Interventional Cardiology

Biotronik has announced the enrolment of the first patient in the Leave Nothing Behind-trial, which aims to demonstrate the non-inferiority of drug-coated balloons (DCB) or DCBs in combination with resorbable magnesium scaffolds (RMS) compared to drug-eluting stents (DES) in chronic total occlusions (CTO) in percutaneous coronary interventions (PCI).

In patients who had undergone PCI and discontinued DAPT, at a follow-up of about 5.5 years, P2Y12 inhibitor monotherapy with ticagrelor or clopidogrel was associated with lower MACCE, owing to reduced rates of myocardial infarction and stroke compared with aspirin monotherapy, without a concurrent increased risk of major bleeding.

Thrombus treatment remains a significant challenge, primarily due to factors such as the short half-life of thrombolytic agents, suboptimal drug utilization, and limited therapeutic efficacy. In this study, we developed a platelet membrane-camouflaged bioactive glass nanoparticles (BGs) as drug carriers to load thrombolytic agent urokinase (UK) and anticoagulant drug tirofiban (TF).

The arrival of bioresorbable vascular scaffolds (BVS) in the clinical arena was heralded by an impressive list of promises which, in the end, led to a declaration that the fourth revolution in percutaneous coronary intervention (PCI) had taken place1. The reasons for that announcement were sound: it was expected that BVS would put an end to the problem of stent thrombosis and other vascular issues associated with leaving behind a metallic cage once the stenosis had been successfully resolved.

The 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes (ACS) introduced a paradigm shift in secondary prevention by endorsing ticagrelor monotherapy after ≥1 month of dual antiplatelet therapy (DAPT) as a Class 1 (Level of Evidence: A) recommendation for patients undergoing percutaneous coronary intervention (PCI).1 This endorsement is likely to raise debate because P2Y12 inhibitor monotherapy trials have been criticized for design heterogeneity, a predominant focus on bleeding, and noninferiority frameworks for ischemic outcomes. This recommendation is nonetheless supported by a strong rationale and robust clinical evidence, challenging the long-established 12-month DAPT dogma and, more broadly, the necessity of prolonged DAPT when alternative strategies that balance bleeding risk and ischemic protection are available.

The increasing adoption of drug-coated balloons (DCBs) in percutaneous coronary intervention (PCI) represents a significant shift in interventional cardiology. While experienced operators perceive this as a revival of a familiar technique, newer generations remain skeptical. The concept of leaving a dissection 'uncovered' contradicts the longstanding practice of routine stenting of dissections, a gold standard in PCI for nearly three decades. Concerns regarding abrupt vessel occlusion, increased restenosis, and target lesion failure fuel skepticism.

The drug-coated balloon (DCB) is an emerging percutaneous coronary intervention (PCI) device that delivers drugs to diseased vessels to decrease the rate of vascular stenosis. Recent clinical studies have demonstrated that DCBs tend to have both good safety and efficacy profiles, leading to extended application indications in the clinic, including in-stent restenosis (ISR) for metal stents such as drug-eluting stents (DESs), small vascular disease, bifurcation disease, large vascular disease, acute coronary syndrome (ACS), and high bleeding risk. However, some previous clinical data have suggested that DCBs performed less effectively than DESs. No studies or reviews have systematically discussed the improvement strategies for better DCB performance until now. Drug loss during the process of delivery to the target lesion and inefficient delivery of the coating drug to the diseased vascular wall are two key mechanisms that weaken the efficiency of DCBs.

Among participants with acute coronary syndrome who could be treated by drug coated balloons exclusively, a stepwise DAPT de-escalation was non-inferior to 12 month DAPT for net adverse clinical events.

The artificial blood could be a game-changer for blood transfusions as it can safely be administered to all patients regardless of blood type.

Essaimage du CEA, la société AlchiMedics développe un revêtement biomimétique destiné aux implants endovasculaires. Cette innovation majeure, qui est le fruit de travaux de recherche menés à l'Inserm, devrait apporter une solution durable à une problématique persistante depuis plus de 25 ans.

While PCI and CABG have improved over time, CABG remains the superior strategy in patients with multivessel disease. The findings for FAME 3 at 5 years are no different from the 1-year outcomes. The only change has been in how the authors presented the results. 

Thrombosis is a major complication of surgeries to open up arteries in the brain and heart. AlchiMedics has developed a coating technology named “Electro-grafting”, delivering covalently bonded nanometric polymer brushes, that accelerates healing and reduces thrombosis by accelerating healing.

Les dispositifs médicaux implantés pour remédier à des rétrécissements artériels doivent être bien acceptés par le corps humain. La brosse de polymère déposée par électro-greffage avec la technologie d’AlchiMedics accélère la cicatrisation et éteint le risque d’accidents graves liés à la thrombose tardive.

Dual antiplatelet therapy (DAPT) has become an essential medication in daily clinical practice, but the optimal duration of DAPT after the implantation of a DCB remains unknown. At the time of the first in vivo implantation of paclitaxel-DCB for the treatment of ISR in 2006, the protocol-defined DAPT duration was only 1 month. Subsequently, DAPT duration ranging from 1 to 12 months has been recommended by various trials. However, there have been no randomized controlled trials (RCTs) on the optimal duration of DAPT after DCB angioplasty. Current clinical guidelines normally recommend the duration of DAPT after DCB-only angioplasty based on data from RCTs on the optimal duration of DAPT after stenting. In this review, we summarized current clinical trials on DCB-only angioplasty for different types of CADs and their stipulated durations of DAPT, and compared their clinical results such as restenosis, target lesion revascularization (TLR) and stent thrombosis event.

While prolonged DAPT confers thrombotic risk reduction, it invariably increases bleeding complications, which are themselves associated with adverse prognostic implications. This dilemma has prompted the exploration of de-escalation strategies—gradual tapering of antiplatelet intensity or duration—as a means of optimising patient outcomes. Currently, the concept of DAPT de-escalation refers to the strategy of discontinuing aspirin after a short period of dual antiplatelet therapy after PCI, leaving patients on monotherapy with a potent P2Y12 inhibitor—typically ticagrelor, as supported by available evidence. The rationale behind this approach is to maximise ischaemic protection during the initial months after PCI, when the thrombotic risk is highest, while simultaneously mitigating the bleeding risk, which remains relatively constant and is directly associated with DAPT duration.

Thrombus treatment remains a significant challenge, primarily due to factors such as the short half-life of thrombolytic agents, suboptimal drug utilization, and limited therapeutic efficacy. In this study, we developed a platelet membrane-camouflaged bioactive glass nanoparticles (BGs) as drug carriers to load thrombolytic agent urokinase (UK) and anticoagulant drug tirofiban (TF). UK and TF were firstly incorporated onto BGs, and followed by a camouflage of polydopamine (PDA) and platelet membrane (PM) to form composite nano-formulation (TUBGs@PP). This composite nano-formulation leverages the PM camouflage to enhance its biocompatibility, prolong circulation time in vivo, and extend the half-life of drugs.

Pharmacologically, the trial used various paclitaxel-coated balloons without subgroup stratification, introducing heterogeneity in drug delivery and healing responses [2]. Furthermore, no platelet function or pharmacogenomic testing was employed to tailor antiplatelet therapy—despite known interindividual variability in response, especially with ticagrelor and clopidogrel [3]. This limits the precision and personalization of therapy.

Stentless treatment of acute coronary syndrome uses gradual, prolonged predilation. A perfusion balloon combined with a drug-coated balloon was used. The stentless strategy achieved successful revascularization in most patients. No acute occlusion or in-hospital major adverse cardiac events were reported. A low incidence of target vessel failure at 24 months was reported.

DCBs were similarly safe and effective as current-generation DES in the treatment of coronary arteries <3 mm, regardless of bleeding risk. In patients treated with DCB, there was a trend towards a reduction of severe bleeding events at 3 years.

Vascular occlusive diseases, ranging from acute blockages to chronic arterial narrowing, represent a leading cause of morbidity and mortality worldwide. The deployment of vascular stents has long stood as a frontline therapeutic approach to restore blood flow within narrowed or obstructed vessels. Yet, despite advancements, the current landscape remains burdened by recurrent complications such as “intravascular restenosis,” where excessive smooth muscle cell proliferation narrows the vessel again, and delayed endothelial recovery that compromises vessel healing.

While stroke treatment has dramatically changed in recent years, still around 795,000 people experience a new or recurrent stroke each year, and of all strokes 87% are ischaemic.1 A high variability in accessing stroke treatments exists across different countries or different regions within the same nation, even if at present guidelines are quite definitive in indicating endovenous thrombolysis and mechanical thrombectomy (MT) in selected cases as key treatment points. However, treatment indications are continuously evolving and so the vascular surgery world should be prepared to evolve accordingly.

“Tracking a bridging stent to its target lesion can be a challenge,” Haulon remarked, going into more detail about some issues commonly encountered during FEVAR. “You need to get a sheath all the way from the groin through the fenestration and into the target vessel to protect the tracking of your bridging stent, so you need a bridging stent that can adapt to the anatomy and be flexible enough to get all the way to the target vessel.”

A press release notes that the SirPAD (Major adverse limb events in patients with femoropopliteal and below-the-knee peripheral arterial disease treated with either sirolimus-coated or uncoated balloon) randomised controlled trial is the world’s largest study evaluating the treatment of PAD using the MagicTouch PTA sirolimus-coated balloon versus uncoated balloons and one of the largest device studies ever performed for PAD.