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Advanced Techniques for the Treatment of Complex Coronary Artery Disease
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Advanced Techniques for the Treatment of Complex Coronary Artery Disease

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (25 August 2024) | Viewed by 12266

Special Issue Editor

Dr. Simone Calcagno

E-Mail Website
Guest Editor
Department of Cardiology, San Paolo Hospital, Civitavecchia, Rome, Italy
Interests: coronary artery disease; antiplatelet therapy; intracoronary imaging; acute myocardial infarction; refractory angina; multivessel disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Recently, there has been rapid progress in the device and strategies for the treatment of coronary artery disease. The complex coronary artery diseases represent the challenging in the interventional cardiologists.  Advanced techniques have changed our way of thinking about indications for coronary revascularization. In addition, the large sharing of operator experiences with several studies and international conferences, growing the operator skills advancing the limits of successful percutaneous procedures. These have also reduced the failure of percutaneous revascularization procedures, resulting in improved patient outcomes. Not least, the important knowledge about pharmacotherapy pathways in patients with coronary artery disease helped to solidify these results in short and long terms outcomes. In light of this evidences born the importance to share the investigation results on the treatment of complex coronary artery disease scenario to improve the revascularization and clinical outcomes. It is my pleasure to invite you to contribute to this Special Issue on the “Advanced Techniques for the Treatment of Complex Coronary Artery Disease: 2nd Edition”, following the previous collection of six papers (https://www.mdpi.com/journal/jcm/special_issues/610J5CLEP3).

The aim is to present original research clinical studies as well as state-of-the-art reviews focused on complex coronary artery disease treatment.

Dr. Simone Calcagno
Guest Editor

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 100 words) can be sent to the Editorial Office for announcement on this website.

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-blind 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 Clinical Medicine is an international peer-reviewed open access semimonthly 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 2600 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

  • coronary calcified lesion
  • IVUS
  • OCT
  • intravascular lithotripsy
  • bifurcation coronary lesions
  • left main
  • chronic total occlusions
  • multivessel disease
  • STEMI
  • NSTEMI

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Published Papers (6 papers)

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Research

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10 pages, 482 KiB  
Article
Comparison of Two Surgical Approaches for Coronary Artery Bypass of Left Anterior Descending Artery
by Saad Salamate, Farhad Bakhtiary, Ali Bayram, Sami Sirat, Mirko Doss, Veaceslav Ciobanu, Nadejda Monsefi and Ali El-Sayed Ahmad
J. Clin. Med. 2024, 13(11), 3158; https://doi.org/10.3390/jcm13113158 - 28 May 2024
Viewed by 1036
Abstract
Background/Objectives: The minimally invasive approach through left mini-thoracotomy is a promising alternative to the median sternotomy for coronary artery bypass. The aim of this study was to compare the short-term outcomes of patients undergoing minimally invasive coronary artery bypass (MIDCAB) with off-pump [...] Read more.
Background/Objectives: The minimally invasive approach through left mini-thoracotomy is a promising alternative to the median sternotomy for coronary artery bypass. The aim of this study was to compare the short-term outcomes of patients undergoing minimally invasive coronary artery bypass (MIDCAB) with off-pump coronary artery bypass through sternotomy (OPCAB) for single-vessel disease. Methods: From January 2017 to February 2023, 377 consecutive patients aged above 18 years undergoing off-pump bypass of the left anterior descending artery (LAD) with left internal thoracic artery underwent OPCAB. Propensity score matching was then applied. Primary endpoints were in-hospital mortality and 30-day mortality. Results: Prior to matching, 30-day mortality occurred in 2 (0.7%) patients in the MIDCAB group vs. 1 (1%) patient in the OPCAP group (p = 1). Transfusion of red blood cells (RBC) was required in 9.4% and 29% of patients within the MIDCAB and the OPCAB groups, respectively (p < 0.001). Median intensive care stay (ICU) was 1 [1–2] day in the MIDCAB group, vs. 2 [1–3] in the OPCAB (p < 0.001). In the matched cohort, 10% of MIDCAB patients received RBCs vs. 27.5% of OPCAB patients (p = 0.006). Median ICU stay was significantly lower in the MIDCAB group, 1 [1–2] vs. 2 [1–3] days. Conclusions: MIDCAB is as safe and effective as OPCAB for single coronary artery bypass of the LAD with the LITA in select patients. It is associated with a decreased ICU stay and lower transfusion rates when compared with OPCAB. Full article
(This article belongs to the Special Issue Advanced Techniques for the Treatment of Complex Coronary Artery Disease)
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12 pages, 1843 KiB  
Article
Acute Kidney Injury in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: The Role of Vascular Access Site
by Stefano Rigattieri, Ernesto Cristiano, Federica Tempestini, Luca Pittorino, Vincenzo Cesario, Matteo Casenghi, Francesca Giovannelli, Antonella Tommasino, Emanuele Barbato and Andrea Berni
J. Clin. Med. 2024, 13(8), 2367; https://doi.org/10.3390/jcm13082367 - 18 Apr 2024
Cited by 1 | Viewed by 1238
Abstract
Background: in patients undergoing percutaneous coronary interventions (PCI), radial access should be favoured over femoral access as it reduces the risk of vascular complications and bleeding. Furthermore, a preventive role of radial access in the occurrence of acute kidney injury (AKI), mainly mediated [...] Read more.
Background: in patients undergoing percutaneous coronary interventions (PCI), radial access should be favoured over femoral access as it reduces the risk of vascular complications and bleeding. Furthermore, a preventive role of radial access in the occurrence of acute kidney injury (AKI), mainly mediated by the reduction of bleeding and cholesterol crystal embolization into renal circulation, has been investigated in several studies, yielding conflicting results. Methods: we designed a retrospective study to appraise the effect of the use of a vascular access site on the occurrence of AKI in a cohort of 633 patients with acute myocardial infarction treated by PCI at our centre from 2018 to 2020. Results: after propensity score adjustment, radial access was associated with a reduced, albeit statistically not significant, incidence of AKI (14.7% vs. 21.0%; p = 0.06) and major bleeding (12.5% vs. 18.7%; p = 0.04) as compared to femoral access. At multivariate analysis, femoral access was an independent predictor of AKI, together with in-hospital occurrence of BARC 3–5 bleeding, Killip class >1 at presentation, female gender, baseline eGFR <60 mL/min, and baseline haemoglobin <12 g/dL. Conclusions: although limited by the observational design, our study supports the hypothesis that radial access may exert a protective role on the occurrence of AKI in patients with acute myocardial infarction undergoing PCI. Full article
(This article belongs to the Special Issue Advanced Techniques for the Treatment of Complex Coronary Artery Disease)
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10 pages, 987 KiB  
Article
Comparison of Orbital Atherectomy and Rotational Atherectomy in Calcified Left Main Disease: Short-Term Outcomes
by Piotr Rola, Jan Jakub Kulczycki, Mateusz Barycki, Szymon Włodarczak, Łukasz Furtan, Michalina Kędzierska, Katarzyna Giniewicz, Adrian Doroszko, Maciej Lesiak and Adrian Włodarczak
J. Clin. Med. 2023, 12(12), 4025; https://doi.org/10.3390/jcm12124025 - 13 Jun 2023
Cited by 7 | Viewed by 2017
Abstract
Background: Coronary calcifications, particularly in left main disease (LMD), are independently associated with adverse outcomes of percutaneous coronary intervention (PCI). Adequate lesion preparation is pivotal to achieve favorable short- and long-term outcomes. Rotational atherectomy devices have been used in contemporary practice to obtain [...] Read more.
Background: Coronary calcifications, particularly in left main disease (LMD), are independently associated with adverse outcomes of percutaneous coronary intervention (PCI). Adequate lesion preparation is pivotal to achieve favorable short- and long-term outcomes. Rotational atherectomy devices have been used in contemporary practice to obtain adequate preparation of the calcified lesions. Recently, novel orbital atherectomy (OA) devices have been introduced to clinical practice to facilitate the preparation of the lesion. The objective of this study is to compare the short-term safety and efficacy of orbital and rotational atherectomy for LMD. Methods: we retrospectively evaluated a total of 55 consecutive patients who underwent the LM PCI supported by either OA or RA. Results: The OA group consisted of 25 patients with a median SYNTAX Score of 28 (26–36). The Rota group consisted of 30 patients with a median SYNTAX Score of 28 (26–33.1) There were no statistical differences in MACCE between the RA and OA subpopulations when recorded in-hospital (6.7% vs. 10.3% p = 0.619) as well as in a 1-month follow-up after the procedure (12% vs. 16.6% p = 0.261). Conclusion: OA and RA seem to be similarly safe and effective strategies for preparating the lesion in the high-risk population with calcified LMD. Full article
(This article belongs to the Special Issue Advanced Techniques for the Treatment of Complex Coronary Artery Disease)
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Review

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14 pages, 1587 KiB  
Review
Coronary Artery Aneurysms: A Clinical Case Report and Literature Review Supporting Therapeutic Choices
by Michele Sannino, Matteo Nicolai, Fabio Infusino, Luciani Giulio, Tommaso Leo Usai, Giovanni Biscotti, Alessandro Azzarri, Marina De Angelis D’Ossat, Sergio Calcagno and Simone Calcagno
J. Clin. Med. 2024, 13(18), 5348; https://doi.org/10.3390/jcm13185348 - 10 Sep 2024
Cited by 1 | Viewed by 2097
Abstract
Coronary artery aneurysms (CAAs) are uncommon but significant cardiovascular abnormalities characterized by an abnormal increase in vascular diameter. CAAs are classified based on their shape as either saccular or fusiform, and their causes can range from atherosclerosis, Kawasaki disease, to congenital and iatrogenic [...] Read more.
Coronary artery aneurysms (CAAs) are uncommon but significant cardiovascular abnormalities characterized by an abnormal increase in vascular diameter. CAAs are classified based on their shape as either saccular or fusiform, and their causes can range from atherosclerosis, Kawasaki disease, to congenital and iatrogenic factors. CAAs often present asymptomatically, but when symptoms occur, they can include angina, myocardial infarction, or even sudden cardiac death due to intravascular thrombosis involving the CAA. Diagnosis is typically confirmed through coronary angiography, though CT and other imaging techniques can provide additional details. The management of CAAs is variable depending on their size, location, and the presence of symptoms or complications. Treatment options include medical therapy, percutaneous coronary intervention (PCI), or surgical approaches. In this paper, we describe the case report of a 79-year-old male who presented with palpitations and was diagnosed with a right coronary artery aneurysm, and a review of the literature is delineated, underscoring the importance of individualized treatment strategies for CAAs. Full article
(This article belongs to the Special Issue Advanced Techniques for the Treatment of Complex Coronary Artery Disease)
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15 pages, 1326 KiB  
Review
Coronary Chronic Total Occlusion Revascularization: When, Who and How?
by Elisabetta Ricottini, Federica Coletti, Annunziata Nusca, Nino Cocco, Andrea Corlianò, Alessandro Appetecchia, Rosetta Melfi, Fabio Mangiacapra, Paolo Gallo, Raffaele Rinaldi, Francesco Grigioni and Gian Paolo Ussia
J. Clin. Med. 2024, 13(7), 1943; https://doi.org/10.3390/jcm13071943 - 27 Mar 2024
Viewed by 2705
Abstract
Coronary chronic total occlusions (CTO) are an increasingly frequent entity in clinical practice and represent a challenging percutaneous coronary intervention (PCI) scenario. Despite data from randomized trials that have not yet demonstrated a clear benefit of CTO recanalization, the widespread of CTO-PCI has [...] Read more.
Coronary chronic total occlusions (CTO) are an increasingly frequent entity in clinical practice and represent a challenging percutaneous coronary intervention (PCI) scenario. Despite data from randomized trials that have not yet demonstrated a clear benefit of CTO recanalization, the widespread of CTO-PCI has substantially increased. The improvement in operators’ techniques, equipment, and training programs has led to an improvement in the success rate and safety of these procedures, which will represent an important field of future development of PCI. The present review will summarize clinical outcomes and technical and safety issues of CTO revascularization with the aim to guide clinical daily cath-lab practice. Full article
(This article belongs to the Special Issue Advanced Techniques for the Treatment of Complex Coronary Artery Disease)
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11 pages, 576 KiB  
Review
A New Frontier for Drug-Coated Balloons: Treatment of “De Novo” Stenosis in Large Vessel Coronary Artery Disease
by Alessandro Sciahbasi, Tiziano Maria Mazza, Chiara Pidone, Simona Samperi, Edoardo Cittadini and Antonino Granatelli
J. Clin. Med. 2024, 13(5), 1320; https://doi.org/10.3390/jcm13051320 - 26 Feb 2024
Cited by 2 | Viewed by 2472
Abstract
Background: Drug-coated balloons (DCB) are a well-established option for treating in-stent restenosis endorsed by European Guidelines on myocardial revascularization. However, in recent years, a strategy of “leaving nothing behind” with DCB in de novo coronary stenosis has emerged as an appealing approach. [...] Read more.
Background: Drug-coated balloons (DCB) are a well-established option for treating in-stent restenosis endorsed by European Guidelines on myocardial revascularization. However, in recent years, a strategy of “leaving nothing behind” with DCB in de novo coronary stenosis has emerged as an appealing approach. Methods: We performed a systematic review to evaluate the current literature on the use of drug-coated balloons in the treatment of de novo stenosis in large vessel disease. Results: Observational studies, as well as randomized studies, demonstrated the safety of DCB percutaneous coronary interventions (PCI) in large vessel disease. The rate of major adverse cardiac events is even lower compared to drug-eluting stents in stable coronary artery disease. Conclusions: DCB PCI is feasible in large vessel disease, and future large, randomized studies are ongoing to confirm these results. Full article
(This article belongs to the Special Issue Advanced Techniques for the Treatment of Complex Coronary Artery Disease)
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