Percutaneous Coronary Intervention (PCI): Current Challenges and Future Perspectives

Dear Colleagues,

After the initial introduction of the first coronary intervention by Dr. Grunzig, percutaneous coronary intervention (PCI) has been one of the most commonly performed procedures with the greatest benefit occurring in patients with acute coronary syndrome. With the increasing clinical knowledge and complexity of coronary interventions, it is important to have periodic updates on clinical indications and technical advances in PCI, which is the goal of this Special Issue.

As the Guest Editor, I would like to invite you to contribute to our Special Issue, entitled “Percutaneous Coronary Intervention (PCI): Current Challenges and Future Perspectives”. We appreciate your contribution.

Dr. M. Reza Movahed
Guest Editor

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• coronary revascularization
• percutaneous coronary intervention
• PCI
• revascularization
• stenting
• balloon angioplasty

• Uncaging of coronary arteries: a philosophy revisited to optimize clinical outcomes of coronary interventions
• Abstract: Despite the continuing evolution of stent technologies and the increased performances of the currently available platforms, literature has consistently reported a continuous risk of very late adverse events after percutaneous coronary intervention (PCI), irrespectively of stent types and designs, with a major cardiac adverse events (MACE) rate of 2-3% per year, after 12 months from index revascularization. Such outcomes, together with the recent results of large randomized clinical trials, has shifted the focus to  a more patient- and vessel-tailored approach in the new age of optimal percutaneous revascularization. In light of this, the interventional community has been focusing, on one hand, on further improvement of plaque modification techniques and device optimization, in particular with the assistance of intravascular imaging (IVI) and invasive physiology and, on the other hand, on the development of new technologies that could potentially improve the long-term efficacy of coronary interventions. The persistent caging of coronary artery by means of permanent metal stents has been proposed as a relevant mechanism of longer-term adverse events secondary to the impairment of positive remodelling, abnormal vessel motility, abnormal shear-stress patterns and altered biochemical homeostatic pathways. Recently, novel device technologies that specifically target “uncaging” of the coronary arteries have been introduced into clinical practice with the hope of further improvement of vessel- and patient-oriented outcomes at long term. The aim of our manuscript is to evaluate the current available technologies that free coronary vessels from a restrictive metal cage, specifically bioresorbable vascular scaffolds (BRS), drug coated balloons (DCB) and the DynamX™ Drug-Eluting Bioadaptor. We propose to analyse the data currently available in literature and consider future perspectives.