Search Results (198)

Percutaneous coronary intervention (PCI) using drug-coated balloons (DCBs) may provide outcomes comparable to drug-eluting stents (DESs) due to the absence of a permanent implant and improved coronary artery remodelling. This study compared clinical outcomes of DCB-only angioplasty with DESs in a real-world setting. All patients undergoing PCI with DCBs or DESs for de novo disease were included in a propensity score-matched analysis using prospective and retrospective collected data from a single centre. The primary outcome was target lesion revascularisation (TLR) at 12 months. The secondary outcomes were major adverse cardiac events (MACEs) defined as a composite of all-cause death, myocardial infarction, or TLR at 12 months. Propensity matching produced 904 DCB lesions (719 patients) matched to 1424 DES lesions (1271 patients). The DCB group had smaller coronary arteries, shorter treated segments, and more bifurcation lesions. The mean age was 65 years, 22% of patients had prior MI, 16% had diabetes, and 58% had acute coronary syndromes. The rate of TLR at 12 months was as follows: 2.3% with DCBs; 2.5% with DESs (OR 0.86, p = 0.726, 95% CI 0.37–2.02). MACE was 8.2% with DCBs and 7.3% for DESs (OR 1.04, 95% CI 0.73–1.47). Results suggest comparable outcomes in patients who received paclitaxel DCBs compared to DESs without excess MACE, highlighting the need for randomised controlled trials. Full article

Background/Objectives: Drug-coated balloons (DCBs) deliver paclitaxel to the vessel wall and leave nothing behind, which makes them mechanistically appealing here, yet head-to-head data confined to the isolated popliteal/SFA segment are still scarce. We directly compared 12-month hemodynamic, symptomatic, and patency loss outcomes between DCB and plain old balloon angioplasty (POBA) in this anatomical setting. Methods: We retrospectively reviewed 401 consecutive endovascular procedures performed at a single center between January 2021 and December 2024 for isolated popliteal and/or SFA disease, comprising 179 DCB and 222 POBA cases. 12-month endpoints of composite clinical success, asymptomatic recovery, and composite patency loss were analyzed. The composite patency loss endpoint was further fitted to a multivariable logistic regression with baseline ABI, baseline Rutherford category, lesion length, and total occlusion as covariates. The composite patency loss endpoint was further fitted to a multivariable logistic regression with baseline ABI, baseline Rutherford category, lesion length, and total occlusion as covariates, designated as the principal effect estimate. Kaplan–Meier cumulative incidence plots are presented descriptively only. Results: The study population comprised 401 patients (mean age 68.4 ± 10.6 years; 316 male [78.8%]), with 179 in the DCB arm (mean age 65.3 ± 10.5 years; 80.4% male) and 222 in the POBA arm (mean age 71.0 ± 9.8 years; 77.4% male). DCB-treated lesions started out more advanced: longer (94.5 ± 48.2 vs. 82.7 ± 43.3 mm; p = 0.010), more often totally occluded (39.7% vs. 19.4%; p < 0.001), and weighted toward TASC II C/D (p < 0.001). Mean ABI improved by +0.27 in both arms, with no detectable between-arm difference (p = 0.860; within-arm p < 0.001 in each). Asymptomatic recovery at 12 months was more common after DCB (62.0% vs. 51.4%; p = 0.033; OR 1.55, 95% CI 1.04–2.31), and composite patency loss was roughly halved (6.7% vs. 12.6%; p = 0.050; OR 0.50, 95% CI 0.25–1.01). Documented TLR (4.5% vs. 7.2%; p = 0.251) and composite clinical success (86.6% vs. 82.4%; p = 0.255) did not reach significance. Conclusions: Across 401 real-world procedures in isolated popliteal and/or SFA disease, mean ABI gain was identical between arms, yet DCB delivered measurably more complete symptomatic recovery and a near-significant halving of composite patency loss at 12 months, with both signals robust to multivariable adjustment. In this real-world setting, DCB was associated with more complete symptomatic recovery and a numerically lower composite patency loss rate; these findings are hypothesis-generating and require confirmation in adequately powered randomized trials. Full article

Patients with heavily calcified coronary arteries represent a challenge in percutaneous coronary intervention (PCI), as severe calcification impairs device delivery and limits optimal stent expansion, leading to higher risks of stent thrombosis, restenosis, and adverse clinical outcomes. Approximately 20% of patients undergoing PCI exhibit severe coronary calcification, which independently predicts incomplete revascularization, increased mortality, and higher rates of major adverse cardiovascular events over mid-term follow-up. Recent advances have focused on improving the assessment and management of calcified lesions. Intracoronary imaging modalities, including intravascular ultrasound and optical coherence tomography, allow precise detection and characterization of calcium burden, overcoming the limitations of angiography. These tools play a pivotal role in guiding procedural strategy, enabling tailored selection of calcium-modifying techniques based on lesion morphology, and optimizing stent deployment. Technological innovations have significantly expanded therapeutic options. While non-compliant balloon angioplasty alone is often insufficient, adjunctive devices such as cutting and scoring balloons improve plaque modification in focal disease. Atherectomy techniques, including rotational and orbital systems, are effective for more complex lesions but require technical expertise and carry procedural risks. Intravascular lithotripsy has emerged as a promising, less aggressive modality capable of fracturing deep calcium, while excimer laser atherectomy offers an alternative for resistant lesions. Despite these advances, current evidence supporting calcium-modifying strategies is largely based on procedural outcomes rather than definitive improvements in long-term clinical endpoints. Meta-analyses and randomized trials have not demonstrated clear superiority of any single technique, and most studies remain underpowered. Intriguingly, recent data suggest that outcomes in treated calcified lesions may approximate those of non-calcified disease, raising the hypothesis that these technologies could mitigate the adverse impact of calcification. However, this remains unproven, highlighting the urgent need for adequately powered randomized trials to determine their true clinical benefit. Full article

Background: Intravascular lithotripsy (IVL) has emerged as a novel vessel preparation device for patients with peripheral artery disease undergoing angioplasty. The IVL catheter includes an integrated balloon, which emits high pressure and transient sonic waves. The release of shockwaves results in cracking of intimal and medial calcium within the vessel wall improving lumen patency. Objectives: The aim of this prospective observational cohort study is to evaluate the morphological and imaging changes in atherosclerotic plaque in patients with PAD undergoing IVL as a vessel preparation technique, followed by angioplasty with drug-coated balloon (DCB) or stent placement if required. Secondary endpoint is to evaluate the efficacy of IVL in the perfusion of the lower extremities, by calculating the ankle–brachial index (ABI) and toe–brachial index (TBI) post-angioplasty, as well as adverse events within 30 days. Methods: Consecutive adult (≥18 years of age) patients with symptomatic femoropopliteal artery disease selected to undergo IVL will be included in the study. Computed tomography angiography (CTA) of the lower limbs will be performed pre- and postoperatively. Intraoperatively, an intravascular ultrasound (IVUS) will be used before and immediately post-angioplasty, for real-time evaluation of the morphological and quantitative changes in the atherosclerotic plaque. All participants will be clinically re-evaluated in 30 days postoperatively and a color Duplex ultrasound of the lower extremity arteries will be performed. The perfusion of the peripheral arteries will be assessed using ABI and TBI post-procedurally. Outcomes: The primary outcome is the quantitative assessment of changes in plaque morphology and volume within the index target lesion, based on pre- and post-procedural computed tomography angiography using TeraRecon™ (Durham, NC, USA) plaque analysis module, reflecting plaque modification and redistribution, in the context of IVL-based vessel preparation. Secondary outcomes include improvement of peripheral arterial perfusion and freedom from clinically driven target lesion revascularization (CD-TLR) and major adverse events. Full article

Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the two dominant revascularisation strategies for obstructive coronary artery disease, yet their relative roles continue to shift because they address coronary pathophysiology differently with ever-evolving techniques. PCI has advanced through iterative improvements, including balloon angioplasty, bare-metal stents, and drug-eluting stents, with contemporary outcomes increasingly driven by procedural optimisation using intracoronary imaging and physiology-guided lesion selection rather than device category alone. CABG has progressed through perioperative management, improvements in operative safety, and, critically, conduit durability. Recognition of progressive saphenous vein graft failure has underpinned a conduit-optimisation era in which the left internal mammary artery to left anterior descending artery remains the gold standard. Further, broader arterial grafting (including radial artery use, multiple arterial grafting, and selected total-arterial strategies) has been increasingly applied, albeit with deliverability and competing-risk constraints highlighted in randomised evidence. This perspective review reframes the CABG versus PCI comparison not as a binary contest, but as a context-dependent assessment in which the relative value of each strategy depends on the specific technologies, techniques, and conduits available at the time of comparison. We summarise comparative effectiveness where evidence is most consistent and where it remains sensitive to anatomy, comorbidity, and endpoint definitions. In diabetes with multivessel disease, trial data favour CABG for long-term survival and clinical outcomes despite higher stroke risk. In left main disease, outcomes depend on lesion pattern and overall complexity, with trial-era stent technology and composite endpoint definitions influencing conclusions. In ischaemic left ventricular dysfunction, a long-term survival benefit is established for CABG added to medical therapy, while multi-vessel PCI has not demonstrated comparable prognostic modification in contemporary data. We then examine hybrid coronary revascularisation as territory-specific allocation, highlighting its physiological rationale, program dependence, and limited, adequately powered randomised evidence. Finally, we outline how artificial intelligence (AI) and robotics may accelerate a precision revascularisation paradigm by standardising lesion assessment, supporting procedural planning, improving procedural reproducibility, and enabling more patient-specific selection among PCI, contemporary CABG with optimised conduits, and hybrid pathways. Full article

After vessel preparation, using different strategies such as balloon angioplasty, specialty balloons, atherectomy or intravascular lithotripsy, definitive treatment has emerged as a key feature in endovascular treatment strategies. Based on current guidelines, endovascular treatment is the most common treatment option in patients with claudication. In patients with chronic limb-threatening ischemia (CLTI), on the other hand, the best treatment modality, including bypass surgery and endovascular revascularization, needs to be selected by an interdisciplinary team, focusing on individual anatomic and patient-specific characteristics, on the availability of a vein graft and on cardiovascular and other comorbidities of the patients. With endovascular therapy, currently, a plethora of options are available for the treatment of femoropopliteal lesions, which are increasingly gaining in complexity. Therefore, a practical systematic case-based approach, entailing contemporary treatment options, like drug-coated balloon (DCB) angioplasty tools, self-expanding bare-metal stents (BMSs), drug-eluting stents (DESs), interwoven stents and covered stents, is crucial. Generally, most endovascular operators adhere to the ‘leave nothing behind’ concept, meaning that, after proper lesion preparation, lesions can be treated with DCBs, avoiding the implantation of permanent metallic implants. However, in the case of severe dissections or significant recoil, stent implantation becomes necessary to achieve adequate limb perfusion. The selection between long versus spot stenting and the different stent options depends on the current scientific evidence, guidelines and expert opinion statements. An interdisciplinary expert consensus was recently compiled on how these modalities should be used in specific lesions and patients in the femoropopliteal segment. Herein we present a practical case-based approach, which is based on this algorithm and aims at harmonization of endovascular treatment strategies in daily practice and ultimately at further improvements in limb and patient outcomes. Full article

Background/Objectives: Coronary bifurcation lesions (CBLs) are common, and the treatments remain nuanced. Side branch (SB) patency is a key determinant of clinical success in CBL intervention. In this paper, data exploring the routine use of drug-coated balloons (DCBs) in the SB is presented as an alternative to standard plain old balloon angioplasty (POBA). Methods: A meta-analysis was performed comparing DCBs in the SB to POBA after drug-eluting stent (DES) implantation in the main vessel (MV) of a true CBL. Outcomes including myocardial infarction (MI), target lesion revascularisation (TLR), cardiac death, and late lumen loss (LLL) up to 1 year post-procedure are reported. Results: Six studies comprising of 1982 patients were included in the analyses. Patients were predominantly male, and the mean age was >60 years. Four studies included patients with acute coronary syndrome. The primary outcomes were a statistically significant reduction in MI rate (OR 0.38, 95% CI 0.19–0.76, p = 0.006), and in the TLR rate (OR 0.45, 95% CI 0.23–0.87, p = 0.02) in the DCB group compared to the control. There was no significant difference in cardiac death. Furthermore, there was a significant reduction in SB LLL in the DCB group (Mean difference −0.22mm, 95% CI −0.33–−0.11mm, p = 0.0001). Conclusions: Following DES implantation in the MV of a true CBL, this analysis demonstrated that DCBs in the SB is superior to POBA in reducing MI, TLR, and LLL of the SB. Large, randomized trials are required to consolidate the role of DCB in the treatment of CBL. Full article

Background: Spontaneous recanalized coronary thrombus (SRCT) is an uncommon and often underrecognized coronary pathology that may be angiographically subtle despite having functional significance. Optical coherence tomography (OCT) enables accurate diagnosis and treatment planning. However, optimal treatment strategies remain incompletely defined. Materials and Methods: A 55-year-old man presenting with severe exertional dyspnea, atypical chest pain episodes, and abnormal stress echocardiography underwent invasive coronary assessment with angiography, fractional flow reserve (FFR), and OCT. An SRCT of the left anterior descending artery (LAD) was identified and treated using OCT-guided lesion preparation followed by sirolimus-coated drug-coated-balloon (DCB) angioplasty. Results: Although there was only moderate angiographic disease, a functional assessment confirmed significant ischemia. OCT revealed a characteristic honeycomb morphology. Post-procedural OCT demonstrated satisfactory lumen gain, with preserved vessel integrity. Follow-up imaging showed vessel-healing and late lumen enlargement, and the patient remained asymptomatic. Conclusion: OCT-guided drug-coated-balloon angioplasty may be an effective “leave-nothing-behind” strategy for selected SRCT lesions, highlighting the importance of intracoronary imaging beyond angiography. Full article

Background: Patients with single-ventricle physiology represent a high-risk group for heart transplantation. Due to complex anatomical and physiological challenges, including multiple prior sternotomies, pulmonary artery abnormalities, and systemic consequences of altered circulation, they represent both a surgical and a clinical challenge. We aimed to analyze perioperative challenges, as well as early and long-term complications, in this specific group of patients. Methods: We performed a retrospective data analysis of a high-volume heart transplant center, focusing on patients with single-ventricle physiology who were scheduled for heart transplantation due to end-stage heart failure. We retrospectively analyzed the period from the beginning of the transplant program in November 1985 to the end of November 2024. Results: Among 1553 transplanted patients (adults and children), 29 were transplanted due to congenital heart disease (congenital valvular disease not included). In this group, nine patients were transplanted due to end-stage heart failure in the course of single-ventricle physiology. Age at transplantation ranged from 7 to 31 years (median, 17 years), and body weight ranged from 15 to 69 kg (median, 47.9 kg). All nine patients referred for heart transplantation presented with single-ventricle physiology. Their underlying congenital heart defects were heterogeneous and included hypoplastic left heart syndrome (HLHS), double-outlet left ventricle (DOLV), transposition of the great arteries (TGA) with associated ventricular septal defects (VSDs), atrial septal defects (ASDs), valvular abnormalities such as tricuspid and or pulmonary valve atresia or stenosis, systemic or atrioventricular valve regurgitation, and vascular abnormalities, including right-sided aortic arch, aortic coarctation, and pulmonary artery hypoplasia, stenosis, or occlusion, as well as associated pulmonary vascular abnormalities such as left pulmonary artery stenosis and MAPCAs. All patients had previously undergone staged palliative procedures, including Norwood, Hemi-Fontan, Fontan, bidirectional Glenn, modified Blalock–Taussig shunts, Bjork–Fontan, or pulmonary artery banding, often with repeated interventions such as balloon angioplasty, stent placement, or MAPCA closure. Extracardiac comorbidities were common and included coagulopathies, protein-losing enteropathy, hepatic dysfunction, and chronic venous insufficiency. Preoperative functional status was markedly impaired in all patients (NYHA III-IV, INTERMACS 3-4), with severely reduced exercise capacity and thrombotic events in several individuals. Perioperative transplant surgical strategies included femoral cannulation in four cases and standard aortic and caval cannulation in five cases. Pulmonary artery reconstruction was required in all patients. Extended donor pulmonary arteries were applied in eight cases, while a bifurcated Dacron prosthesis was utilized in one patient. Perioperative mortality was 33%, with three deaths attributed to bleeding and hemodynamic instability, while overall mortality was 44% including one late death unrelated to transplantation. Protein-losing enteropathy, although persistent in the immediate postoperative period, resolved in all surviving patients, underscoring the transformative impact of transplantation. Conclusions: These findings emphasize the importance of individualized surgical planning, extended donor pulmonary artery harvesting, and careful preoperative coordination. Heart transplantation remains a viable and life-extending option for selected single-ventricle patients, despite the significant technical and clinical challenges involved. Full article

Type 2 myocardial infarction (T2MI) is defined as myocardial necrosis caused by an imbalance between oxygen supply and demand in the absence of acute atherothrombotic coronary occlusion/erosion. Unlike type 1 myocardial infarction (T1MI), T2MI comprises a heterogeneous group of clinical scenarios, often triggered by systemic or cardiac conditions, and it frequently affects elderly patients with a high burden of comorbidities. T2MI often underline multivessel coronary artery disease and, despite its growing clinical relevance, the diagnostic and therapeutic approach to T2MI remains challenging and lacks standardized recommendations. In this review, we present an updated and a comprehensive synthesis of current evidence on the diagnosis and management of T2MI, focusing on the role of coronary angiography and interventional strategies. We discuss the utility of high-sensitivity cardiac biomarkers, imaging modalities, and clinical risk scores to guide patient selection for invasive evaluation. Specific attention is given to conservative and alternative revascularization approaches—including drug-coated balloon angioplasty and stentless percutaneous coronary intervention (PCI)—in frail and high-bleeding-risk patients. The review emphasizes the need for individualized decision-making in a population where standard invasive strategies may not always be appropriate, and where a tailored balance between ischemic and hemorrhagic risk is crucial. Full article

Background: Restenosis after coronary stent implantation remains a major clinical challenge, especially in patients with diabetes, long lesions, or multiple stents. Standard therapy with aspirin and P2Y12 inhibitors does not reliably prevent this complication. Objectives: We reviewed experimental and clinical evidence on cilostazol, a selective phosphodiesterase-3 inhibitor, as a strategy to reduce restenosis after percutaneous coronary intervention (PCI). Methods: Preclinical and clinical studies were critically appraised, focusing on the effects of cilostazol on vascular smooth muscle and endothelial cells, platelet aggregation, lipid metabolism, and restenosis rates. Results: Experimental models show that cilostazol inhibits smooth muscle proliferation and intimal hyperplasia after arterial injury. Clinical trials demonstrate reduced restenosis after balloon angioplasty and stent implantation compared with aspirin, ticlopidine, or clopidogrel. Although approved by the FDA for intermittent claudication, cilostazol remains underused in the prevention of coronary restenosis. Conclusions: Current evidence supports cilostazol as an effective adjunctive therapy to reduce restenosis following PCI. Wider adoption and further large-scale trials are warranted to better define its role in contemporary interventional practice. Full article

Drug-coated balloons (DCBs) have emerged as an alternative to drug-eluting stents (DESs) in percutaneous coronary intervention, delivering antiproliferative drugs without leaving a permanent implant. This review provides a comparative analysis of sirolimus-coated DCBs (DCB-S), paclitaxel-coated DCBs (DCB-P), and DESs across key scenarios: de novo coronary lesions in chronic coronary syndrome (CCS), acute coronary syndromes (ACS), and in-stent restenosis (ISR). We discuss late lumen loss (LLL), target lesion/vessel revascularization (TLR/TVR), vessel patency, and major adverse cardiac events (MACE) outcomes, along with current guidelines and emerging indications for DCB-S. We also examine pharmacological differences between sirolimus and paclitaxel (mechanisms of action, tissue uptake, and healing profiles), trial methodologies, and recent innovations in DCB technology. Across stable de novo lesions (especially small vessels and high bleeding-risk patients), multiple trials show DCB-P can achieve non-inferior clinical outcomes to DES. Early data suggest newer DCB-S may likewise match DES outcomes in broader populations. In ACS, DCB-only strategies have demonstrated feasibility and safety in carefully selected lesions without heavy thrombus, with randomized studies like REVELATION (STEMI) showing non-inferior fractional flow reserve and low revascularization rates compared to DES. For ISR, DCB-P is an established Class I treatment in both BMS-ISR and DES-ISR, yielding similar or lower TLR rates than repeat stenting. DCB-S are now being evaluated as an alternative in ISR, aiming to avoid additional stent layers. Contemporary guidelines endorse DCB use in ISR and small vessels, and experts anticipate expanding indications as evidence grows. Sirolimus and paclitaxel differ in antiproliferative mechanisms and pharmacokinetics—sirolimus (cytostatic, mTOR inhibition) may offer faster endothelial recovery, whereas paclitaxel’s high lipophilicity ensures sustained arterial wall retention. Technological advances (e.g., phospholipid micro-reservoirs for sirolimus) are enhancing drug transfer and addressing prior limitations. In summary, DCB-P and DCB-S now represent viable alternatives to DES in specific scenarios, especially where “leaving nothing behind” could reduce long-term complications. Ongoing large randomized trials, such as SELUTION DeNovo, currently available as conference-presented data, together with longer-term follow-up will further clarify the optimal niches for DCB-S versus DCB-P and DES. Full article

Background: There are limited data about the use of drug-coated balloon (DCB)-only angioplasty for multivessel coronary disease. Objectives: The aim of this study was to assess the safety and efficacy of DCB-only angioplasty as compared with second-generation drug-eluting stents (DESs) in patients undergoing multivessel angioplasty. Methods: We compared major adverse cardiovascular events (MACEs) in all patients undergoing multivessel angioplasty in our institution from 1 January 2015 until 15 November 2019, with either the DCB-only or DES-only strategy. The primary endpoint of our study was a MACE, including cardiovascular mortality, acute coronary syndrome, target lesion revascularisation, stroke, or major bleeding. Data were analysed using Cox regression models, Kaplan–Meier estimator plots, and propensity score matching. Results: A total of 159 consecutive patients treated with DCB-only angioplasty and 222 consecutive patients treated with DES-only angioplasty were identified. The majority of the vessels treated were large vessels (>3 mm). After a median follow-up of 4 years, a total of 52 (33%) patients in the DCB and 73 (33%) patients in the DES group encountered a MACE (p = 0.97). The results did not change following propensity score matching. On multivariate Cox regression analysis in the propensity score-matched cohort, atrial fibrillation [HR = 2.37, CI: (1.22–4.61), p = 0.011] and diabetes [HR = 1.71, CI: (1.13–2.60), p = 0.011] were the only independent adverse predictors of MACE. Conclusions: DCB-only angioplasty appears to be safe and efficient when compared to DES for multivessel angioplasty in terms of MACEs after a follow-up of 4 years. Full article

Balloon pulmonary angioplasty (BPA) has become an established treatment modality for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), particularly in those with distal pulmonary artery lesions or significant comorbidities precluding pulmonary endarterectomy. BPA provides significant improvement in pulmonary hemodynamics, right ventricular function, exercise tolerance, and quality of life. Recent randomized controlled trials, including the RACE and MR-BPA trials, have demonstrated that BPA results in greater reduction in pulmonary vascular resistance and mean pulmonary arterial pressure compared to riociguat, although with a higher incidence of procedure-related complications. Ancillary follow-up data further suggest that a sequential strategy combining medical therapy and BPA may optimize outcomes and reduce adverse events. Advances in procedural techniques, imaging guidance, and patient selection have substantially improved the safety profile of BPA. International registries and expert consensus guidelines now support its incorporation into the multimodal management of CTEPH. This review synthesizes current evidence on the efficacy, safety, and practical aspects of BPA, while highlighting ongoing challenges, including long-term outcome data, standardization of treatment endpoints, and the role of combination therapy. BPA is poised to play an increasingly central role in personalized care strategies for CTEPH. Full article

Coronary artery disease (CAD) remains one of the leading causes of mortality worldwide, affecting more than 300 million people. Over the past two decades, percutaneous coronary intervention (PCI) has become the cornerstone of CAD treatment, involving the implantation of coronary stents. This review clarifies how coronary stents emerged, evolved, and ultimately reshaped modern interventional cardiology. Beginning with balloon angioplasty and progressing through bare-metal and drug-eluting stents, we show how each advancement solved key clinical shortcomings—dramatically reducing restenosis, thrombosis, and repeat revascularization. We further review the major technological advances driving modern stent development, such as biodegradable alloys and biomimetic coatings. We also highlight the remaining challenges, including long-term stability, manufacturing complexity, and limited translational readiness. Together, these elements support our central thesis: that the historical evolution of coronary stents is fundamental to understanding present PCI practice and to guiding the next phase of device innovation. Full article