Human induced pluripotent stem cell–derived extracellular vesicles (EVs) were released in a controlled manner from core-shell nanofibrous membranes coated onto a bare metal stent. This localized EV delivery strategy accelerated endothelial regeneration while inhibiting excessive smooth muscle cell proliferation.

DCB therapy in both coronary and peripheral disease is facilitated by achieving a predictable treatment substrate rather than maximal lesion modification. Thus, vessel preparation should be lesion and vessel specific, overcoming the primary mechanical constraint and enabling appropriate expansion, controlled injury, and effective balloon–vessel contact. The longevity of DCB in coronary disease may be influenced by residual plaque burden, calcium morphology, and vessel-wall features, while residual stenosis, recoil, and flow-limiting dissection are more closely related to peripheral results. Atherectomy and IVL may enhance procedural success and lesion reduction but their incremental influence on long-term DCB-specific outcomes is unknown. Future trials should establish objective, imaging-based preparation targets and determine whether achieving a “DCB-ready” vessel improves drug delivery and durable clinical outcomes. Ultimately, the goal is not to select the most advanced preparation device, but to identify the least aggressive strategy that reliably prepares the vessel for successful DCB therapy.

High-pressure drug-coated balloon (HP@DCB) angioplasty enhances vascular drug delivery by overcoming the limitations of passive diffusion-based conventional noncompliant DCB (NC@DCB) systems. We developed a dual-layer HP balloon catheter composed of an outer Nylon 12 layer and an inner Pebax 7233 layer, and evaluated its feasibility and therapeutic efficacy as a paclitaxel (PTX)-coated platform. Shellac-based PTX coating was uniformly applied to HP@DCB and NC@DCB, and coating thickness, drug amount, release behavior, and mechanical properties were compared. Pressure-assisted drug penetration was assessed in a vascular-mimicking agarose gel phantom using fluorescent PTX and confocal microscopy.

Primary percutaneous coronary intervention is the standard treatment for acute ST-segment elevation myocardial infarction, yet some patients experience the "no-reflow" phenomenon, characterized by inadequate myocardial reperfusion despite successful coronary artery reopening. This condition results from microvascular obstruction caused by multiple factors including myocardial ischemia, distal embolization, and ischemia-reperfusion injury. Occurring in approximately 40-50% of patients undergoing intervention, with higher prevalence in STEMI cases, no-reflow remains a significant clinical challenge. Currently, no consensus exists regarding effective pharmacological or interventional prevention and treatment strategies. This article comprehensively examines the pathophysiology of no-reflow and slow-flow phenomena, exploring established and emerging therapeutic approaches tested in clinical research.

Intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) has demonstrated improved clinical outcomes, yet US adoption patterns remain understudied. Researchers analyzed 5,220,590 PCI admissions from the National Inpatient Sample between 2012 and 2022 to assess adoption trends, disparities, and clinical outcomes. IVI-guided PCI adoption increased significantly from 7.1% in 2012 to 21.3% in 2022, with minimal demographic disparities but substantial geographic variations—Northeast hospitals led at 27.6% adoption compared to 16.3% in Western facilities. IVI guidance was associated with lower in-hospital mortality (2.32% versus 2.88%) and higher routine discharge rates (84.1% versus 83.7%). After multivariable adjustment and propensity score matching, IVI-guided procedures showed significantly reduced odds of in-hospital mortality (aOR 0.783, 95% CI 0.742–0.827). While IVI adoption continues expanding nationwide, results highlight regional disparities and increased procedural costs alongside improved patient safety outcomes, underscoring the technique's growing clinical importance in contemporary PCI practice.

Researchers conducted a meta-analysis comparing angiography-derived fractional flow reserve (FFR) with traditional wire-based FFR for guiding coronary revascularization decisions. Analyzing four randomized controlled trials encompassing 6,542 patients, the study examined whether angiography-derived FFR—which enables functional coronary assessment from standard angiograms without requiring pressure-wire equipment or adenosine-induced hyperemia—could match wire-based FFR's clinical outcomes. Results revealed no significant differences in major adverse cardiovascular events, all-cause mortality, cardiac mortality, recurrent myocardial infarction, or stent thrombosis between the two approaches. However, angiography-derived FFR was associated with higher percutaneous coronary intervention rates at both patient and lesion levels, plus shorter procedural times. While procedural outcomes were rated as high-certainty evidence, most clinical endpoints achieved only moderate certainty, with trial sequential analysis suggesting insufficient sample sizes for definitive conclusions. The findings suggest angiography-derived FFR provides comparable ischemic outcomes to wire-based FFR while potentially streamlining procedures, though it may increase PCI utilization. Larger, longer-term trials are needed to establish optimal clinical applications and confirm long-term safety profiles.

This research article examines the relationship between peripheral microvascular function and in-stent late lumen loss, investigating how small blood vessel health may influence outcomes following coronary stent placement. The study addresses an important clinical question about restenosis—the re-narrowing of stented arteries—which remains a significant complication in interventional cardiology despite advances in stent technology. Researchers evaluated peripheral microvascular dysfunction as a potential predictor of in-stent late lumen loss, analyzing whether systemic vascular changes correlate with localized stent performance. The findings contribute to understanding the pathophysiological mechanisms underlying restenosis and suggest that peripheral microvascular assessment may help identify patients at higher risk for adverse stent outcomes. This work has implications for risk stratification following percutaneous coronary intervention and could inform personalized treatment strategies or enhanced follow-up protocols for vulnerable patient populations.

Quantitative flow ratio (QFR) is a computational technique that analyzes coronary angiograms to determine whether arterial narrowing functionally limits blood flow, without requiring invasive pressure wires or hyperemic drugs. A prespecified secondary analysis of the FAVOR III China randomized trial, conducted across 26 Chinese centers between December 2018 and January 2020, examined whether QFR-guided percutaneous coronary intervention (PCI) provided benefits for patients with multivessel disease. The study included 3,825 participants with a mean age of 62.7 years, of whom 54% had multivessel disease. Participants were randomized to receive either QFR-guided or standard angiography-guided treatment, with QFR-guided lesions treated when values were 0.80 or below. At three years, QFR-guided PCI demonstrated fewer major adverse cardiac events in multivessel disease patients compared to angiography-guided approaches. However, the treatment effect difference between multivessel and single-vessel disease groups did not reach statistical significance. This analysis contributes to understanding lesion selection for PCI but does not establish QFR equivalence to invasive fractional flow reserve or compare PCI with bypass surgery.

Artificial intelligence is transforming the management of acute coronary syndromes through multiple clinical applications. This comprehensive review examines AI-driven innovations across the diagnostic and interventional spectrum. AI-enabled electrocardiography enhances early recognition of acute coronary syndromes in prehospital and emergency settings, while specialized algorithms identify occluding myocardial infarctions with improved accuracy. The integration of AI with biomarker analysis, particularly high-sensitivity troponin measurements, enables personalized diagnostic approaches that move beyond fixed thresholds toward individualized probability assessments. Advanced imaging applications utilize AI for coronary plaque characterization and culprit lesion identification, moving beyond simple luminal stenosis assessment to sophisticated quantitative phenotyping that incorporates morphological, physiological, and inflammatory markers. These innovations bridge diagnostic performance with meaningful workflow improvements, bringing diagnosis closer to patients and enabling earlier intervention. The convergence of AI-enhanced ECG analysis, biomarker integration, and plaque assessment represents a paradigm shift in acute coronary syndrome management, ultimately improving patient outcomes through faster, more accurate, and personalized clinical decision-making.

Researchers have conducted a comprehensive systematic review of literature from 2015 to 2026 examining the conversion of agricultural waste biomass into sustainable bionanomaterials. The study, led by scientists at Shoolini University and VSB-Technical University of Ostrava, evaluated synthesis methods for metallic, non-metallic, polymeric, and carbon-based nanoparticles derived from agro-waste precursors. The analysis assessed key metrics including particle size distribution, zeta potential, synthesis yield, cytotoxicity through cell viability assays, and antimicrobial efficacy measured by minimum inhibitory concentration and zone of inhibition. Findings indicate that green-synthesized nanoparticles generally demonstrate reduced cytotoxicity and comparable or enhanced biological activity in vitro compared to conventionally manufactured counterparts, though outcomes vary significantly based on precursor composition and synthesis conditions. While agro-waste-derived nanomaterials show promising biocompatibility, colloidal stability, and multifunctional properties for emerging biomedical applications including antimicrobial and antioxidant uses, variability in experimental protocols and reporting standards hinders direct comparison across studies. This valorization approach addresses sustainability demands while transforming agricultural residues into valuable advanced materials.

Coronary revascularization—restoring adequate blood supply to oxygen-deprived heart tissue—can be achieved through percutaneous coronary intervention with stents (PCI) or coronary artery bypass grafting (CABG). When fatty deposits and cholesterol narrow coronary arteries, patients may develop stable angina, acute coronary syndromes, or heart failure, necessitating intervention. The choice between stenting and bypass surgery depends primarily on coronary anatomical complexity, the number of narrowed arteries, diabetes status, and cardiac function. While stenting offers a minimally invasive catheter-based approach with shorter recovery, bypass surgery provides superior long-term durability and lower repeat intervention rates, particularly for patients with diabetes and extensive multi-vessel disease. Contemporary clinical practice employs a multidisciplinary Heart Team approach, bringing together interventional cardiologists and cardiac surgeons to evaluate cases systematically using validated risk-stratification tools such as the SYNTAX score. This collaborative decision-making model, endorsed by major cardiology associations, leverages diagnostic angiograms, echocardiograms, and hemodynamic assessments to tailor treatment plans to individual patient characteristics. This approach has become the standard of care in modern cardiac decision-making, moving beyond reliance on a single specialist's recommendation.

The PROPHET-FFR study, an ambispective observational analysis of 1,986 patients undergoing invasive physiological assessment for intermediate coronary stenoses, demonstrates the clinical value of physiology-guided percutaneous coronary intervention (PCI). Patients were stratified into three treatment approaches: deferred revascularization based on non-ischemic physiology, conventional PCI without post-procedural physiological assessment, and physiology-guided PCI with post-PCI assessment and optimization when indicated. At 12 months, major adverse cardiovascular events (MACE), defined as cardiovascular death, spontaneous myocardial infarction, and target-vessel revascularization, occurred in 4.1%, 7.6%, and 3.4% of respective groups. Post-PCI physiology demonstrated significantly lower MACE compared to conventional PCI (3.4% versus 7.6%), driven primarily by reduced target-vessel revascularization. These findings remained consistent following propensity score matching. Additionally, adoption of post-PCI physiological assessment increased from 11.8% to 22.8% across registry phases. These results suggest that routine physiological guidance following PCI may improve patient outcomes and reduce repeat revascularization procedures, supporting broader clinical integration of this optimization strategy in coronary intervention practice.

A comprehensive meta-analysis published in eClinicalMedicine has demonstrated that drug-coated balloons (DCBs) achieve cardiovascular outcomes comparable to drug-eluting stents for treating newly diagnosed coronary artery disease. Led by Natasha Corballis and Vassilios Vassiliou, the analysis pooled data from ten randomized controlled trials encompassing 7,832 patients. Drug-coated balloons are angioplasty balloons coated with paclitaxel, an antiproliferative drug that prevents arterial renarrowing without leaving permanent metallic implants. Unlike drug-eluting stents, which contain a metallic mesh scaffold, DCBs preserve the artery's natural function and reduce chronic inflammation from foreign bodies. While stents have dominated interventional cardiology since proving their efficacy in landmark trials, DCBs offer distinct advantages: elimination of mechanical stent failure risks, shorter antiplatelet therapy courses, and preserved options for future revascularization. This finding is particularly significant for small vessels where stent struts can obstruct a disproportionate portion of the lumen. These results challenge the stent-centric treatment paradigm and suggest DCBs merit broader consideration in coronary artery disease management.

Antithrombotic therapy, including antiplatelet and anticoagulant agents, is the cornerstone of pharmacological treatment to optimize clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Intravenous anticoagulant drugs available for PPCI include the indirect thrombin inhibitors unfractionated heparin and low-molecular-weight heparin, and the direct thrombin inhibitor bivalirudin. Intravenous antiplatelet drugs mainly include glycoprotein IIb/IIIa inhibitors and the P2Y12-receptor inhibitor cangrelor. Dual antiplatelet therapy with aspirin and an oral P2Y12-receptor inhibitor is pivotal for the acute and long-term treatment of patients with STEMI undergoing PPCI. Prasugrel and ticagrelor provide a more prompt, potent, and predictable antiplatelet effect compared with clopidogrel, which translates into better clinical outcomes. Therefore, these agents are the first-line treatment in PPCI. However, patients can still experience adverse ischaemic events, which might be in part attributed to alternative pathways triggering thrombosis. Thrombin has an important role, suggesting the need for strategies directly targeting circulating thrombin or other factors of the coagulation cascade, such as oral anticoagulants (rivaroxaban), and the thrombin receptor on the platelet membrane (vorapaxar). In this Review, we provide an overview of currently available antithrombotic therapies used in patients with STEMI undergoing PPCI, results from pivotal clinical trials and their implications for guidelines, as well as recommendations for clinical practice.

For 20 years, dual antiplatelet therapy (DAPT), consisting of the combination of aspirin and a platelet P2Y12 receptor inhibitor, has been the gold standard of antithrombotic pharmacology after percutaneous coronary intervention (PCI). In the past 5 years, several investigations have challenged this paradigm by testing the efficacy and safety of P2Y12 inhibitor monotherapy (that is, without aspirin) following a short course of DAPT. Collectively, these studies suggested a reduction in the risk of major bleeding and no significant increase in thrombotic or ischaemic events compared with guideline-recommended DAPT. Current recommendations are evolving to inform clinical practice on the ideal candidates for P2Y12 inhibitor monotherapy after PCI. Generalizing the results of studies of P2Y12 inhibitor monotherapy requires a thorough understanding of their design, populations, interventions, comparators and results. In this Review, we provide an up-to-date overview on the use of P2Y12 inhibitor monotherapy after PCI, including supporting pharmacodynamic and clinical evidence, practical recommendations and future directions.

Dual antiplatelet therapy (DAPT) consisting of aspirin and a P2Y12 receptor antagonist (either a thienopyridine (clopidogrel or prasugrel) or a cyclopentyl-triazolopyrimidine (ticagrelor)) is the cornerstone of antithrombotic treatment after an acute coronary syndrome (ACS) and after coronary stenting. Treatment with DAPT after stent implantation reduces both stent thrombosis (ST) and cardiac ischaemic events that are caused by coronary lesions outside the stented segment, albeit at the cost of an increased risk of bleeding. The optimal duration of DAPT that incorporates this complex interaction between efficacy and safety remains debateable. Although treatment for 12 months with DAPT had been considered a standard of care for years, the plethora of evidence-based data from recent years suggest that shorter or longer durations may yield preferred outcomes in different patient populations.

Multiple de-escalation strategies for DAPT have been shown to mitigate bleeding risk, but it remains unclear which approach is ideal, necessitating head-to-head investigations to determine which exhibits the most favorable cost-to-benefit ratio. However, there is likely a role for more than one approach in clinical practice, depending on patient risk profile. Our approach to aspirin use is also in need of reassessment: strategies to improve adherence, avoidance of enteric aspirin in cardiac patients, and dose adjustment according to bodyweight and/or BMI are all likely to improve rates of therapeutic response. Moreover, platelet function testing may have a role in identifying patients expected to benefit from primary prophylactic aspirin.

This case report from Japanese Red Cross Musashino Hospital presents a novel stent-less approach to treating severely calcified coronary lesions. An 83-year-old woman with exertional angina underwent percutaneous coronary intervention for severe calcification in the proximal left anterior descending artery. Using optical coherence tomography imaging to guide treatment, clinicians employed a stepwise calcium modification strategy combining orbital atherectomy and intravascular lithotripsy. Orbital atherectomy initially achieved partial calcium modification, but extensive calcification remained. Subsequent intravascular lithotripsy, delivered via an 80-pulse sequence using a 2.5-millimeter balloon, successfully created multiple calcium fractures and improved vessel compliance. Rather than implanting a drug-eluting stent, the team applied two paclitaxel-coated balloons, achieving excellent angiographic and imaging outcomes without complications. Follow-up imaging at seventeen months confirmed sustained vessel patency without restenosis and patient remained asymptomatic. This case demonstrates that the complementary mechanisms of orbital atherectomy and intravascular lithotripsy enable effective lesion preparation, potentially allowing safe stent deferral and successful drug-coated balloon angioplasty for severely calcified coronary disease.

Coronary artery calcification represents a significant challenge in percutaneous coronary intervention, as inadequate plaque preparation risks stent under-expansion and thrombosis, while aggressive debulking strategies may cause dissection or perforation. This comprehensive review examines the expanding arsenal of calcium-modification techniques, including intravascular lithotripsy, rotational atherectomy, orbital atherectomy, and excimer laser coronary atherectomy, each offering distinct mechanisms and evidence profiles. The authors emphasize that advanced imaging modalities—intravascular ultrasound, optical coherence tomography, and computed tomography—are essential for detailed lesion assessment and procedural planning. Current evidence supports an individualized, imaging-guided approach rather than a one-size-fits-all strategy, as balloon-based techniques, intravascular lithotripsy, atherectomy, and laser therapy each demonstrate specific strengths and limitations across different lesion subsets. The review synthesizes recent randomized evidence and guideline recommendations while proposing a practical framework that balances procedural innovation with patient safety, recognizing that atherectomy and laser remain particularly valuable for selected uncrossable and undilatable lesions.

Researchers from Huaihe Hospital conducted a network meta-analysis to evaluate optimal antiplatelet monotherapy strategies following percutaneous coronary intervention in high bleeding risk patients not receiving oral anticoagulants. The study searched multiple databases through July 2026 and analyzed six randomized controlled trials comparing antiplatelet monotherapy after ultrashort dual antiplatelet therapy with DAPT or alternative monotherapy strategies. Primary outcomes measured BARC major bleeding for safety and major adverse cardiovascular events for efficacy. Results showed that aspirin, clopidogrel, and ticagrelor monotherapy had lower major bleeding odds compared with DAPT, with ORs of 0.26, 0.28, and 0.42 respectively, though confidence intervals were wide and inconclusive. No significant differences emerged in MACE, all-cause death, or stroke rates. The findings suggest that current evidence remains insufficient to definitively confirm whether antiplatelet monotherapy reduces major bleeding versus DAPT. Ticagrelor monotherapy demonstrated numerically favorable outcomes for both MACE and bleeding, yet these differences lacked statistical significance. The authors emphasize that the sparse evidence network and low certainty warrant cautious interpretation before clinical implementation.