Despite the abundance of research examining the effects of coffee, tea, and alcohol on inflammatory diseases, there is a notable absence of conclusive evidence regarding their direct causal influence on circulating inflammatory cytokines. Previous studies have primarily concentrated on established cytokines, neglecting the potential impact of beverage consumption on lesser-studied but equally important cytokines.

The model suggests that inhibiting M-CSF significantly affects the formation of atherosclerotic plaques by altering macrophage behavior and inflammatory responses, while disturbances in cholesterol homeostasis continue to lead to lipid accumulation. This is supported by research indicating M-CSF’s pivotal role in macrophage activation, foam cell creation, and chronic inflammation, which are essential for plaque development and instability. As a result, future therapeutic strategies that aim to target M-CSF and its associated cytokines are proposed to mitigate inflammatory conditions, thus potentially decreasing the risk of adverse events related to atherosclerosis.

Pre-clinical studies have suggested a direct role of vitamin D in the regulation of several pathophysiological pathways, such as endothelial dysfunction and platelet aggregation; moreover, observational data have confirmed the relationship with different conditions, including coronary artery disease, heart failure, and hypertension. Despite the significant evidence available so far, most clinical trials have failed to prove any positive impact of vitamin D supplements on cardiovascular outcomes. This discrepancy indicates the need for further information and knowledge about vitamin D metabolism and its effect on the cardiovascular system, in order to identify those patients who would benefit from vitamin D supplementation.

The relationship between vigorous physical activity (PA) and the development of coronary atherosclerosis has remained less explored for many years. Recently, literature data have focused on coronary atherosclerosis in athletes showing that prevalence is not trivial, that there are differences among various types of sport, and that there are some peculiar features. As a matter of fact, plaque composition in athletes seems to be characterized by calcium rather than soft components. Specific mechanisms through which vigorous PA influences coronary artery disease are not yet fully understood. However, the prevalent calcific nature of coronary plaques in athletes could be related with a trend in a lower cardiovascular event rate.

Indobufen shared the same risk of MACCE but a lower risk of bleeding after PCI versus aspirin from a real-world perspective. Due to the observational nature of the current analysis, future studies are still warranted to further evaluate the efficacy of indobufen based DAPT, especially in patients with ACS.

Replacing aspirin with indobufen in the dual antiplatelet (DAPT) regimen for patients without elevated cardiac troponin after successful drug-eluting stent implantation results in a lower risk of 1-year net clinical outcomes, a difference driven by nonserious bleeding events, according to the randomized OPTION trial.

Antiplatelet therapy is a cornerstone in the management of acute coronary syndromes. Even if recent guidelines confirm the use of a dual antiplatelet regimen consisting of aspirin and a P2Y12 inhibitor as the standard of care, dramatic changes in stent technology and features of patients have led to greater attention to the balance between hemorrhagic and thrombotic risk. Taking into consideration all these aspects, recent years have been characterized by an effort to define alternative strategies to limit hemorrhagic complications while ensuring an efficacious antithrombotic effect, which have been tested in numerous RCTs, such as P2Y12 monotherapy and guided or unguided downgrading of DAPT.

Although there are no recommendations in the guidelines for the use of DCB in the “de novo” lesions, the literature evidence supports the use of DCB in de novo lesions for small vessel disease and suggests promising early results in the treatment of de novo lesions in large vessel disease. In general, DCB PCI in large vessels is feasible, but a careful selection of patients and adequate preparation of the target lesion are key criteria in the treatment of these lesions. While the evidence suggests the potential effectiveness of DCB, it is important to interpret the results with care, considering the variability in study dimensions and patient characteristics, and only the incoming large randomized clinical trials will clarify if the DCB technology will be a new option for the treatment of patients with large vessel coronary atherosclerosis.

Efemoral Medical, developer of advanced interventional bioresorbable therapies, today announced that the United States Food & Drug Administration (FDA) has granted its novel Efemoral Vascular Scaffold System (EVSS) Breakthrough Device status for the treatment of de novo or restenotic lesions of the infrapopliteal arteries in patients with Chronic Limb Threatening Ischemia (CLTI).

Rotational atherectomy is a validated technique for the treatment of CLTI with BTK-lesions, demonstrating both safety and effectiveness. Importantly, its application does not demand additional procedural time or specialized experience and training. The use of atherectomy-assisted angioplasty in the BTK segment showed clinical advantages over POBA. In order to establish this promising technology in the arsenal of the modern vascular specialist, multicenter studies with control groups others than POBA and mid- and long-term outcome evaluation are required.

Although simple balloon angioplasty remains the standard due to its safety, cost-effectiveness, and repeatability, it is limited by high rates of restenosis and flow-limiting dissection. The Tack endovascular system is a valuable rescue device post-PTA dissection but still results in a permanent metallic implant in small-calibre arteries. The use of coronary sirolimus-eluting DESs has shown encouraging results, with excellent primary patency compared with PTA and BMSs, but they are limited by their short length, which complicates applicability to long disease segments that represent the majority of infrapopliteal CLTI, as well as affecting cost. Novel DRSs pose a solution to some of these issues by providing an antiproliferative agent before completely resorbing, eliminating the risk of chronic inflammation and late failure associated with permanent implants. Devices like the Esprit BTK bioresorbable scaffold and similar next-generation devices may herald a new generation of treatment options to overcome the historical challenges of treating long occlusive segment disease.

Watch the replay of this webinar with P. O'Kane, D. Pan and H. Routledge to understand what factors during PCI lead to the switch from DCB to DES and much more!

Intracoronary artery visualisation of crystalline sirolimus deposits after drug-coated balloon angioplasty for acute coronary syndrome. Author: Jiménez Díaz, Víctor Alfonso, MD; Íñiguez Romo, Andrés, PhD.

The guidelines are introduced by NMPA Center of Medical Device Evaluation (CMDE). It is not legally binding but highly recommended by regulatory authorities. The revision plan will not only impact the new product registration but also renewals and modifications. It involves type testing, clinical, registration review guidelines, technical guidelines, e.g., Real World Study design, and documentation guidelines, e.g., Indication for Use (IFU) writing.

Following percutaneous coronary intervention with stent placement to treat acute coronary syndromes, international clinical guidelines generally recommend dual antiplatelet therapy with aspirin plus a P2Y12 receptor inhibitor for 12 months to prevent myocardial infarction and stent thrombosis. However, data on single antiplatelet therapy with a potent P2Y12 inhibitor earlier than 12 months after percutaneous coronary intervention for patients with an acute coronary syndrome are scarce. The aim of this trial was to assess whether the use of ticagrelor alone, compared with ticagrelor plus aspirin, could reduce the incidence of clinically relevant bleeding events without an accompanying increase in major adverse cardiovascular or cerebrovascular events (MACCE).

Withdrawing aspirin one month after percutaneous coronary intervention (PCI) in high-risk heart patients and keeping them on ticagrelor alone safely improves outcomes and reduces major bleeding by more than half when compared to patients taking aspirin and ticagrelor combined (also known as dual antiplatelet therapy or DAPT), which is the current standard of care.

The potential of IJP extends beyond oral and transdermal drug delivery. Researchers have successfully employed this technology for ocular drug delivery using drug-loaded contact lenses, as well as for the development of drug-eluting stents for cardiovascular applications. Moreover, IJP has shown promise in the field of bioprinting, enabling the precise placement of cells, biomaterials, and biomolecules to create complex tissue constructs and advance regenerative medicine.

Results from the IVUS-DCB trial were recently presented at the American College of Cardiology Annual Scientific Session, ACC.24. Researchers found one-year success rates from angioplasty procedures, to open clogged arteries in the legs, were significantly higher among patients whose procedures were guided by intravascular ultrasound (IVUS) alongside angiography — compared with those whose procedures were guided by angiography alone.

Sanna Uskela et al., at North Karelia Central Hospital-Heart Center, Finland, conducted a retrospective single-center registry study that focused on the use of drug-coated balloon (DCB)-only strategy for treating de novo left main coronary artery disease. This study is significant as it addresses a treatment approach that has not been extensively studied before, particularly in the context of high bleeding risk (HBR) patients.

Despite other differences between the real-world and CT data, most of the differences in the bleeding rates between the two data sources are driven by the differences in the patient population, and the CT data underestimates the burden of bleeding in real-world clinical practice due to a lower representation of elderly and high-risk patients compared to RWD. Evaluating CT data and RWD provides an opportunity to improve future CT design and better align with real-world practice by identifying populations with less representation and subgroups that may influence outcomes.