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Advances in Diagnosis and Interventional Therapy of Coronary Artery Disease

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A Special Issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425) belonging to the section "Acquired Cardiovascular Disease".

Deadline for manuscript submissions: closed (15 April 2026) | Viewed by 15291

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Editors

Dr. Dario Buccheri

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Guest Editor

U.O.S. Emodinamica, U.O.C. Cardiologia, Ospedale San Antonio Abate, 91016 Erice, Italy
Interests: interventional cardiology; intravascular ultrasound (IVUS); coronary imaging; optical coherence tomography (OCT); percutaneous coronary intervention (PCI); bioresorbable scaffold (BRS); drug-coated balloon (DCB)
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Dr. Stefano Cangemi

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Guest Editor Assistant

U.O.S. Emodinamica, U.O.C. Cardiologia, Ospedale San Antonio Abate, 91016 Erice, Italy
Interests: percutaneous coronary intervention (PCI); optical coherence tomography (OCT); coronary bifurcation PCI technique; T and small protrusion (TAP) PCI; severe aortic stenosis; transcatheter aortic valve implantation (TAVI)

Special Issue Information

Dear Colleagues,

Coronary artery disease is the leading cause of death worldwide. Intracoronary imaging and coronary physiology techniques allow for a tailored diagnosis (distinguishing between fixed coronary stenosis, vasospasm, microcirculatory dysfunction, coronary dissection, and plaque rupture and erosion). Furthermore, percutaneous coronary intervention (PCI), the most widely used myocardial revascularization technique, has undergone numerous advances thanks to the introduction of intracoronary imaging, drug-coated balloons, and bioresorbable scaffolds (BRSs). Moreover, coronary bifurcations represent a challenge for the interventional cardiologist and are associated with a higher failure rate.

This topic will cover the following important aspects of coronary artery disease diagnosis and treatment:

Treatment of coronary bifurcation lesions;
Intracoronary imaging (intravascular ultrasound (IVUS); optical coherence tomography (OCT));
Coronary physiology techniques;
Drug-coated balloons;
Bioresorbable scaffold (BRS).

Research articles, review articles, and communications are invited.

Dr. Dario Buccheri
Guest Editor

Dr. Stefano Cangemi
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

percutaneous coronary intervention (PCI)
coronary bifurcation techniques
intracoronary imaging (optical coherence tomography (OCT))
intravascular ultrasound (IVUS)
bioresorbable scaffold (BRS)
drug-coated balloon (DCB)
coronary physiology technique

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Published Papers (6 papers)

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Research

Jump to: Review

24 pages, 1986 KB

Open AccessArticle

Electrocardiographic Alterations Combined with Hematological, Biochemical, and Metabolic Profiles Predict Prognosis in Kawasaki Disease

by Qirun Wang, Wenjuan Li, Jiaojiao Wan, Li Wei, Yuting Xia, Yimin Hua, Kaiyu Zhou, Di Qie, Weikai Li and Yifei Li

J. Cardiovasc. Dev. Dis. 2026, 13(6), 228; https://doi.org/10.3390/jcdd13060228 - 27 May 2026

Cited by 1 | Viewed by 423

Abstract

Objective: Kawasaki disease (KD) is characterized as an acute systemic vasculitis predominantly affecting young children, with coronary artery lesions (CALs) representing the most serious complication. Therapeutic resistance to intravenous immunoglobulin (IVIG) remains a significant clinical challenge. Consequently, numerous investigations have sought to identify predictive risk factors for IVIG resistance (IVIGR) and CAL development. Limited research has systematically evaluated the prognostic utility of electrocardiographic (ECG) parameters in KD outcome prediction. This study was therefore undertaken to assess the contributory value of ECG analysis in determining KD prognosis and therapeutic responses. Methods: This prospective cohort study enrolled 255 hospitalized children diagnosed with KD at West China Second University Hospital between July 2022 and December 2024. Initially, univariate analysis was performed to identify risk factors differentiating IVIGR from non-IVIGR patients and CAL from non-CAL patients. Statistically significant parameters were subsequently incorporated into machine learning analyses. Random forest algorithms were employed to construct predictive models based on the following: (1) complete blood count parameters, (2) biochemical and metabolic profiles, (3) electrocardiographic features, and (4) a comprehensive multimodal model integrating all parameters. These models generated feature importance scores, providing hierarchical rankings that quantified the relative contribution of each predictor to outcome prediction. Results: Univariate analysis demonstrated that alterations in hematological parameters, biochemical and metabolic profiles, and electrocardiographic features were significantly associated with therapeutic responses to IVIG and CAL development. Machine learning analysis revealed that ECG parameters individually contributed modest predictive weight for KD prognosis. However, the integration of ECG features into the comprehensive model substantially enhanced the discriminatory capacity, elevating the area under the curve (AUC) to 0.92 for CAL prediction. For IVIGR prediction, ECG-exclusive models demonstrated suboptimal performance in early disease management. Nevertheless, the multimodal integration of ECG with inflammatory and metabolic biomarkers achieved a comparable AUC of 0.92 for IVIGR prediction. Conclusions: This study establishes that ECG parameter alterations are significantly associated with CAL development and IVIGR in KD patients. Although ECG features demonstrate a limited independent predictive capacity compared to inflammatory and metabolic biomarkers, their integration into comprehensive predictive models substantially enhances discriminatory performance. These findings underscore the complementary value of electrocardiographic assessment in multimodal risk stratification strategies for KD management, supporting the clinical utility of ECG analysis as an adjunctive prognostic tool when combined with conventional laboratory parameters. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Interventional Therapy of Coronary Artery Disease)

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12 pages, 2279 KB

Open AccessArticle

Diagnostic Performance of Carotid Contrast-Enhanced Ultrasound for Identifying Functionally Significant Coronary Artery Stenosis Assessed by Quantitative Flow Ratio: A Preliminary Prospective Study

by Yuehao Song, Jili Long and Hao Wang

J. Cardiovasc. Dev. Dis. 2026, 13(5), 202; https://doi.org/10.3390/jcdd13050202 - 9 May 2026

Viewed by 470

Abstract

Background: Carotid contrast-enhanced ultrasound (CEUS) provides a noninvasive means of assessing plaque vulnerability and may reflect the systemic burden of atherosclerosis. This study aimed to evaluate the diagnostic performance of carotid CEUS characteristics for identifying functionally significant coronary artery stenosis (CAS) defined by quantitative flow ratio (QFR). Methods: In this preliminary prospective study, 46 patients with suspected stable coronary artery disease who underwent carotid CEUS and coronary angiography with QFR assessment between September 2022 and November 2023 were enrolled. Patients were categorized into a QFR ≥ 0.80 group (n = 18) and a QFR < 0.80 group (n = 28). Carotid plaque burden, morphology, and CEUS-derived quantitative parameters were compared between groups. Univariate and multivariable logistic regression analyses were performed to identify independent factors associated with QFR < 0.80, and receiver operating characteristic (ROC) analysis was used to assess discriminatory performance. Results: Compared with patients with QFR ≥ 0.80, those with QFR < 0.80 had significantly higher mean intima-media thickness (IMT), larger plaque area, higher plaque-to-lumen enhancement ratios (Pmax/Cmax and Pmean/Cmean), and more vulnerable plaque features, including irregular margins and thin fibrous caps. In multivariable analysis, Pmax/Cmax (adjusted OR: 14.394, 95% CI: 2.718–76.220; p = 0.002) and mean IMT (adjusted OR: 7.740, 95% CI: 2.040–29.363; p = 0.003) remained independently associated with QFR < 0.80. ROC analysis showed that the combined model incorporating Pmax/Cmax and mean IMT achieved the best discrimination for QFR < 0.80 (AUC: 0.931, 95% CI: 0.845–0.989), with 78.6% sensitivity and 94.4% specificity. Conclusions: Carotid CEUS-derived plaque enhancement characteristics, particularly Pmax/Cmax, together with mean IMT, were independently associated with functionally significant CAS. These findings suggest that carotid CEUS may provide complementary, noninvasive information for vascular risk stratification, but it should not be considered a substitute for coronary angiography-based physiological assessment. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Interventional Therapy of Coronary Artery Disease)

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12 pages, 380 KB

Open AccessArticle

TAP (T and Small Protrusion) and Culotte Stenting Techniques Versus a Reverse Crush in Case of Bailout of Provisional Stenting

by Stefano Cangemi, Dario Buccheri, Vittorio Virga, Massimo Benedetto, Federico Giannino, Francesco Stabile, Federico Inglese, Daniele Vinci and Giovanna Geraci

J. Cardiovasc. Dev. Dis. 2026, 13(1), 24; https://doi.org/10.3390/jcdd13010024 - 1 Jan 2026

Cited by 1 | Viewed by 1570

Abstract

Coronary bifurcation lesions are considered among the most challenging lesions to treat with percutaneous coronary intervention (PCI), particularly in cases of extensively diseased branches. In the event of failure of a provisional (one-stent) approach, many two-stent bifurcation techniques can be performed for the treatment of coronary bifurcation lesions. Two techniques (culotte and T/TAP) are suggested by the European Bifurcation Club, but a reverse crush is performed by some operators. This study aims to retrospectively compare these two different approaches (EBC-recommended techniques vs. reverse crush). Full article

(This article belongs to the Special Issue Advances in Diagnosis and Interventional Therapy of Coronary Artery Disease)

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Review

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23 pages, 5643 KB

Open AccessReview

Coronary Bifurcation PCI—Part II: Advanced Considerations

by Rongras Damrongwatanasuk, Sara Pollanen, Ju Young Bae, Jason Wen, Michael G. Nanna, Abdulla A. Damluji, Mamas A Mamas, Elias B. Hanna and Jiun-Ruey Hu

J. Cardiovasc. Dev. Dis. 2025, 12(11), 439; https://doi.org/10.3390/jcdd12110439 - 6 Nov 2025

Cited by 2 | Viewed by 3787

Abstract

Performance of percutaneous coronary intervention (PCI) for bifurcation lesions involves complex decision-making informed by anatomic, hemodynamic, technical, and clinical factors. Building on the procedural foundations discussed in the companion paper in this two-part series, this second paper focuses on advanced considerations in bifurcation PCI. Factors associated with side branch (SB) compromise are discussed, including bifurcation angle and distribution of plaque location, along with strategies for SB protection and SB rewiring. Outcomes of landmark randomized controlled trials of provisional versus two-stent approaches, as well as specific two-stent techniques, are summarized. Based on these factors, an algorithmic approach for bifurcation PCI is outlined. Lastly, the use of drug-coated balloons, dedicated bifurcation stents, bioresorbable vascular scaffolds, bioadaptor stents, physiologic testing, intravascular imaging, and other emerging innovations are explored to provide a perspective on the future of bifurcation PCI. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Interventional Therapy of Coronary Artery Disease)

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27 pages, 3387 KB

Open AccessReview

Coronary Bifurcation PCI—Part I: Fundamentals

by Sara Pollanen, Rongras Damrongwatanasuk, Ju Young Bae, Jason Wen, Michael G. Nanna, Abdulla Al-Damluji, Mamas A. Mamas, Elias B. Hanna and Jiun-Ruey Hu

J. Cardiovasc. Dev. Dis. 2025, 12(10), 410; https://doi.org/10.3390/jcdd12100410 - 16 Oct 2025

Cited by 3 | Viewed by 4027

Abstract

Percutaneous coronary intervention (PCI) of bifurcation lesions remain one of the most technically challenging areas in interventional cardiology. Careful planning and execution are needed to preserve main vessel and side branch patency, with evolving evidence guiding the choice between provisional and two-stent strategies, and between individual techniques. This narrative review, which represents the first installment of a two-part series, synthesizes current knowledge on bifurcation PCI, detailing the anatomical classifications, lesion assessment tools, procedural planning, and execution of techniques including T and Protrusion (TAP), double-kissing (DK) crush, mini-crush, culotte, V-stent, and emerging modifications. We contextualize the choice of strategy within lesion complexity, procedural goals, and patient-specific considerations. This review is intended as a visual, practical, technique-focused reference for interventionalists and interventional trainees involved in the management of bifurcation lesions. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Interventional Therapy of Coronary Artery Disease)

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20 pages, 631 KB

Open AccessReview

Trading off Iodine and Radiation Dose in Coronary Computed Tomography

by Guillaume Fahrni, Thomas Saliba, Damien Racine, Marianna Gulizia, Georgios Tzimas, Chiara Pozzessere and David C. Rotzinger

J. Cardiovasc. Dev. Dis. 2025, 12(5), 195; https://doi.org/10.3390/jcdd12050195 - 20 May 2025

Cited by 5 | Viewed by 4183

Abstract

Coronary CT angiography (CCTA) has seen steady progress since its inception, becoming a key player in the non-invasive assessment of coronary artery disease (CAD). Advancements in CT technology, including iterative and deep-learning-based reconstruction, wide-area detectors, and dual-source systems, have helped mitigate early limitations, such as high radiation doses, motion artifacts, high iodine load, and non-diagnostic image quality. However, the adjustments between ionizing radiation and iodinated contrast material (CM) volumes remain a critical concern, especially due to the increasing use of CCTA in various indications. This review explores the balance between radiation and CM volumes, emphasizing patient-specific protocol optimization to improve diagnostic accuracy while minimizing risks. Radiation dose reduction strategies, such as low tube voltage protocols, prospective ECG-gating, and modern reconstruction algorithms, have significantly decreased radiation exposure, with some studies achieving sub-millisievert doses. Similarly, CM volume optimization, including adjustments in strategies for calculating CM volume, iodine concentration, and flow protocols, plays a role in managing risks such as contrast-associated acute kidney injury, particularly in patients with renal impairment. Emerging technologies, such as photon-counting CT and deep-learning reconstruction, promise further improvements in dose efficiency and image quality. This review summarizes current evidence, highlights the benefits and limitations of dose control approaches, and provides practical recommendations for practitioners. By tailoring protocols to patient characteristics, such as age, renal function, and body habitus, clinicians can achieve an optimal trade-off between diagnostic accuracy and patient safety, ensuring optimal operation of CT systems in clinical practice. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Interventional Therapy of Coronary Artery Disease)

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