Coronary artery calcification (CAC) represents a clear sign of advanced atherosclerosis and a strong indicator of coronary artery disease burden and cardiovascular risk. Beyond its established prognostic value, CAC significantly influences plaque biology, lesion morphology, and the technical complexity of percutaneous coronary intervention (PCI). This review summarizes current knowledge on the mechanisms of vascular calcification, its clinical determinants, diagnostic assessment, and therapeutic implications. Vascular calcification is now understood as an active, regulated process involving osteogenic transdifferentiation of vascular smooth muscle cells, inflammatory signaling pathways, extracellular vesicle release, and disturbances in mineral metabolism. Distinct calcification phenotypes exert different effects on plaque stability: micro- and spotty calcifications are frequently linked to plaque vulnerability, whereas dense, sheet-like calcification is more typical of stable fibrocalcific lesions.

, termed neointimal hyperplasia, Everolimus-eluting stents (EES) use derivatives of sirolimus neointimal tissue, which reduces the risk of arteriosclerosis and ...

Peripheral artery disease affects over 12 million Americans and represents a leading cause of limb loss and cardiovascular mortality. Atherectomy, the mechanical removal of atherosclerotic plaque, has emerged as a critical adjunctive therapy to balloon angioplasty and stenting. This clinical review examines FDA-approved atherectomy platforms, including directional, rotational, orbital, and laser photoablation modalities. These catheter-based devices employ cutting, photoablation, or rotational mechanisms to debulk obstructive plaque, particularly in calcified or fibrotic lesions, thereby optimizing drug delivery, reducing elastic recoil, and minimizing stent requirements. Extensive clinical evidence spanning randomized controlled trials and real-world datasets demonstrates that atherectomy achieves superior luminal gain and improved patency outcomes, with directional atherectomy showing 78 percent primary patency rates and low target lesion revascularization rates in claudication patients.

This professional video resource series explores contemporary advances in interventional radiology and image-guided procedures. The content highlights innovations enhancing clinical practice through optimized workflows, precision technologies, and improved patient outcomes. Key topics include planning and confirmation software for microwave ablation, which establishes standardized approaches and reproducible results in interventional imaging. Additional discussions address multidisciplinary team collaboration in venous care, microwave ablation techniques as procedural standards, and advanced imaging technologies such as cone-beam computed tomography for enhanced targeting accuracy. Expert practitioners share clinical insights and best practices regarding emerging solutions like IntelliBlate and SIR-Spheres, emphasizing how technological integration supports precision, reliability, and seamless teamwork in interventional settings.

# BTK Endovascular Device Innovation Summary This article examines current challenges and future requirements for below-the-knee (BTK) endovascular devices through expert perspectives from leading vascular surgeons. Key clinical shortcomings identified include vessel recoil in small-caliber, diseased arteries and unrecognized dissections during intervention. Delivery challenges, particularly across tortuous and calcified lesions, represent significant obstacles despite advanced engineering in contemporary devices. While physicians often employ unconventional solutions to facilitate device crossing, these workarounds can compromise procedural outcomes. The experts emphasize the necessity for continued technological innovation and enhanced imaging protocols to address these persistent limitations and improve treatment efficacy in complex BTK disease scenarios.

Recent developments in vascular medicine highlight significant shifts in clinical practice and patient outcomes. Key findings indicate that carotid endarterectomy outperforms stenting in reducing stroke and mortality rates, while structured exercise following acute deep vein thrombosis shows promise in mitigating long-term complications. The field is increasingly emphasizing multidisciplinary collaboration and addressing healthcare disparities, particularly in acute limb ischemia management. Emerging research suggests conservative approaches may benefit elderly patients with claudication, and transcarotid artery revascularization demonstrates durable long-term outcomes with minimal reinterventions. Additionally, surveillance protocols for abdominal aortic aneurysms are being reevaluated for older populations, and advances in medical management are transforming peripheral arterial disease treatment paradigms. These developments underscore a broader trend toward evidence-based, patient-centered care strategies.

Quantifying rat venous stent patency and endothelialization via histology and microscopy revealed complete patency with anticoagulation and pathological occlusions (RT, ISR) when withholding anticoagulation. This rodent model will facilitate the preclinical testing of future venous stents.

This document from the UHC Provider Portal outlines clinical guidelines and reimbursement policies for lower extremity endovascular procedures. It serves as a comprehensive reference for healthcare providers administering minimally invasive vascular interventions for patients with peripheral arterial disease and related conditions. The portal resource provides essential information regarding procedural protocols, coverage criteria, and documentation requirements to ensure appropriate authorization and payment processing. Healthcare providers can utilize this material to understand UHC's specific requirements and standards for endovascular treatment of lower extremity vascular pathologies, facilitating efficient patient care delivery and claims management within the UnitedHealth framework.

Start documenting AI-assisted analyses in a way that supports the new code descriptors. 3. Lower Extremity Revascularization — Complete Code Restructure.

The 2026 revision of the Current Procedural Terminology (CPT) codes for lower extremity revascularization introduces important changes that are intended to better align code selection with contemporary endovascular practice.1 In this article, I highlight several key updates and illustrate how I applied the revised codes to a case of chronic limb-threatening ischemia (CLTI) in the setting of multilevel occlusive peripheral artery disease (PAD).

Calcified femoropopliteal arterial disease presents a significant challenge in endovascular intervention, necessitating effective vessel preparation technologies. Laser atherectomy and intravascular lithotripsy represent two prominent approaches for managing this condition prior to balloon angioplasty or drug-coated balloon therapy. Laser atherectomy employs photomechanical forces to disrupt calcified plaque, while intravascular lithotripsy utilizes sonic pressure waves to fracture calcium deposits. Clinical evidence from the Auryon system and Shockwave Medical devices demonstrates comparable safety profiles and procedural outcomes. Comparative analyses indicate that intravascular lithotripsy achieves greater immediate luminal expansion, whereas laser atherectomy produces superior luminal gain following adjunctive balloon angioplasty. Both modalities effectively reduce residual narrowing and offer reliable procedural safety, making them valuable options for optimizing treatment outcomes in calcified peripheral arterial disease.

This article presents insights from the FDA's Center for Devices and Radiological Health on contemporary clinical trial design for lower extremity revascularization, particularly in chronic limb-threatening ischemia (CLTI) populations. The discussion addresses key challenges in peripheral artery disease trials, including patient population heterogeneity, clinical complexity, and patient frailty that complicate data collection and protocol adherence. The regulatory perspective emphasizes the importance of developing clear, data-driven treatment approaches while maintaining flexibility in trial design. The examination of endpoint evolution, surrogate endpoint applications, and adaptive trial design strategies provides valuable guidance for optimizing future CLTI clinical investigations within an increasingly sophisticated regulatory framework.

This article examines current limitations and future opportunities in below-the-knee (BTK) endovascular device technology through expert perspectives. Leading vascular specialists discuss device shortcomings across critical procedural phases including access, crossing, vessel preparation, and primary therapy deployment. The experts analyze technical challenges in BTK interventions and identify gaps in imaging capabilities that currently impact clinical outcomes. Their insights encompass preferred access techniques, crossing strategies, and evolving solutions such as specialized catheter techniques and atherectomy approaches. The discussion emphasizes the need for continued innovation to address unmet clinical needs in limb salvage procedures, providing valuable guidance for practitioners and device manufacturers focused on advancing BTK treatment options.

This research evaluates additively manufactured reinforced polymeric stents designed to address peripheral artery disease, where traditional metallic stents frequently fail due to continuous mechanical stress from limb movement. The study investigates whether polymeric stents produced through the ST3DT process with photoresin reinforcement can withstand the complete manufacturing and deployment lifecycle, including printing, sterilization, and crimping, while maintaining adequate mechanical properties. Nine distinct stent geometries were created by varying strut angles and printing parameters to achieve different profiles. Comprehensive testing included curing analysis via differential scanning calorimetry and Fourier-transform infrared spectroscopy, alongside mechanical evaluation through radial and axial compression tests, three-point bending assessments, and crimping procedures. CT scanning evaluated the radiopacity of reinforced polymer structures. This research demonstrates that tunable polymeric stents represent a promising advancement to overcome limitations inherent in conventional metallic stent designs for peripheral vascular applications.

Chronic non-healing wounds represent a significant clinical challenge, particularly in patients with systemic diseases like diabetes. This research examines macrophage efferocytosis—the process by which macrophages remove apoptotic cells—as a critical mechanism for inflammation resolution and tissue repair. In chronic wounds, impaired efferocytosis leads to inadequate clearance of apoptotic cells, prolonging inflammatory responses and delaying healing. The article reviews the molecular mechanisms governing macrophage efferocytosis during inflammation and explores clinical strategies to enhance wound healing outcomes by optimizing this cellular process.

enVVeno Medical Corporation announced that its Chief Executive Officer participated in a virtual investor discussion highlighting the company's landmark FDA Investigational Device Exemption approval. This first-ever FDA IDE approval enables enVVeno to conduct a U.S. pivotal study of its non-surgical replacement venous valve, positioning the company to develop potentially the first effective treatment for approximately three million Americans suffering from deep venous insufficiency. The transcatheter-delivered enVVe system represents an innovative bioprosthetic solution designed to restore one-way valve function and improve blood circulation. The minimally invasive procedure is performed under light sedation without requiring overnight hospitalization, addressing significant unmet clinical needs in venous disease treatment.

Humans stand alone as the singular species with propensity to develop spontaneous DVT. Because Virchow's original description of a canine model, there has been interest in the development of animal models of thrombosis to mimic the human condition. Initial labors were directed toward development of large mammal models. The transgenic mouse era led toward efforts to translate the existing models into the smaller rodent species. Mice are amenable for the study of venous thrombosis and have the advantages of relatively low cost and the availability of different genetically manipulated strains.

This study underscores the potential of multi-objective optimization in stent design, paving the way for PAD stents that more effectively accommodate femoropopliteal biomechanics and promote favorable mechanical conditions for healing.

In patients requiring bailout stenting for FPA lesions, adjunctive DCB use was associated with lower 1-year CD-TLR; however, this finding should be considered hypothesis-generating due to the retrospective design and limited sample size. No sustained benefit was observed at 2 years. No signal for increased short-term mortality was identified, although the study was not powered for safety endpoints.

Cordis has launched the Selution SLR percutaneous transluminal angioplasty drug-eluting balloon in Japan for treating peripheral artery disease. The device delivers sirolimus in a controlled, sustained manner to reduce restenosis and restore vessel function. Clinical trial data from SELUTION SFA Japan demonstrated robust long-term outcomes, achieving 81.5% primary patency and 93.8% freedom from reintervention at three years in a complex patient population. Results were presented at the Japan Endovascular Treatment conference and published in JACC: Cardiovascular Interventions by principal investigators Yoshimitsu Soga and Osamu Iida.