Electrospun aligned CS/SF scaffolds loading heparin are successfully fabricated. Scaffolds exhibit oriented fibers, good mechanical properties, hydrophilicity, and controllable degradation. The scaffolds synergistically improve anticoagulant, antibacterial and endothelialization effect. Scaffolds represents a promising candidate for next-generation vascular grafts and interventional devices. The study provides experimental and theoretical basis for artificial cardiovascular implants.

Stentless PCI with DCB was frequently used in patients undergoing PCI for bypass graft lesions in Japan and was not associated with a significant difference in 1-year clinical outcomes compared with contemporary DES-based PCI strategies.

Patients preparing for coronary angioplasty are rarely handed a choice between stent types in any meaningful sense today. Yet, many still arrive at consultation having read, somewhere online, that one kind of stent is inherently superior to another. The honest answer is more interesting than a simple hierarchy, and understanding it equips a patient to ask better questions and to understand, with genuine clarity, what is actually being placed inside their artery.

In-stent restenosis of coronary arteries is the major reason for the recurrence of occlusion after successful percutaneous coronary intervention (PCI) and occurs in 20–50% of patients.1 The development of in-stent restenosis depends on complex cellular interactions within the vessel wall involving endothelial cells (ECs), smooth muscle cells (SMCs), fibroblasts, lymphocytes, and macrophages.2 Vessel injury from balloon angioplasty and stenting cause the release of soluble mediators that initiate cellular activation, migration, proliferation, extracellular matrix production and secretion via autocrine or paracrine mechanisms.

Despite significant advances in stent technology, long-term complications—such as restenosis and stent thrombosis—remain relatively common and clinically impactful due to their association with recurrent myocardial infarction and adverse outcomes. Among the causes of stent failure, neoatherosclerosis has gained recognition as a key pathological mechanism, driven by impaired vascular healing, chronic inflammation, platelet activation, and immune responses following coronary stenting. Advances in diagnostic accuracy, particularly intracoronary imaging, have provided new insights into its development. In response, emerging strategies—including refined pharmacotherapy, targeted intraprocedural interventions, novel stent designs, and alternative drug-delivery systems—are being explored. This review presents recent preclinical, diagnostic, and clinical advances in understanding and addressing neoatherosclerosis and discusses current and emerging therapeutic approaches (Graphical Abstract).

Conventional cardiology has long treated coronary artery disease like a plumbing problem, using stents or bypass surgery to physically open blocked arteries. However, landmark research is fundamentally challenging this approach. The COURAGE trial, which followed over 2,000 patients with stable heart disease, and the ISCHEMIA trial, involving 5,179 patients with moderate-to-severe ischemia, revealed surprising findings: patients receiving immediate stent placement plus medical therapy showed no significant survival advantage over those treated with medication and lifestyle changes alone, with benefits sustained over up to 15 years of follow-up. These massive studies suggest the human body functions more like a self-healing biological system than mechanical plumbing. This paradigm shift has profound implications for cardiac care, suggesting that for many patients with stable coronary artery disease, aggressive pharmaceutical interventions and lifestyle modifications—potentially including dietary changes—may be as effective as invasive procedures, potentially sparing millions from unnecessary surgery while reducing healthcare costs and associated risks.

The LIBREXIA ACS trial evaluated milvexian, a selective factor XIa inhibitor, as a potential treatment to prevent harmful blood clots while preserving normal clotting in acute coronary syndrome patients. Researchers randomized 14,194 participants to receive oral milvexian 25 mg twice daily or placebo alongside standard antiplatelet therapy. Following a median of ten months, the trial was discontinued after a preplanned interim analysis indicated futility. The primary efficacy endpoint of cardiovascular death, myocardial infarction, or ischaemic stroke showed no difference between groups at 5.4% for milvexian versus 5.1% for placebo. Importantly, the safety profile was reassuring, with no increased intracranial or fatal bleeding observed in either group. These findings have implications for ongoing LIBREXIA trials in atrial fibrillation and stroke prevention, which involve different patient populations and disease contexts. While milvexian demonstrated no efficacy advantage in ACS, the favorable bleeding safety profile warrants continued investigation in other clinical settings.

This WikiDoc resource page provides a comprehensive medical information portal addressing percutaneous coronary intervention (PCI) management in patients experiencing in-stent restenosis, a condition where previously placed coronary stents become re-narrowed. The page aggregates medical literature, clinical evidence, and professional resources from major journals including the New England Journal of Medicine, Lancet, and BMJ, alongside multimedia educational content such as presentations, images, and videos. It directs users to evidence-based medicine resources via the Cochrane Collaboration and clinical trial registries at ClinicalTrials.gov, while incorporating regulatory guidance from the FDA and clinical recommendations from NICE and NHS PRODIGY. The platform offers multifaceted support for healthcare providers through diagnostic study information, treatment protocols, continuing medical education, and risk assessment tools. Additionally, it provides patient-centered resources including educational handouts and community discussion forums. This consolidated approach to in-stent restenosis management reflects the clinical significance of this common interventional cardiology challenge and supports informed decision-making across the medical community.

This ESC Congress 2026 presentation, delivered by Dr. Ryo Bando from Tokushima University Hospital, presents a propensity-matched three-year outcome analysis comparing drug-coated balloon (DCB)–only strategies with drug-eluting stents (DES) in large-vessel complex percutaneous coronary intervention (PCI). The study evaluates whether DCB-only approaches provide comparable efficacy and safety to traditional DES implantation in complex coronary lesions. This comparison is clinically significant as it addresses the potential benefits of DCB therapy in reducing stent-related complications while maintaining therapeutic efficacy in challenging anatomies. The research contributes to ongoing discussions about optimal revascularization strategies in complex PCI, particularly relevant as interventional cardiologists seek to minimize long-term stent-related adverse events. Understanding the three-year outcomes of these competing approaches helps inform treatment selection for high-complexity cases, potentially expanding the therapeutic armamentarium for interventional practitioners managing difficult coronary anatomy and reducing patient morbidity associated with permanent metallic implants.

The A-CLOSE trial, presented at ESC Congress 2026 and published simultaneously in NEJM, was a prospective randomized non-inferiority study evaluating antiplatelet strategies in high-ischaemic-risk patients one year after percutaneous coronary intervention with drug-eluting stents. Enrolling 3,203 patients across 19 centers between August 2019 and August 2023, the trial compared clopidogrel monotherapy against extended dual antiplatelet therapy (DAPT with aspirin and clopidogrel) for 24 months. Patients qualified for inclusion based on clinical high-risk features including acute coronary syndrome, diabetes, chronic kidney disease, or heart failure, alongside angiographic risk factors such as left main stem disease, bifurcation lesions, chronic total occlusions, and multivessel disease. The trial addresses an ongoing clinical debate regarding optimal antiplatelet strategies post-DAPT, as previous trials suggest clopidogrel monotherapy may reduce ischaemic events without increasing bleeding risk. This research matters because it provides evidence to guide treatment decisions balancing ischaemic protection against hemorrhagic complications in vulnerable patient populations following coronary intervention.

A drug-coated balloon (DCB) strategy has become an established option for de novo coronary lesions, offering the advantage of avoiding permanent implants. However, very long-term vascular changes after stentless percutaneous coronary intervention (PCI) remain insufficiently characterized. We report a case of chronic total occlusion that developed eight years after DCB angioplasty for a diffuse long right coronary artery lesion in a patient with unstable angina.

More than two decades of clinical research have firmly established the role of drug-eluting stents (DES) in contemporary interventional cardiology. Randomized trials and long-term follow-up studies support the safety and efficacy of contemporary DES, particularly in reducing restenosis and repeat revascularization while maintaining a favorable safety profile. Continuous advancements in stent engineering, biomaterials, and drug-delivery technologies have driven the evolution of second -generation drug eluting stents. While clinicians and patients often seek the best drug eluting stent, treatment decisions should be guided by robust clinical evidence, individual patient characteristics, lesion complexity, and current evidence-based clinical practice guidelines.

Angiography-derived FFR-guided revascularization was noninferior to pressure wire–based FFR-guided strategy for determining revascularization in patients with stable coronary artery disease. This finding suggests that angiography-derived FFR may serve as a practical, wire-free alternative for physiologic guidance of coronary revascularization, warranting confirmation in larger outcome-driven trials. (PROVISION; UMIN000049230)

Percutaneous coronary intervention with stent placement, or PCI, is a minimally invasive catheter-based procedure that restores blood flow to narrowed or blocked coronary arteries without open-heart surgery. One of the most commonly performed cardiac procedures in the United States, PCI typically requires only a small puncture in the wrist or groin, enabling same-day or overnight discharge. The procedure addresses cholesterol plaque buildup that restricts blood flow, causing chest pressure, shortness of breath, and fatigue. During PCI, a thin catheter advances to the blockage site where a balloon inflates to compress plaque and widen the artery. A metal mesh stent is then deployed to maintain arterial patency. PCI is indicated for acute heart attacks, unstable or stable angina limiting daily activities, abnormal stress tests, and confirmed significant blockages. However, not all narrowings require intervention; pressure-wire measurements and intravascular imaging during catheterization help determine which lesions warrant treatment versus medication management. Performed in a cardiac catheterization laboratory under conscious sedation, the procedure is typically painless and offers substantial advantages over traditional open-heart surgery.

This systematic review and meta-analysis, following PRISMA 2020 guidelines, evaluated drug-coated balloons (DCBs) against drug-eluting stents (DES) for acute myocardial infarction treatment. Analyzing 34 studies encompassing 19,642 participants and 2,313 major adverse cardiovascular events, researchers found that DCBs—which deliver antiproliferative therapy via paclitaxel or sirolimus without permanent scaffold implantation—demonstrated a 15% relative reduction in MACE compared with DES. Late stent thrombosis occurred significantly less frequently with DCBs. Rates of myocardial infarction, target lesion revascularization, and cardiovascular mortality remained comparable between groups. While paclitaxel-coated balloons dominated the evidence base, sirolimus-coated DCB data, though directionally consistent, remained limited. The findings suggest DCBs offer a viable stent-free percutaneous coronary intervention strategy with comparable safety and efficacy to DES while reducing late thrombosis risk, potentially addressing long-term DES complications such as extended dual antiplatelet therapy requirements. However, larger randomized trials, particularly for sirolimus-coated variants, are needed to confirm these results.

The A-CLOSE trial, presented at ESC Congress 2026 and published in the New England Journal of Medicine, evaluated optimal antiplatelet therapy duration in high-risk patients one year after drug-eluting stent implantation. Conducted across 19 South Korean centers, the randomized trial enrolled 3,203 patients (mean age 63 years) with high ischemic risk features including acute coronary syndrome, diabetes, chronic kidney disease, or complex coronary lesions. Participants received either clopidogrel monotherapy or extended dual antiplatelet therapy (DAPT) through 24 months. The study found that while monotherapy reduced bleeding complications, extended DAPT provided superior cardiovascular event protection in this high-risk population. These findings address a critical clinical gap, as the optimal DAPT duration beyond the standard 6-12 months remains uncertain for patients at elevated ischemic risk. The results help clinicians balance ischemic protection against bleeding risk when determining post-stent antiplatelet strategies, informing treatment decisions for complex coronary disease management.

The intensified strategy failed to improve ischemic outcomes. At 6 weeks, the primary efficacy endpoint—a hierarchical composite including death, stent thrombosis, myocardial infarction (MI), ischemic stroke, systemic thromboembolism and urgent revascularization—showed a win-loss ratio of 1.19 (95% CI 0.61–2.32; P=0.61), with no significant reduction in individual ischemic endpoints.  More importantly, potent P2Y12 inhibition produced a consistent excess of bleeding. The primary hierarchical safety endpoint favored standard therapy numerically (win-loss ratio 0.66, 95% CI 0.39–1.11), and conventional analyses demonstrated increased BARC bleeding with ticagrelor/prasugrel. The bleeding signal was sufficiently concerning that the independent DSMB recommended premature termination of the trial. Interestingly, BARC ≥2 bleeding was itself associated with a subsequent increase in ischemic complications (HR 2.18, 95% CI 1.16–4.11).

Platelets contract forcefully after their activation, contributing to the strength and stability of platelet aggregates and fibrin clots during blood coagulation. Viscoelastic approaches can be used to assess platelet-induced clot strengthening, but they require thrombin and fibrin generation and are unable to measure platelet forces directly. Here, we report a rapid, microfluidic approach for measuring the contractile force of platelet aggregates for the detection of platelet dysfunction. We find that platelet forces are significantly reduced when blood samples are treated with inhibitors of myosin, GPIb-IX-V, integrin αIIbβ3, P2Y12, or thromboxane generation. Clinically, we find that platelet forces are measurably lower in cardiology patients taking aspirin. We also find that measuring platelet forces can identify Emergency Department trauma patients who subsequently require blood transfusions. Together, these findings indicate that microfluidic quantification of platelet forces may be a rapid and useful approach for monitoring both antiplatelet therapy and traumatic bleeding risk.

The role of platelets in hemostasis and thrombosis is dependent on a complex balance of activatory and inhibitory signaling pathways. Inhibitory signals released from the healthy vasculature suppress platelet activation in the absence of platelet receptor agonists. Activatory signals present at a site of injury initiate platelet activation and thrombus formation; subsequently, endogenous negative signaling regulators dampen activatory signals to control thrombus growth. Understanding the complex interplay between activatory and inhibitory signaling networks is an emerging challenge in the study of platelet biology, and necessitates a systematic approach to utilize experimental data effectively. In this review, we will explore the key points of platelet regulation and signaling that maintain platelets in a resting state, mediate activation to elicit thrombus formation, or provide negative feedback. Platelet signaling will be described in terms of key signaling molecules that are common to the pathways activated by platelet agonists and can be described as regulatory nodes for both positive and negative regulators.

The outcomes of patients with acute coronary syndrome events have been improving as percutaneous coronary intervention and its accompanying medical therapy have evolved. Newer, more potent antiplatelet agents are preferred over clopidogrel when possible. Two earlier studies showed no advantage of extended dual antiplatelet therapy over the standard 12-month duration, but the recent Dual Antiplatelet Therapy trial did. The protection against ischemia afforded by dual anti-platelet therapy comes at the price of increased risk of bleeding.