Orbital Atherectomy No Better Than Balloon Angioplasty - Physician's Weekly www.physiciansweekly.com Nov. 11, 2024, 10:13 a.m.
For patients with severely calcified coronary lesions, routine treatment with orbital atherectomy prior to drug-eluting stent implantation does not yield greater minimal stent area or reduce the rate of target vessel failure compared with conventional balloon angioplasty, according to a study presented at the annual Transcatheter Cardiovascular Therapeutics conference, held from Oct. 27 to 30 in Washington, D.C.
Localization of Hemostasis Elements in Aspirated Coronary Thrombi at Different Stages of Evolution www.mdpi.com Nov. 4, 2024, 8:49 a.m.
Generally, we can conclude that, by the evaluation of coronary thrombi, delicate, constant structural changes are observed during their age evolution. The appearance of FXIII closely follows the structure and amount of fibrin, while the amount of α2-PI is lower and it rather shows a discrete and consistent association to fibrin. Since both FXIII and α2-PI are pivotal factors in thrombus stabilization and fibrinolysis, it seems to be beneficial to test them as therapeutic targets in coronary atherosclerosis for the prevention and treatment of STEMI. PC/APC has a high amount in all stages of coronary thrombi and the close association with the elements of NET suggests its function in histone degradation. The protective role of APC in thrombo-inflammatory processes makes it a potential therapeutic agent in acute cardiovascular complications.
Prothrombotic Rebound After Discontinuation of Direct Oral Anticoagulants Therapy: A Systematic Review www.mdpi.com Nov. 4, 2024, 8:47 a.m.
The results of 15 studies describing 16 case reports indicate a correlation between the cessation of direct oral anticoagulant therapy and the development of hypercoagulability state. The findings of this study suggest that the discontinuation of DOACs therapy may be associated with an increased risk of thrombotic incidents. Further clinical trials or meta-analyses are required to ascertain whether DOACs treatment cessation can be linked to rebound phenomena associated with thromboembolic events. This will provide the data needed to determine the incidence and risk of this phenomenon.
Paclitaxel-Coated Versus Sirolimus-Coated Eluting Balloons for Percutaneous Coronary Interventions www.mdpi.com Nov. 4, 2024, 8:44 a.m.
PTX and SRL exhibit different pharmacodynamic properties, which translate into different clinical performance sand safety profiles. The divergent effects of PTX and SRL observed in preclinical models and varying conditions underscore the complexity of drug selection in clinical settings. While PTX has demonstrated potent cytotoxicity and antirestenotic effects, concerns about its safety in certain environments persist. Conversely, SRL’s mechanism of action, particularly its inhibition of the mTOR pathway, offers an alternative approach, but raises questions about effective drug distribution in the vessel wall and permanence. So far, we have sufficient information on when to use the more potent cytotoxic effect of paclitaxel, aiming at observing a higher lumen enlargement, or the more anti-inflammatory effect of sirolimus, with both devices aiming to optimize DCB use in clinical practice.
Synthetic Flavonoid 3,7-Dihydroxy-Isoflav-3-Ene (DHIF) Reduces In-Stent Restenosis in an Atherosclerotic Watanabe Heritable Hyperlipidemic Rabbit Stent Model www.mdpi.com Oct. 28, 2024, 11:33 a.m.
Inflammation is a major component of the pathogenesis of atherosclerosis and the formation of in-stent restenosis (ISR). A novel flavonoid, DHIF, attenuates reactive oxygen species and nf-κB signaling and has potential to limit ISR via antioxidant action. While current drug eluting stents (DESs) perform well in clinical practice, new therapies to prevent ISR without dependance on cytotoxic drugs are warranted. Our objective was to test whether DHIF reduces ISR in a hyperlipidemic rabbit aorta model of ISR via attenuated inflammatory responses. WHHL rabbit aortas (n = 24) were denuded. Six weeks after injury, stents were implanted into the denuded aortas. DHIF was dissolved in carboxymethyl cellulose (CMC) and administered orally with two doses. CMC served as a control.
Angiography vs Angioplasty: Which Leads to Stenting?  www.healthcarebloggers.com Oct. 27, 2024, 7:31 p.m.
That knowledge is invaluable when it comes to heart health and the procedures doctors use in diagnosing, treating—and preventing—a host of cardiovascular issues. The two most popularly discussed procedures are angiography and Angioplasty, both of which are often named together but have entirely different purposes. Every component has a place within the broader framework of coronary artery disease management and understanding how they interact with one another is critical during stenting.
Role of Lipoprotein(a) Reduction in Cardiovascular Disease www.mdpi.com Oct. 27, 2024, 7:28 p.m.
Lp(a) is considered a major risk factor for atherosclerotic CVD, with several studies confirming an association between elevated Lp(a) levels and incident CAD in the general population. Additionally, observational data suggest that Lp(a) is associated with increased adverse events in patients with established CAD and with aortic stenosis. Imaging data suggest that the mechanism of Lp(a) and worse CV outcomes may be due to the adverse effect of high Lp(a) levels on plaque vulnerability. Promising pharmacotherapy interventions show reductions in serum Lp(a) levels, but trial data of cardiovascular risk reduction are awaited.
Medtronic’s Prevail DCB to be studied in US IDE trial cardiovascularnews.com Oct. 27, 2024, 7:23 p.m.
“As physicians treat more patients with complex lesions, it is important to have a device that helps to maintain durable patency while preserving future treatment options,” said David Kandzari (Piedmont Heart Institute and Cardiovascular Services, Atlanta, USA), co-principal investigator of the Prevail Global Study. “Drug-coated balloons provide clinicians with an anti-restenosis solution, without the need of a permanent stent. This groundbreaking trial will include the first head-to-head randomised trial of two drug coated balloons in the USA and will provide important additional evidence for this growing therapy.”
First-in-human results for dual-drug therapy DCB released cardiovascularnews.com Oct. 27, 2024, 7:23 p.m.
SirPlux Duo DCB is the only therapy designed to deliver sirolimus and paclitaxel simultaneously to inhibit cell growth at a higher potency and efficient dose, according to Advanced NanoTherapies. The novel nanoparticle drug encapsulation and delivery platform is designed to provide the two drugs with safe, reliable, and sustained long-term in-tissue bioavailability with no stent burden.
Platelets in Kawasaki disease: mediators of vascular inflammation www.nature.com Oct. 25, 2024, 12:43 p.m.
Platelets are essential for haemostasis and thrombosis; however, platelets also have multifaceted roles in regulating immune responses and contributing to the pathogenesis of inflammatory diseases Thrombocytosis is usually reported in Kawasaki disease, a systemic paediatric vasculitis, and has been associated with increased risk of developing coronary artery aneurysms Levels of monocyte–platelet aggregates (MPAs) and neutrophil–platelet aggregates (NPAs) increase during Kawasaki disease; these leukocyte–platelet aggregates (LPAs) might amplify Kawasaki disease pathogenesis through their pro-inflammatory and thrombotic functions and have been related to the development of coronary artery aneurysms in Kawasaki disease Although aspirin therapy does not reduce MPA formation, studies suggest that targeting the P-selectin–PSGL1 axis or inhibiting the P2Y12 receptor might attenuate platelet-induced monocyte activation Platelets are active participants and mediators of cardiovascular inflammation during Kawasaki disease vasculitis, not innocent bystanders. Hence, platelets might be promising therapeutic targets for Kawasaki disease vasculitis.
Dual Antiplatelet Therapy Versus Antiplatelet Monotherapy Plus Oral Anticoagulation in Patients with Acute Coronary Syndrome and Coronary Artery Ectasia link.springer.com Oct. 24, 2024, 8:06 p.m.
Expected results and conclusions: OVER-TIME is the first randomized controlled trial to assess different antithrombotic strategies in patients with CAE and acute coronary syndrome, and its results will offer preliminary data for the prevention of major cardiovascular events and bleeding events in this group of patients.
Effect of enhanced external counterpulsation on coronary microcirculation dysfunction (CMD) in patients with coronary artery disease (EECP-CMD II) bmjopen.bmj.com Oct. 24, 2024, 7:59 p.m.
Coronary microcirculation dysfunction (CMD) is prevalent in patients with coronary artery disease (CAD). Current therapies for CMD are focused on pharmacotherapy, non-pharmacological treatments such as enhanced external counterpulsation (EECP) have shown favourable results in patients with CAD. However, whether EECP can improve CMD remains unknown. This study is designed to evaluate the effectiveness of EECP on CMD in patients with CAD, and to assess the feasibility of conducting a multicentre randomised controlled trial.
Coronary Artery Aneurysm or Ectasia as a Form of Coronary Artery Remodeling: Etiology, Pathogenesis, Diagnostics, Complications, and Treatment www.mdpi.com Oct. 24, 2024, 7:58 p.m.
Coronary artery aneurysm or ectasia (CAAE) is a term that includes both coronary artery ectasia (CAE) and coronary artery aneurysm (CAA), despite distinct phenotypes and definitions. This anomaly can be found in 0.15–5.3% of coronary angiography. CAE is a diffuse dilatation of the coronary artery at least 1.5 times wider than the diameter of the normal coronary artery in a patient with a length of over 20 mm or greater than one-third of the vessel. CAE can be further subdivided into diffuse and focal dilations by the number and the length of the dilated vessels.
A Giant Left Anterior Descending Artery Aneurysm and an Updated Review on Coronary Aneurysms www.ajconline.org Oct. 24, 2024, 7:56 p.m.
Coronary aneurysm is defined as a focal dilation of the coronary artery that is at least 1.5 times the diameter of an adjacent normal segment.1 The term coronary aneurysm is often interchangeably used with coronary ectasia, which is arbitrarily defined as a more diffuse dilation of the coronary artery of the same dimensional features as an aneurysm.2 Coronary aneurysms and ectasia are observed in at least 5% of patients who underwent coronary imaging.3 Given the recent expansive use of noninvasive coronary artery imaging, especially coronary computed tomography angiography and magnetic resonance imaging angiography, the detection of coronary aneurysm has become more frequent.4
New Insights into the Pathophysiology of Coronary Artery Aneurysms www.mdpi.com Oct. 24, 2024, 7:55 p.m.
In recent years, our understanding of CAAs has advanced, but many aspects remain unclear. Nevertheless, some conclusions can be drawn: CAAs are rare but can lead to severe, potentially lethal outcomes They are commonly related to CAD and are a concern due to percutaneous coronary interventions Various mechanisms underlying CAA formation have been proposed, but precise processes remain elusive Recent research has identified genetic polymorphisms that may increase the risk of developing CAAs, especially in conditions such as Kawasaki disease Further research is needed to understand the risk factors and underlying mechanisms associated with CAAs, improving preventive and therapeutic strategies.
Supraflex Cruz RCT in High Bleeding Risk Patients Now Published in 'Circulation' www.businesswireindia.com Oct. 21, 2024, 10:01 p.m.
Clinically driven TLR rates were significantly lower with Supraflex Cruz, supporting its superior performance in reducing the need for repeat interventions. Stent thrombosis rates with Supraflex Cruz were impressively low, even in this high-risk population. This trial marks the first major study to include only HBR patients in accordance with the ARC HBR guidelines, making it a pioneering study for managing patients who are at both high bleeding and ischemic risk.
SMT Publishes Trial Results for Supraflex Cruz Stent www.dicardiology.com Oct. 21, 2024, 9:57 p.m.
The trial results demonstrate the non-inferiority of the Supraflex Cruz stent compared to the Ultimaster Tansei stent in terms of net adverse clinical events (NACE) at 12 months, with event rates of 15.4% and 17.1%, respectively (P=0.02 for noninferiority). Notably, the Supraflex Cruz stent showed a significant reduction in clinically driven target lesion revascularization (TLR) rates and very low rates of stent thrombosis, despite the fact that the enrolled patients were at substantial risk for bleeding and ischemic events.
Aspirin Hypersensitivity in Patients with Coronary Artery Disease www.mdpi.com Oct. 21, 2024, 9:54 p.m.
Aspirin hypersensitivity represents a significant clinical challenge in patients with CAD who require aspirin as part of an antithrombotic treatment. The percentage of patients reporting aspirin hypersensitivity is in fact high, although the real prevalence is low in general population, making it crucial to identify those patients who really are hypersensitive. The mechanisms underlying aspirin hypersensitivity, moreover, are not fully understood, and further studies are needed to better understand the pathophysiology beneath this condition. Despite these challenges, and depending on the clinical setting, multiple strategies are available to allow aspirin administration in patients with CAD and reporting drug hypersensitivity, and suspicion of this condition should not automatically deter the use of aspirin. The low-dose ASA challenge and desensitization are in fact safe and effective strategies to overcome this condition, although still underused in clinical practice. For those few patients who cannot (or fail to) undergo ASA desensitization, further approaches may be also considered, including the use of alternative antiplatelet agents or antithrombotic regimens.
Ablation of CCDC8 provides cardioprotection against cardiomyocyte apoptosis via TNF signaling pathway in myocardial ischemia reperfusion injury www.sciencedirect.com Oct. 20, 2024, 8:29 p.m.
This study identifies CCDC8 as a key mediator of cardiomyocyte apoptosis via the TNF signaling pathway in myocardial I/R injury. These findings suggest that targeting CCDC8 could be a potential therapeutic strategy for mitigating cardiac dysfunction in myocardial I/R injury.
Anti-inflammatory action of astaxanthin and its use in the treatment of various diseases www.sciencedirect.com Oct. 17, 2024, 10:20 a.m.
AST modulates inflammatory signaling pathways such as NF-kB and downregulates the expression of inflammatory cytokines. Although there are only a few clinical reports related to the protective effect of AST against inflammatory diseases, AST should be further characterized for its properties as a potential therapeutic strategy in combating inflammatory diseases.