Benefits and Challenges of Drug-Coated Balloons in Peripheral Artery Disease: From Molecular Mechanisms to Clinical Practice.

Multiple clinical trials have reported favorable outcomes after drug-coated balloon therapy for peripheral artery disease in above-the-knee and below-the-knee lesions and in both de novo and in-stent restenosis. However, there are still insufficient data to identify and tackle the risk factors associated with a higher risk of restenosis, which is the primary concern for patients who are treated with an endovascular approach. A modern armamentarium, which includes improved lesion preparation techniques such as plaque modification balloons, mechanical atherectomy, intravascular lithotripsy, and imaging, is crucial for obtaining better long-term clinical outcomes.

A Review Paper on Optical Coherence Tomography Evaluation of Coronary Calcification Pattern: Is It Relevant Today?

The process of coronary calcification represents one of the numerous pathophysiological mechanisms involved in the atherosclerosis continuum. Optical coherence tomography (OCT) represents an ideal imaging modality to assess plaque components, especially calcium. Different calcification patterns have been contemporarily described in both early stages and advanced atherosclerosis.

Ultrasonography for the optimal selection of patients suitable for single session arteriography and endovascular revascularization in severe peripheral artery disease.

Peripheral artery disease (PAD) represents a high burden on the healthcare and social assistance systems. Revascularization reduces symptoms, amputation rate and increases the chances of social reintegration. Our aim was to evaluate the benefits of vascular duplex ultrasonography (DUS) for identifying patients suitable for direct percutaneous transluminal angioplasty (PTA) without the need for a prior angiography.

Correlation between Ultrasound Peak Systolic Velocity and Angiography for Grading Internal Carotid Artery Stenosis.

(1) Background: The success of carotid revascularization depends on the accurate grading of carotid stenoses. Therefore, it is important for every vascular center to establish its protocols for the same. In this study, we aimed to determine the peak systolic velocity (PSV) thresholds that can predict moderate and severe internal carotid artery (ICA) stenoses.

Outcomes after stenting of renal artery stenosis in patients with high-risk clinical features.

Background: In patients with renal artery stenosis, revascularization was seen as a mean to improve outcomes, but large studies failed to show significant benefit in general population. However, data on benefits of renal artery stenting in patients with high-risk features, such as rapidly declining renal function and cardiac destabilization syndromes, are limited, as they were excluded from trials. In this descriptive study, we aimed to evaluate short- and long-term outcomes in high-risk patients with renal artery stenosis, treated by angioplasty and stenting.

Superficial Calcified Plates Associated to Plaque Erosions in Acute Coronary Syndromes.

This study investigates the clinical relevance and therapeutic implications of the OCT identification of intracoronary superficial calcified plates (SCPs) in acute coronary syndromes (ACSs). In 70 consecutive ACS patients (pts), we studied the three main underlying ACS mechanisms: plaque erosion (PE), plaque rupture and eruptive calcified nodule (CN). The PE lesions, occurring on an intact fibrous cap overlying a heterogeneous substrate, were identified in 12/70 pts (17.

Distinctive Morphological Patterns of Complicated Coronary Plaques in Acute Coronary Syndromes: Insights from an Optical Coherence Tomography Study.

Optical coherence tomography (OCT) is an ideal imaging technique for assessing culprit coronary plaque anatomy. We investigated the morphological features and mechanisms leading to plaque complication in a single-center observational retrospective study on 70 consecutive patients with an established diagnosis of acute coronary syndrome (ACS) who underwent OCT imaging after coronary angiography. Three prominent morphological entities were identified.

Interventional Management of a Rare Combination of Nutcracker and Wilkie Syndromes.

Nutcracker and Wilkie syndromes are rare mesoaortic compression entities, and their association is even less common. Data on interventional treatment of these pathologies are still scarce, but results from limited case series are encouraging. We report the case of a previously healthy 45-year-old woman diagnosed with nutcracker and Wilkie syndromes who presented with macroscopic hematuria, intermittent pain in the left flank and hypogastric region, postprandial nausea, and unexplained significant weight loss.

Optical Coherence Tomography-OCT for Characterization of Non-Atherosclerotic Coronary Lesions in Acute Coronary Syndromes.

Cardiovascular diseases are the main cause of death worldwide, with coronary artery disease being the predominant underlying etiology. The most prevalent coronary lesions are represented by the atherosclerotic plaques, in more than 85% of cases, but there are several other non-atherosclerotic lesions such as spontaneous coronary artery dissection and/or hematoma and spontaneous recanalization of coronary thrombus, which are less common, approximately 5% of cases, but with similar clinical manifestations as well as complications. There are insufficient data regarding the pathological mechanism, true prevalence and optimal treatment of these kind of coronary lesions.

Intravascular ultrasound insights into the unstable features of the coronary atherosclerotic plaques: A systematic review and meta-analysis.

Background: There is a lack of a comprehensive picture of plaque geometry and composition of unstable atherosclerotic lesions as observed with intravascular ultrasound techniques. We analysed through a systematic review with meta-analysis 39 characteristics of atherosclerotic plaques in three scenarios involving culprit and non-culprit lesions from acute coronary syndromes vs stable angina pectoris patients, and culprit vs non-culprit lesions in acute coronary syndromes patients.

Methods: A systematic search of PubMed and EMBASE, from inception to April 2020 was performed.

Optical Coherence Tomography for Identification, Characterization and Optimal Treatment of Spontaneous Recanalization of Coronary Thrombus.

Background/aim: Spontaneous recanalization of coronary thrombus (SRCT) is a rare in vivo appearance, with a nonspecific angiographic aspect. The aim of this study was to investigate the importance of optical coherence tomography (OCT) use for SRCT identification, characterization of pathogenic mechanisms and optimal treatment.

Patients And Methods: We retrospectively analyzed all patients with angiographic suspicion of SRCT who underwent coronary angiography for suspected coronary artery disease and afterward investigated by OCT imaging.

New Predictors of Early and Late Outcomes after Primary Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction and Unprotected Left Main Coronary Artery Culprit Lesion.

Objectives: The study evaluated the correlation between baseline SYNTAX Score, Residual SYNTAX Score, and SYNTAX Revascularization Index and long-term outcomes in ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI) on an unprotected left main coronary artery lesion (UPLMCA).

Background: Previous studies on primary PCI in UPLMCA have identified cardiogenic shock, TIMI 0/1 flow, and cardiac arrest, as prognostic factors of an unfavourable outcome, but the complexity of coronary artery disease and the extent of revascularization have not been thoroughly investigated in these high-risk patients.

Methods: 30-day, 1-year, and long-term outcomes were analyzed in a cohort of retrospectively selected, 81 consecutive patients with STEMI, and primary PCI on UPLMCA.

Acute Limb Ischemia: An Update on Diagnosis and Management.

This review presents an update on the diagnosis and management of acute limb ischemia (ALI), a severe condition associated with high mortality and amputation rates. A comprehensive spectrum of ALI etiology is presented, with highlights on embolism and in situ thrombosis. The steps for emergency diagnosis are described, emphasizing the role of clinical data and imaging, mainly duplex ultrasound, CT angiography and digital substraction angiography.

Renal Failure Impact on the Outcomes of ST-Segment Elevation Myocardial Infarction Patients Due to a Left Main Coronary Culprit Lesion Treated Using a Primary Percutaneous Coronary Intervention.

Background: Patients with ST-segment elevation myocardial infarction (STEMI) and primary percutaneous coronary intervention (PPCI) on a left main culprit lesion have very high mortality rates. The interaction of chronic kidney disease (CKD) with such a catastrophic acute event on the background of their highly complex atherosclerotic lesions is not well established. Therefore, we sought to evaluate in these patients the influence of the estimated glomerular filtration rate (eGFR) on short- and long-term mortality.

Real-Life Benefit of OCT Imaging for Optimizing PCI Indications, Strategy, and Results.

Background: The aim of this study was to evaluate the benefit of standard practice Optical Coherence Tomography (OCT) imaging, as a complement to coronary angiography (CA), for optimizing the indications, strategy, and results of percutaneous coronary interventions (PCI).

Methods: We retrospectively analyzed 182 patients with OCT imaging in a single tertiary center.

Results: OCT use had a low prevalence (3.

In vivo imaging of complicated atherosclerotic plaque - role of optical coherence tomography (OCT).

Cardiovascular diseases are the main cause of death worldwide, with coronary artery disease (CAD) being the predominant underlying etiology. Coronary angiography (CA) is the current invasive method used for CAD diagnosis, as well as for defining the coronary interventional treatment strategy. However, CA offers sometimes-poor accuracy in estimating atherosclerotic plaque volume, morphology and degree of stenosis severity.

Epidemiology of peripheral artery disease in Europe: VAS Educational Paper.

This paper reviews the current epidemiological data on peripheral artery disease (PAD) in Europe. Cardiovascular disease (CVD) burden is presented and PAD prevalence is discussed, as compared to coronary (CAD) and cerebrovascular (CeVD) diseases, in European Union (EU) countries and European continent countries. The article reviews PAD clinical manifestations, PAD diagnosis, risk factors for PAD incidence and progression, PAD prognosis and financial implications.

Antithrombotic treatment in peripheral artery disease.

This review treats antithrombotic use for peripheral arterial disease (PAD). In asymptomatic patients, there are no scientific data to support single antiplatelet therapy (SAPT) for primary prophylaxis. In symptomatic PAD, SAPT with aspirin or clopidogrel is indicated.

Takotsubo Cardiomyopathy presenting as ST-elevation myocardial infarction: wide triggering spectrum and specific echocardiographical pattern in a consecutive case series report.

We report a series of six consecutive cases of Takotsubo Cardiomyopathy (TCM) presenting as ST-elevation acute myocardial infarction and consequently addressed to the emergency coronary angiography, inside a time-frame of one year (2015). This series underlines the wide possible triggering spectrum and clinical severity of TCM and recognizes echocardiography as an essential imaging technique in the diagnosis due to its widespread availability and feasibility in the acute care setting.

Development of a methodology for structured reporting of information in echocardiography.

Unlabelled: In order to conduct research relying on ultrasound images, it is necessary to access a large number of relevant cases represented by images and their interpretation. DICOM standard defines the structured reporting information object. Templates are tree-like structures which offer structural guidance in report construction.