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Advances in the Diagnosis and Treatment of Coronary Artery and Peripheral Artery Diseases

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (15 December 2025) | Viewed by 6067

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Special Issue Editors

Dr. Ovidiu Mitu

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Guest Editor

1st Medical Department, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
Interests: atherosclerosis; cardiovascular diseases; thrombosis; cardiovascular prevention; coronary intervention; antithrombotic drugs; dyslipidemia
Special Issues, Collections and Topics in MDPI journals

Dr. Alexandru Dan Costache

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Guest Editor Assistant

1. Department of Medical Specialties I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
2. Clinical Rehabilitation Hospital, 700661 Iasi, Romania
Interests: cardiology; internal medicine; cardiac rehabilitation; sports medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cardiovascular disease has both a high incidence and an increased mortality worldwide. This is supported by the newest statistics, which also show high rates of diseases of the vessels, either those of the heart leading to coronary artery disease or those of other circulatory pathways leading to peripheral artery disease.

Considering these, there is a constant need for medical publications on the topic to either update current knowledge or promote newer concepts regarding optimal patient management (i.e., preventive measures, associated risk factors, revascularization procedures, drug treatments, and patient rehabilitation).

We therefore warmly invite and highly encourage your submissions to the “Advances in the Diagnosis and Treatment of Coronary Artery and Peripheral Artery Diseases” of the Medicina Journal.

Dr. Ovidiu Mitu
Guest Editor

Dr. Alexandru Dan Costache
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-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina 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 2200 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

peripheral artery disease
coronary artery disease
cardiac rehabilitation
cardiovascular prevention
revascularisation
percutaneous coronary intervention
coronary artery bypass graft

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Published Papers (6 papers)

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Research

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9 pages, 262 KB

Open AccessArticle

Assessment of the Association Between Whole Blood Viscosity and Coronary Artery Calcium Score

by Serkan Duyuler, Pınar Türker Duyuler, Süleyman Kalaycı, Koray Arslan, Raif Can Karabulut and Mustafa Dağlı

Medicina 2026, 62(1), 169; https://doi.org/10.3390/medicina62010169 - 14 Jan 2026

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Abstract

Background and Objectives: Whole Blood Viscosity (WBV), estimated using the De Simone formula, is a key hemodynamic parameter linked to endothelial dysfunction and atherosclerosis. Its association with significant coronary calcification, defined as a high Coronary Artery Calcium Score (CACS ≥ 100), remains unclear. This study investigated whether calculated WBV predicts high CACS. Materials and Methods: In this single-center, retrospective, cross-sectional study, 403 patients undergoing coronary computed tomography angiography for suspected stable coronary artery disease were included. Participants were stratified into CACS < 100 (n = 258) and CACS ≥ 100 (n = 145). WBV was calculated at High Shear Rate (HSR) and Low Shear Rate (LSR) using the De Simone formula. Multivariate binomial logistic regression adjusted for conventional cardiovascular risk factors was used to identify independent predictors of high CACS. Results: Patients with CACS ≥ 100 were older, more frequently male, and had a higher prevalence of diabetes and hypertension (all p < 0.01). Mean WBV did not differ significantly between groups: WBV-HSR, 4.3 ± 0.5 cP vs. 4.4 ± 0.5 cP (p = 0.456); WBV-LSR, 29.9 ± 8.0 cP vs. 30.4 ± 8.6 cP (p = 0.505). In multivariate models, neither WBV-HSR (OR: 0.489; p = 0.462) nor WBV-LSR (OR: 0.987; p = 0.520) independently predicted high CACS. Age and sex were the strongest independent predictors (p < 0.001). Conclusions: No independent association was found between calculated WBV and high CACS in this cross-sectional study. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Coronary Artery and Peripheral Artery Diseases)

11 pages, 564 KB

Open AccessArticle

Ultrasound-Guided Femoral Hemostasis in Peripheral Angioplasty: Real-World Outcomes with Vascular Closure Devices Versus Manual Compression

by Ioannis Skalidis, Livio D’Angelo, Mariama Akodad, Youcef Lounes, Hakim Benamer, Benjamin Honton, Antoine Sauguet, Neila Sayah, Pietro Laforgia, Nicolas Amabile, Thomas Hovasse, Philippe Garot, Antoinette Neylon, Francesca Sanguineti, Stephane Champagne and Thierry Unterseeh

Medicina 2026, 62(1), 28; https://doi.org/10.3390/medicina62010028 - 23 Dec 2025

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Abstract

Background and Objectives: Access-site complications (ASCs) remain clinically relevant after peripheral endovascular procedures, particularly with large femoral sheaths and complex anatomy. While randomized coronary trials show non-inferiority of vascular closure devices (VCDs) versus manual compression (MC), real-world data in peripheral interventions performed under systematic ultrasound-guided access are limited. Materials and Methods: This retrospective single-center cohort included consecutive peripheral arterial revascularizations (2010–2023) performed via common femoral access under real-time ultrasound guidance. Hemostasis was achieved using MC or VCDs, categorized as collagen plug-based, suture-mediated, or clip-based systems. The primary endpoint was 30-day ASCs, defined as hematoma requiring management, pseudoaneurysm, bleeding requiring transfusion, access-site thrombosis/occlusion, arteriovenous fistula, or infection. The secondary endpoint was VCD failure, defined as unsuccessful hemostasis requiring adjunctive measures. Multivariable logistic regression adjusted for prespecified anatomical and procedural covariates, including sheath size > 6 Fr and puncture-site calcification. Results: Among 231 procedures, VCDs were used in 139 (60.2%) and MC in 92 (39.8%). ASC occurred in 28 cases (12.1%), with higher rates in the MC group compared with VCDs (18.5% vs. 9–14% across device types; p = 0.044). In adjusted analyses, MC (vs any VCD) (odds ratio [OR] 2.41, 95% confidence interval [CI] 1.06–5.47; p = 0.035), sheath size > 6 Fr, and puncture-site calcification were independently associated with ASCs. VCD failure occurred in 5 cases (3.6%) and was not observed with collagen plug-based devices. Conclusions: In this ultrasound-guided real-world peripheral cohort, VCD use was associated with lower 30-day ASC rates and low device failure rates compared with MC. Given the retrospective and non-randomized design, these findings should be considered hypothesis-generating and support individualized, imaging-guided strategies for femoral closure in peripheral interventions. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Coronary Artery and Peripheral Artery Diseases)

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14 pages, 577 KB

Open AccessArticle

Serum Trimethylamine N-Oxide Levels Are Associated with Peripheral Artery Disease in Patients with Type 2 Diabetes Mellitus

by Cing-Yu Liang, Jer-Chuan Li, Chin-Hung Liu, Du-An Wu and Bang-Gee Hsu

Medicina 2025, 61(12), 2243; https://doi.org/10.3390/medicina61122243 - 18 Dec 2025

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Abstract

Background and Objectives: Peripheral arterial disease (PAD), frequently observed in individuals with type 2 diabetes mellitus (T2DM), is associated with diminished life quality, increased cardiovascular risk, and higher mortality rates. Similarly, trimethylamine N-oxide (TMAO), a uremic toxin produced by gut microbiota, has been linked to hypertension, cardiovascular disease, and increased overall mortality. In this study, we aimed to investigate whether serum TMAO levels are related to PAD in T2DM cases. Materials and Methods: In this cross-sectional investigation performed at one medical center, 120 patients with type 2 diabetes mellitus (T2DM) were included. High-performance liquid chromatography–mass spectrometry and an automated oscillometric device were used to measure serum TMAO levels and ankle–brachial index (ABI) values, respectively. Individuals exhibiting an ABI of less than 0.9 were classified as belonging to the low-ABI group. Results: Of the 120 participants, 23 (19.2%) had low ABI. Compared with the normal-ABI group, the low-ABI group was older (p = 0.017) and exhibited higher levels of urine albumin-to-creatinine ratio (UACR, p < 0.001), C-reactive protein (CRP, p < 0.001), and TMAO (p < 0.001). After adjusting for age, UACR, and CRP, multivariable logistic regression analysis identified serum TMAO concentration as an independent predictor of PAD in T2DM patients (odds ratio [OR]: 1.051; 95% confidence interval [CI]: 1.017–1.086; p = 0.003). In Spearman’s rank correlation analyses, log-transformed left ABI (log-left ABI, p = 0.017) and log-right ABI (p = 0.001) negatively correlated with log-TMAO. In patients with T2DM, the predictive performance of serum TMAO levels for PAD yielded an area under the receiver operating characteristic (ROC) curve of 0.812 (95% CI: 0.701–0.923; p < 0.001). Conclusions: Among individuals with T2DM, higher serum TMAO levels were associated with lower left and right ABI values and an increased likelihood of PAD. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Coronary Artery and Peripheral Artery Diseases)

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11 pages, 864 KB

Open AccessArticle

Inflammatory Biomarkers and Carotid Atherosclerosis: The Predictive Role of the Neutrophil/Albumin Ratio

by Halis Yilmaz, Cemre Turgul, Yucel Yilmaz, Saban Kelesoglu and Aydin Tuncay

Medicina 2025, 61(8), 1495; https://doi.org/10.3390/medicina61081495 - 21 Aug 2025

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Abstract

Background and Objectives: Carotid artery stenosis is an inflammatory vascular disease closely linked to atherosclerosis and associated with inflammatory biomarkers. The neutrophil/albumin ratio (NAR) is a novel promising biomarker in assessing cardiovascular disease severity. This study aimed to evaluate the relationship between NAR and lesion severity in patients with carotid artery stenosis. Materials and Methods: This retrospective, single-center, comparative study included 625 asymptomatic patients who underwent digital subtraction angiography (DSA) for suspected high-grade carotid artery stenosis between 2012 and 2022. Patients were classified into two groups based on stenosis severity: critical carotid artery stenosis (≥70% stenosis) and non-critical carotid artery stenosis (<70%). Only asymptomatic patients were included; patients with symptoms were excluded. NAR was calculated preoperatively as neutrophil count divided by serum albumin. Additional inflammatory markers, such as neutrophil–lymphocyte ratio (NLR) and C-reactive protein (CRP) to albumin ratio (CAR), were also analyzed. Results: Severe carotid artery stenosis was detected in 191 of the patients who underwent DSA. Individuals in the critical carotid artery stenosis group were older and had a higher prevalence of diabetes mellitus and hypertension (51 (45–57) vs. 60 (54–68), p < 0.001; 143 vs. 83, p = 0.025; 193 vs. 104, respectively, p = 0.021), as well as higher neutrophil counts (4.3 (3.2–6.2) vs. 8.1 (4.9–12.5), p < 0.001), NLR (2.2 (1.4–3.2) vs. 4.2 (2.3–8.9), p < 0.001), while CRP (3.8 (1.8–8) vs. 5.7 (3.6–7.6), p = 0.005) and CAR (0.9 (0.5–1.9) vs. 1.6 (0.8–2.1), p < 0.001) values were significantly higher. NAR was higher in patients of the critical carotid artery stenosis group than the non-critical (1.1 (0.8–1.6) vs. 2.1 (1.4–3.2), p < 0.001). Multivariate analysis identified NAR as an independent predictor of carotid artery stenosis (Odds Ratio [OR]: 3.432; 95% Confidence Interval [CI]: 2.116–5.566; p < 0.001). The best cut-off value of NAR for predicting critical carotid artery stenosis was 1.47, which provided 73.8% sensitivity and 70.5% specificity. Conclusions: NAR, which can be easily measured through a simple blood test, demonstrated moderate sensitivity and specificity in predicting critical carotid artery stenosis, suggesting its potential role as a supportive marker in clinical risk assessment. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Coronary Artery and Peripheral Artery Diseases)

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11 pages, 561 KB

Open AccessArticle

Sex Differences in Epicardial Adipose Tissue and Other Risk Factors for Coronary Artery Disease

by Vesna Lesjak and Laura Kocet

Medicina 2025, 61(5), 934; https://doi.org/10.3390/medicina61050934 - 21 May 2025

Cited by 1 | Viewed by 1142

Abstract

Background and Objectives: To examine individual-level sex differences in traditional and non-traditional risk factors and their potential effects on the severity of coronary artery disease (CAD). Materials and Methods: A cross-sectional analysis was performed on 208 patients with a low-to-intermediate pretest probability of CAD, referred to a Coronary CT angiography (CCTA) at the Department of Radiology, Maribor University Medical Centre, from January 2022 to January 2024. CCTA-derived EAT (epicardial adipose tissue) attenuation and CAC (coronary artery calcification) values were measured. The association between CAD, EAT, and risk factors was analyzed by sex, using correlation analysis and multivariate regression. Results: In the results obtained using the univariate logistic regression model, age (OR 1.122, p < 0.001) and hypertension (OR 4.087, p = 0.048) were significantly associated with the presence of obstructive CAD in women, while in men, age (OR 1.052, p = 0.008), hypercholesterolemia (OR 3.765, p = 0.042), and EAT attenuation (OR 1.053, p = 0.011) were significant factors. In results obtained using the multivariable logistic regression analysis model, EAT attenuation was found to be significantly associated with the presence of obstructive CAD in men (OR 1.087, p = 0.012), and age was a significant factor in women (OR =1.108, p = 0.033), while hypertension, body mass index (BMI), diabetes, hypercholesterolemia, angina pectoris, and smoking were not. Conclusions: In the sex-specific multivariable logistic regression analysis model, EAT attenuation was significantly associated with obstructive CAD in men, while in women, it was associated with age. EAT may function as a beneficial alternative indicator in identifying patients with CAD. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Coronary Artery and Peripheral Artery Diseases)

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Review

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16 pages, 3745 KB

Open AccessReview

The Role of MDCT Coronary Angiography in the Detection of Benign Varieties and Anomalies of Coronary Blood Vessels—A Narrative Review

by Ana Mladenovic Markovic, Ana Tomic, Miodrag Nisevic, Biljana Parapid, Nikola Boskovic, Marina Vitas, Miona Jevtovic and Sandra Grujicic

Medicina 2025, 61(4), 765; https://doi.org/10.3390/medicina61040765 - 21 Apr 2025

Viewed by 1891

Abstract

Coronary arteries may vary in quantity, point of origin, or course. These variations fall under the category of anatomical variants/anomalies of the coronary arteries, representing congenital abnormalities of the coronary vascular system. Generally, they are benign, asymptomatic, and identified inadvertently during coronary angiography conducted for alternative indications. However, in some cases, the anomaly’s characteristics or its interaction with surrounding structures may cause hemodynamic disturbances. These disturbances can lead to turbulent blood flow, which in turn poses an increased likelihood for the development of atherosclerosis and myocardial ischemia. If symptomatic, potential manifestations include chest pain, arrhythmias, syncope, myocardial infarction, and sudden cardiac death. Given the potential for life-threatening complications in certain cases, the early and accurate diagnosis of coronary artery anomalies is of paramount importance. The most common diagnostic procedures used for the evaluation of coronary vessels are coronary angiography and multi-detector row computed tomography (MDCT) coronary angiography. MDCT angiography is a non-invasive, dependable, safe, and sensitive method for the detailed visualization of coronary anatomy. It offers high-resolution imaging that enables precise assessment of congenital coronary variations, aiding in both clinical decision-making and long-term patient management. We conducted a narrative review to analyze and integrate the body of literature on coronary artery varieties and anomalies. Our objective was to provide a comprehensive, albeit non-exhaustive, overview of essential concepts and findings related to their definition, classification, and detection with MDCT angiography. By integrating current knowledge in MDCT imaging, we seek to contribute to a better understanding of the clinical implications of coronary artery variations and their role in cardiovascular health. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Coronary Artery and Peripheral Artery Diseases)

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