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Medicina
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Recent Advances in Interventional Cardiology
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Recent Advances in Interventional Cardiology

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

Deadline for manuscript submissions: 20 November 2026 | Viewed by 4656

Editors

Dr. Dan Mircea Olinic

E-Mail Website
Guest Editor
Medical Clinic Number 1, Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
Interests: intracoronary imaging; mainly OCT; acute coronary syndromes; primary PCI
Special Issues, Collections and Topics in MDPI journals
Dr. Florin-Leontin Lazar

E-Mail Website
Guest Editor Assistant
Medical Clinic Number 1, Internal Medicine Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400006 Cluj-Napoca, Romania
Interests: drug-coated balloons; intracoronary imaging; acute coronary syndromes; primary PCI; debulking; calcific lesions

Special Issue Information

Dear Colleagues,

Over the past decade the general landscape of interventional cardiology has been dramatically changed by new advancements which allow us to tackle increasingly complex lesions. Since the use of intracoronary imaging has become a routine practice for most complex cases and multiple debulking strategies have demonstrated their efficacy, a variety of lesions which were not long ago considered to be the Achille’s heel of interventional cardiology are currently being treated almost daily. Therefore, bifurcation lesions, highly calcific lesions, chronic total occlusions, acute coronary syndromes complicated with cardiogenic shock, multivessel disease, and diffuse lesions have modern solutions in current era, with very good long-term outcomes.

One of the most promising advancements is the growing role of drug-coated balloons (DCBs). Initially developed for in-stent restenosis, DCBs are routinely being used in small vessel disease, with promising results for various other de novo lesions. This popular approach has been studied in more and more complex scenarios, with encouraging results obtained; however, it is vital to gather data from larger trials in order to better understand the role of DCBs in this area.

With the increased availability of intracoronary imaging, the interventionalist’s ability to adjust therapy based on a person’s plaque morphology and lesion characteristics has never been greater. This imaging-guided precision has improved both acute procedural success and long-term outcomes, particularly in complex subsets such as left main disease and bifurcations.

Finally, the management of acute coronary syndromes (ACSs) continues to evolve with advances in both pharmacology and interventional techniques. There are still, however, multiple questions to be answered in complex ACS scenarios, including multivessel PCI in STEMI, plaque erosion-guided strategies, and the use of mechanical circulatory support in cardiogenic shock.

This Special Issue, titled “Recent Advances in Interventional Cardiology,” brings together cutting-edge research focusing on contemporary advances and future directions in percutaneous coronary intervention (PCI). The main topics of interest include, but are not limited to, advances in drug-coated balloons, new strategies for tackling calcific lesions, new approaches to complex bifurcation lesions, and current strategies regarding antithrombotic therapy and high-bleeding-risk patients. 

We invite the submission of original research articles, systematic reviews, meta-analyses, clinical studies, technical innovations, and expert perspectives.

Prof. Dr. Dan Mircea Olinic
Guest Editor

Dr. Florin-Leontin Lazar
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. 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

  • drug-coated balloon
  • acute coronary syndrome
  • primary PCI
  • CHIP patients and lesions
  • intracoronary imaging
  • bifurcation lesions
  • CTO

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Published Papers (4 papers)

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Research

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14 pages, 594 KB  
Article
Drug-Coated Balloon Angioplasty for Isolated Medina 0,0,1 Ostial Side-Branch Lesions: Procedural Outcomes, Bailout Stenting, and 12-Month Clinical Follow-Up
by Ebru Şahin, Cansu Akdeniz, Begüm Sayın, Hakan Aksoy, Fehmi Kaçmaz and Ali Oto
Medicina 2026, 62(9), 1620; https://doi.org/10.3390/medicina62091620 (registering DOI) - 22 Aug 2026
Abstract
Background and Objectives: Stenting isolated Medina 0,0,1 ostial side-branch lesions can result in geographic miss or protrusion into the main vessel. Drug-coated balloon (DCB) angioplasty avoids a permanent implant, but lesion-specific outcome data remain limited. We assessed procedural performance, bailout stenting, and 6- [...] Read more.
Background and Objectives: Stenting isolated Medina 0,0,1 ostial side-branch lesions can result in geographic miss or protrusion into the main vessel. Drug-coated balloon (DCB) angioplasty avoids a permanent implant, but lesion-specific outcome data remain limited. We assessed procedural performance, bailout stenting, and 6- and 12-month outcomes after an intended DCB-only strategy. Materials and Methods: In this retrospective, single-center observational cohort study, we screened 170 patients who underwent coronary DCB treatment at a single center between 1 January 2023 and 31 July 2025. Thirty-one patients with de novo isolated Medina 0,0,1 lesions were included. The primary endpoint was 12-month target lesion failure (TLF), defined as cardiovascular death, target-vessel myocardial infarction, or clinically driven target lesion revascularization (TLR). Results: DCB-only strategy success was achieved in 29/31 patients (93.5%), post-DCB angiographic success in 29/31 (93.5%), and study-defined overall procedural success in 31/31 (100%). Final TIMI grade 3 flow after DCB was present in 30/31 patients; no flow-limiting dissection occurred. Two patients required bailout stenting, one because of deterioration to TIMI grade 2 flow and one because of residual stenosis >30% with recoil. Thirty patients were alive with documented follow-up at 12 months; one patient died from a non-cardiovascular cause at month 1. No TLF was recorded within 12 months. One clinically driven TLR for target-lesion restenosis occurred at month 20, outside the prespecified window. Conclusions: In this selected cohort, an intended DCB-only strategy avoided stent implantation in most patients and had a low bailout rate. The findings support procedural feasibility but do not establish comparative efficacy. Larger prospective studies are required. Full article
(This article belongs to the Special Issue Recent Advances in Interventional Cardiology)
8 pages, 788 KB  
Article
Long-Term Prognostic Value of Post-Revascularization Fractional Flow Reserve and Skin Perfusion Toe Pressure in Patients with Chronic Limb-Threatening Ischemia
by Alexandru Achim, Jeffrey Shi Kai Chan, Szilárd Róna, Ádám Csavajda, Mónika Deák, Gábor G. Tóth, Róbert Bellavics, Attila Nemes and Zoltán Ruzsa
Medicina 2025, 61(9), 1719; https://doi.org/10.3390/medicina61091719 - 22 Sep 2025
Cited by 1 | Viewed by 1011
Abstract
Background and Objectives: The impact of peripheral below-the-knee (BTK) fractional flow reserve (FFR) on long-term clinical outcomes remains unknown. Materials and Methods: We enrolled 40 patients with severe BTK lesions (Rutherford 4–6). FFR (using 40 mg papaverin) and skin perfusion toe [...] Read more.
Background and Objectives: The impact of peripheral below-the-knee (BTK) fractional flow reserve (FFR) on long-term clinical outcomes remains unknown. Materials and Methods: We enrolled 40 patients with severe BTK lesions (Rutherford 4–6). FFR (using 40 mg papaverin) and skin perfusion toe pressure (SPTP) by laser Doppler were measured during the index procedure. The primary outcomes were major adverse limb events (MALEs) (defined as reintervention on the index arterial segment or amputation of the index limb) and death during follow-up. Results: The median follow-up was 7 [IQR 4–8] years. After the index procedure, FFR increased significantly (p < 0.001) and post-revascularization SPTP was significantly higher in the FFR ≥ 0.80 group (p = 0.022). Multivariable regressions showed no association between change in FFR (absolute or percentage) and the risk of death (p = 0.39, p = 0.28) or MALEs (p = 0.83, p = 0.29), but both pre- and post-revascularization FFR values could predict MALEs at follow-up (p = 0.018, p = 0.012). Lower SPTP was also associated with the risk of MALEs (p = 0.027). SPTP > 97.8 mmHg was 100% specific for FFR ≥ 0.80. Conclusions: While there is no association between change in FFR and the risk of death or MALEs, lower FFR values either before or after revascularization were associated with higher long-term risk of MALEs. Moreover, a lower SPTP was associated with a higher risk of MALEs. Aiming for approximately 100 mmHg in SPTP represents a non-invasive surrogate of FFR ≥ 0.80. Larger studies are needed to validate the impact of post-revascularization FFR-SPTP-adjacent values on clinical outcomes. Full article
(This article belongs to the Special Issue Recent Advances in Interventional Cardiology)
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20 pages, 7967 KB  
Article
OCT-Based Morphological Classification of Healed Coronary Plaques: Insights from Imaging of Fresh Thrombi at Different Stages of Healing and Implications for Post-Stenting Edge Dissections
by Calin Homorodean, Horea-Laurentiu Onea, Florin-Leontin Lazar, Mihai Claudiu Ober, Mihail Spinu, Dan-Alexandru Tataru, Maria Olinic, Ioana Rada Popa Ilie, Romana Homorodean, Daniel-Corneliu Leucuta and Dan-Mircea Olinic
Medicina 2025, 61(8), 1440; https://doi.org/10.3390/medicina61081440 - 10 Aug 2025
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Abstract
Background and Objectives: In vivo data on healed coronary plaques (HCPs), the hallmark of previous plaque disruption, remains scarce. The study aimed to use optical coherence tomography (OCT) imaging to assess the prevalence, morphological features, and clinical significance of culprit HCPs in [...] Read more.
Background and Objectives: In vivo data on healed coronary plaques (HCPs), the hallmark of previous plaque disruption, remains scarce. The study aimed to use optical coherence tomography (OCT) imaging to assess the prevalence, morphological features, and clinical significance of culprit HCPs in patients with acute coronary syndrome (ACS). Materials and Methods: A total of 87 ACS patients (74.3% non-ST-segment elevation ACS) who underwent pre-procedural OCT imaging of the culprit vessel at a single center were retrospectively analyzed. A pilot subgroup of patients with intracoronary thrombi at the culprit site, in various stages of organization and healing, enabled a detailed morphological characterization of HCP despite the absence of histological validation. Three distinct HCP imaging aspects were identified: type I—overlaying fibrous tissue, type II—overlaying lipid tissue, and type III—overlaying calcific tissue. HCP presence was subsequently assessed in the entire population. Clinical correlations included associations with post-stenting outcomes, particularly edge dissections (ED). Results: Culprit HCPs were identified in 78 patients (89.7%): type I—30.8%, type II—51.3%, and type III—17.9%. Regarding the underlying substrate and complication mechanism, type I HCP was associated with pathological intimal thickening (70.8%) and plaque erosion (75%), type II with lipid-rich plaque (80%) and plaque rupture (PR) (82.5%), and type III correlated with calcific plaque (92.9%, p < 0.0001) and both PR and calcified nodule (p < 0.0001). A unique signal-rich ring was observed at the HCP–tissue interface in both type II (77.5%) and type III (78.6%, p < 0.0001). There was a significant correlation between stent ED and HCP presence at landing zones (LZ) (HR 4.14, 95% CI: 1.79–9.55; p < 0.001). Conclusions: OCT analysis of intracoronary organizing fresh thrombi allowed detailed characterization of culprit HCPs and in vivo classification into three imaging types. This approach likely contributed to the high observed detection rate of HCP by enhancing recognition of subtle OCT features. HCP may create mechanical vulnerability if located at the stent LZ. Our improved HCP detection techniques may help optimize stent-related outcomes of OCT-guided procedures by choosing an HCP-free LZ or longer stents. Full article
(This article belongs to the Special Issue Recent Advances in Interventional Cardiology)
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Review

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33 pages, 1582 KB  
Review
Optimal Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention of the Left Main Coronary Artery: A Contemporary Narrative Review
by Daniel Miron Brie, Cristian Mornoș, Roxana Popescu and Alina Diduța Brie
Medicina 2026, 62(8), 1487; https://doi.org/10.3390/medicina62081487 - 1 Aug 2026
Viewed by 372
Abstract
Background: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) of the left main coronary artery remains uncertain because this lesion involves a large myocardial territory and requires a careful balance between ischemic protection and bleeding risk. This [...] Read more.
Background: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) of the left main coronary artery remains uncertain because this lesion involves a large myocardial territory and requires a careful balance between ischemic protection and bleeding risk. This review aimed to provide an updated, left-main-focused synthesis of the evidence on DAPT duration after PCI and to clarify how treatment should be individualized according to clinical presentation, lesion complexity, procedural strategy, intravascular imaging, and validated ischemic and bleeding risk scores. Methods: This narrative review with a structured literature search examined studies published from January 2010 through May 2026 in PubMed/MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and Google Scholar. From 248 identified records, 62 studies met the eligibility criteria and were included in the qualitative synthesis, comprising 38 randomized controlled trials and 24 observational studies or pooled analyses. The review prioritized direct left-main-specific evidence while also incorporating broader PCI studies with left-main subgroups and indirect contextual evidence relevant to antiplatelet decision-making. Independent screening, duplicate data extraction, and qualitative risk-of-bias assessment were performed, but the review was not prospectively registered, and no meta-analysis was conducted. Results: The available evidence supports an individualized rather than fixed DAPT strategy after left main PCI. In stable patients with anatomically simple left main lesions and acceptable bleeding risk, 6–12 months of DAPT appears generally sufficient, whereas patients with acute coronary syndromes, two-stent distal bifurcation strategies, high thrombotic burden, or other high-ischemic-risk features may derive greater benefit from extending therapy beyond 12 months when bleeding risk is low. Contemporary guideline recommendations are broadly aligned with this risk-adapted approach, and recent trials further refine decision-making: PARTHENOPE provided randomized support for risk-score-guided personalization of DAPT duration, whereas NEO-MINDSET cautioned against immediate aspirin withdrawal after PCI in acute coronary syndromes. Intravascular imaging, especially IVUS and OCT, improves procedural optimization and may help contextualize post-PCI thrombotic risk, although current data do not validate imaging findings alone as a stand-alone criterion for abbreviated DAPT. Conclusions: DAPT duration after left main PCI should be individualized by integrating clinical presentation, lesion and procedural complexity, intravascular imaging, and validated ischemic and bleeding risk tools. A personalized, risk-adapted strategy currently offers the most appropriate framework for balancing ischemic benefit against bleeding harm in this high-risk population. Full article
(This article belongs to the Special Issue Recent Advances in Interventional Cardiology)
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