy of a novel sirolimus-eluting balloon (SEB) incorporating phospholipid nanocarriers for treating long de novo coronary artery disease. This prospective study assessed a next-generation drug-delivery system designed to improve therapeutic outcomes in complex coronary lesions. Sirolimus, an immunosuppressant with anti-proliferative properties, was delivered via advanced phospholipid nanocarrier technology to enhance drug retention and bioavailability at the treatment site. The phospholipid nanocarrier platform represents a significant advancement in balloon angioplasty technology, enabling sustained drug release while minimizing systemic exposure. By targeting long coronary lesions that traditionally require stent implantation, this innovation offers a potentially less invasive alternative. The trial's prospective design and focus on de novo lesions provide clinically relevant data for interventional cardiologists seeking to expand treatment options for complex coronary disease. Results from GINGER contribute to the growing body of evidence supporting drug-eluting balloon technology as a viable strategy for improved patient outcomes and reduced long-term complications in coronary intervention.

Artificial intelligence is being progressively integrated across interventional cardiology, from pre-procedural planning through post-procedural monitoring and clinical decision support. The maturity of evidence varies substantially across applications. Computed tomography-derived and angiography-derived physiological assessment, selected automated image-analysis tools, and operator-controlled robotic assistance have demonstrated prospective or real-world evidence in specific settings, while digital twins, hybrid intravascular ultrasound-optical coherence tomography interpretation, generative simulations, autonomous robotic control, and large language model-based reasoning remain at earlier validation stages. This review examines AI applications throughout the interventional cardiovascular care pathway and critically evaluates supporting evidence, while addressing translational barriers including dataset heterogeneity, workflow integration, cost-effectiveness, cybersecurity, regulatory oversight, and clinician trust. Rather than viewing AI monolithically, the authors propose an evidence-calibrated framework distinguishing clinically implemented tools from investigational platforms. Future adoption should prioritize prospective validation, transparent evidence grading, reproducibility, regulatory clarity, and demonstrable patient-centered outcomes over algorithmic novelty alone. As interventional cardiology advances toward increasingly complex catheter-based therapies, AI's clinical value depends on specific task validation and outcome improvement rather than computational performance.

Biological safety evaluations remain one of the most expensive and time-consuming phases of medical device development. Traditional approaches that involve full biocompatibility test panels can cost from $150k up to $500k per device and add an additional 3 to 18 months to development timelines. Costs and timeline implications are constraining device launches across the industry. Startups are forced into repeated funding cycles, while established companies face rising expenses to sustain multiple product portfolios.

One month of dual antiplatelet therapy (DAPT) did not reach noninferiority compared with three months of DAPT for net adverse clinical events (NACE) in East Asian patients with high bleeding risk (HBR) following PCI with a drug-eluting stent (DES), according to results from the HOST-BR trial published Oct. 23 in The Lancet. Furthermore, three months of DAPT was noninferior to 12 months of DAPT for net adverse clinical events and major adverse cardiac or cerebral events (MACCE), and it was superior for bleeding in patients without HBR.

The polymer-free sirolimus-eluting submicron carrier stent represents a novel advancement in DES technology designed to address the persistent limitations of contemporary polymer-based and polymer-free DES. Its unique design incorporates several innovative features, including a polymer-free drug-delivery system using phospholipid submicron carriers, an abluminal coating, and a proprietary fusion coating technology that combines the therapeutic benefits of newer-generation DES and DCB technologies within a single device. Preclinical studies have demonstrated low inflammation and early vascular healing characteristics with the polymer-free sirolimus-eluting submicron carrier stent. Small-scale, non-randomized clinical studies have also shown encouraging performance, with low event rates and no stent thrombosis reported at 12-month follow-up.

Single-projection 2D-μQFR provides accurate, rapid, and reproducible physiological assessment comparable to 3D-μQFR with superior specificity to vFFR. These findings support 2D-μQFR as a practical, wire-free alternative to invasive FFR in routine clinical practice.

Bifurcation percutaneous coronary intervention (PCI), which accounts for up to 20% of contemporary interventions, presents significant technical challenges with higher cardiovascular event rates and lower procedural success compared to non-bifurcation PCI. Over the past two decades, clinical trials have optimized strategies for these complex procedures. Intravascular imaging (IVI), particularly intravascular ultrasound (IVUS) and optical coherence tomography (OCT), has emerged as a superior alternative to angiographic guidance alone. Two landmark randomized trials—ULTIMATE and RENOVATE-COMPLEX-PCI—demonstrated that IVUS reduced target vessel failure and thrombosis across all patients, with benefits sustained at three years. The OCTOBER trial further established OCT as effective in true bifurcation lesions. Current American College of Cardiology/American Heart Association guidelines recommend IVUS for left main coronary artery and complex lesion PCI, including bifurcations. These imaging modalities enable detailed assessment of lesion morphology, calcification, and in-stent restenosis mechanisms, facilitating informed clinical decisions regarding side branch intervention and improving overall procedural outcomes.

A comprehensive meta-analysis of 24 randomized controlled trials involving 79,073 patients, published in Circulation, examined optimal dual antiplatelet therapy (DAPT) strategies following percutaneous coronary intervention with drug-eluting stents. Extended DAPT beyond 12 months reduced myocardial infarction rates compared to shorter durations, but significantly increased major bleeding risk. Notably, DAPT lasting less than six months followed by P2Y12 inhibitor monotherapy provided the lowest bleeding risk while maintaining comparable ischemic protection to other short-duration strategies. Cardiovascular and overall mortality showed no significant differences across strategies. The findings, analyzed by a multi-institutional team including Cleveland Clinic cardiologist Dr. Ankur Kalra, highlight that no single antiplatelet approach suits all patients. Rather, clinicians must individualize therapy by balancing each patient's ischemia and bleeding risks. These conclusions build upon earlier European Society of Cardiology and American College of Cardiology/American Heart Association guidelines, incorporating additional evidence that has emerged since their 2016–2017 publication.

Magnesium-based bioresorbable stents represent a potentially transformative advancement in cardiovascular therapy, offering temporary vessel support with complete biodegradability that addresses significant limitations of traditional permanent stents, including in-stent restenosis and long-term complications. Despite their promise, clinical adoption has been hindered by challenges such as rapid corrosion and inadequate endothelialisation. A comprehensive review by Kumar, Preetam, Pandey, Birbilis, and colleagues published in March 2025 examines the latest breakthroughs in surface modification, alloying, and coating strategies designed to enhance mechanical integrity, corrosion resistance, and biocompatibility of magnesium-based stents. The research highlights key surface engineering techniques, particularly polymer and bioactive coatings, for their effectiveness in promoting endothelial healing and minimizing inflammatory responses. The authors propose future directions centered on personalized stent designs optimized for enhanced efficacy and improved long-term outcomes, positioning magnesium-based stents as a transformative solution in interventional cardiology that could fundamentally reshape cardiovascular treatment approaches.

Extending DAPT for an additional year reduced major adverse cardiovascular events (MACE) without increasing bleeding risk compared with aspirin alone among patients with multivessel coronary artery disease (MVCAD) who had no ischemic or bleeding events one year after PCI with a drug-eluting stent, according to results of the DAPT-MVD trial published July 15 in NEJM.

MgBRS technology has the potential for providing temporary vascular support and facilitating revascularisation while gradually degrading after fulfilling their immediate scaffolding function. This avoids the longer-term complications of permanent stents including in-stent restenosis, neoatherosclerosis and stent thrombosis, in addition to being able to allow all future options for coronary intervention. This systematic review has demonstrated notable performance improvements with each subsequent MgBRS generation; however, there is limited long-term data beyond 24 months. Large randomised control trials with good short- and long-term follow-up, along with planned late angiographic assessment to evaluate vascular response following bioresorption of MgBRS are necessary before any recommendations for general use can be made. The results of the randomised BIOMAG-II study comparing MgBRS to contemporary DES are eagerly awaited to guide future use (ClinicalTrials.gov identifier: NCT05540223) [66]. With continual advancement in bioresorbable stent technologies, MgBRS has the potential to vastly improve options for contemporary treatment of obstructive coronary artery disease.

Mg-based alloys as revolutionary implantable biomaterials have increasingly attracted considerable attention, owing to their biodegradability in vivo and beneficial effects on biological systems. The degradation process and products of Mg-based alloys have been reported to exhibit significant biological effects on host-tissue responses. However, these effects have not yet been fully understood. This review systemically summarizes and analyses the current understandings and recent research progress in this area. The primary focal points are the biological effects and related mechanisms associated with the degradation behaviour of Mg-based alloys. The biological impacts of the degradation products are elucidated and the arguable or controversial issues are also discussed, providing a pathway toward a greater understanding of the biological implications of Mg-based alloys. Furthermore, based on these biological implications, the restorative potential of Mg-based alloys for applications in tissue repair and regeneration is summarized. Finally, outlooks on biosafety evaluation and design strategies for Mg-based alloy implants are briefly discussed.

The implantation of devices used to unclog vessels, known as stents, sometimes results in a lack of irrigation due to the excessive proliferation of endothelial tissue within the blood vessels and is known as restenosis. The use of drug-eluting stents (DESs) to deliver antiproliferative drugs has led to the development of different encapsulation techniques. However, due to the potency of the drugs used in the initial stent designs, a chronic inflammatory reaction of the arterial wall known as thrombosis can cause a myocardial infarction (MI). One of the most promising drugs to reduce this risk is everolimus, which can be encapsulated in lipid systems for controlled release directly into the artery. This review aims to discuss the current status of stent design, fabrication, and functionalization.

Coronary stent development has transformed PCI by reducing acute complications, thrombosis, and restenosis. These advances have led to significantly improved clinical outcomes and represent a major achievement in engineering and drug delivery. Nonetheless, important challenges remain. Late safety issues with first-generation DES, modest gains of newer DESs in complex patients, and barriers related to regulation, manufacturing, cost, and global access continue to limit progress. Future progress will require stents that support faster and more complete vascular healing, perform reliably in complex anatomies, and balance long-term durability with biocompatibility. Equally important are robust long-term clinical evaluations and strategies that broaden access across diverse healthcare settings. These efforts will guide the development of safer, more effective, and more equitable coronary interventions.

While some prior studies like BBC ONE and NORDIC have suggested that mortality might be worse with a dual-stent approach in true left main bifurcations, the randomized DKCRUSH-V showed the opposite and formed the basis for a 2018 European Society of Cardiology recommendation that supports double-kissing crush over a planned provisional strategy.

Biodegradable metal alloys emerge as a new class of biomaterials for tissue engineering and medical devices such as cardiovascular stents. Deploying biodegradable materials to fabricate stents not only obviates a second surgical intervention for implant removal but also circumvents the long-term foreign body effect of permanent implants. However, these materials for stents suffer from an un-controlled degradation rate, acute toxic responses, and rapid structural failure presumably due to a non-uniform, fast corrosion process. Here we report that highly uniform, nanophasic degradation is achieved in a new Mg alloy with unique interstitial alloying composition as the nominal formula Mg–2.5Nd–0.2Zn–0.4Zr (wt%, hereafter, denoted as JDBM).

Despite the progress, rapid degradation and inadequate mechanical support remain critical barriers to widespread clinical use. Balancing corrosion resistance, mechanical durability, and biocompatibility is essential for the stents to perform effectively during the critical healing period. Personalised stent design, incorporating patient-specific vessel geometries and tailored degradation profiles, represents a key area of future research. Innovative stent architectures and hybrid coating techniques could further optimise Mg stent performance, aligning degradation rates with individual patient healing needs. Successful clinical translation of Mg-based stents will require comprehensive long-term studies and standardised testing protocols.

DCB angioplasty shows comparable short-term safety and efficacy to modern DES for de novo coronary disease. Long-term follow-up is necessary to confirm whether avoidance of permanent implants translates into clinical benefit.