simvastatin + triflusal (IRIST stent)

Feasibility of On-Site CT-FFR Analysis in Ruling Out In-Stent Restenosis on Cardiac PCCT.

Ayx Isabelle I, Waßmer Felix F, Lichti Lena L, Froelich Matthias F MF et al.

The evaluation of stents in coronary computed tomography angiography (CCTA) is still a major topic in cardiovascular imaging. Using Photon-Counting Detector CT (PCCT) may improve the assessment of coronary stents and make on-site CT-FFR analysis feasible for ruling out in-stent restenosis (ISR). In this study, patients with previous coronary stent implantation who underwent CCTA using PCCT and subsequent invasive catheter angiography (ICA) were included. Stent characteristics such as location and length were reported. CT-FFR measurements were taken 1.8 cm before and after the stent, with a value of ≤0.80 defined as hemodynamically significant under respecting the diagnostic accuracy drop in the gray zone between 0.76 and 0.80. Delta CT-FFR with a cut-off value of ≥0.06, indicating hemodynamic significance, was determined. Any ISR and interventional treatment during the following ICA was recorded. Diagnostic performance metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated for post-stent CT-FFR and Delta CT-FFR in detecting ISR. Patients were followed up to evaluate the rate of major adverse cardiovascular events (MACE) 6 months after CCTA. A total of 19 patients (5 female, 14 male, median age 69 years) were enrolled in this study. In most cases, coronary stents were located in the proximal LAD with a median stent length of 70.2 mm. Pathological CT-FFR < 0.76 distal to the stent was detected in 6 cases (31.6%), while pathological Delta CT-FFR ≥ 0.06 occurred in 14 cases (73.7%). ICA was performed in three of these patients, with ISR confirmed in two cases. These findings yield sensitivity and NPV of 100% for both post-stent CT-FFR and Delta CT-FFR for excluding ISR with a superior specificity (76.5% vs. 29.4%) and overall diagnostic accuracy (78.9% vs. 36.8%) for post-stent CT-FFR. Two patients reported a myocardial infarction in follow-up; however, neither of them was located in the territory of the stented coronary artery. This study outlines the feasibility of on-site CT-FFR analysis using PCCT in excluding ISR in coronary stents with a high diagnostic accuracy. These findings highlight the need to extend the benefits of CT-FFR analysis for non-invasive assessment of possible ISR regarding personalized risk stratification and therapy planning.

Three-Year Outcome of VBX Stent Graft Used as a Bridging Stent in Endovascular Repair of Post-Dissection Thorachoabdominal Aortic Aneurysm.

Jonsdottir Frida F, Bertoglio Luca L, Resch Timothy T, EMBRACE Investigators

Post-dissection thoracoabdominal aortic aneurysm (PD-TAAA) is a late sequela of chronic aortic dissection. Complex endovascular aneurysm repair (EVAR), including fenestrated and branched techniques (F/B-EVAR), enables aneurysm exclusion while preserving visceral perfusion; however, bridging stents are not specifically designed for PD-TAAA and are frequently used off-label. Evidence on bridging stent performance is largely derived from degenerative aneurysm cohorts, and PD-TAAA-specific data remain limited. This study evaluated outcomes of the VBX Stent Graft when used as a bridging stent during F/B-EVAR for PD-TAAA. This retrospective analysis included patients with PD-TAAA from the EMBRACE registry (ClinicalTrials.gov: NCT05143138), a multicenter, single-arm registry with retrospective and prospective components, with all outcomes core-laboratory-adjudicated. Procedural, early (thirty-day), and midterm outcomes at one and three years were assessed. The primary endpoints were all-cause mortality and freedom from target vessel instability, defined as loss of durable target vessel reconstruction. Twenty-one patients (mean age 61.5 years; range, 28-77 years) underwent F/B-EVAR with at least one VBX Stent Graft. In total, 82 visceral arteries were treated, of which 51 were bridged with a VBX Stent Graft. Technical success was 100%. Two serious adverse events occurred perioperatively, one requiring reintervention, with no thirty-day mortality or major adverse events. Freedom from all-cause mortality was 95.2% at one year and 90.5% at three years, with two deaths during follow-up. Freedom from target vessel instability at the patient level was 85.7% at both one and three years (95% CI, 62.0-95.2%). VBX Stent Grafts used as bridging stents during F/B-EVAR for PD-TAAA demonstrated high technical success, low early morbidity and mortality, and acceptable mid-term survival and target vessel stability, supporting their use in this challenging anatomical setting within the limitations of a small PD-TAAA cohort.

Magnetically responsive PLGA-magnetite nanoparticles for in vitro stent targeting and delivery of therapeutic agents.

Kitching Michael M, Kozlowska Dorota D, Bashmail Roa R, Di Luca Mariana M et al.

Coronary artery disease presents as an obstruction to coronary blood flow due to the presence of a vascular lesion. Treatment options include percutaneous transluminal coronary angioplasty and the deployment of a vascular stent to keep the artery open. However, in-stent restenosis can still occur because of neointimal hyperplasia driven by the accumulation of vascular smooth muscle cell (VSMC)-like cells within the stented vessel segment. Drug-eluting stents (DES) reduce restenosis by locally releasing anti-proliferative agents. Yet, current DES platforms are limited by fixed drug loading at implantation and the inability to replenish the drug at the stent after depletion. Here, we developed a magnetically responsive nanoparticle platform as a proof-of-concept strategy for targeted stent drug reloading. Poly (lactic-co-glycolic acid) magnetite nanoparticles (PLGA-MNPs) were engineered to encapsulate paclitaxel or the γ-secretase inhibitors, DAPT and Compound E. Nanoparticles were characterised by dynamic light scattering, electron microscopy, and inductively coupled plasma atomic emission spectroscopy. Their ability to bind stainless steel stents, release drugs, and modulate cellular responses was examined in vitro. PLGA-MNPs exhibited a mean hydrodynamic diameter of ~215 nm with low polydispersity and stable suspension properties. Fluorescence imaging demonstrated increased retention of FITC-labelled PLGA-MNPs on stainless steel stents in the presence of a static magnetic field. Paclitaxel-loaded PLGA-MNPs inhibited murine mesenchymal stem cell proliferation, with enhanced efficacy observed under magnetic field exposure. Similarly, γ-secretase inhibitor-loaded PLGA-MNPs attenuated Jagged-1-induced expression of myogenic and Notch-responsive genes in vitro. Drug release from PLGA-MNPs was increased in the presence of a magnetic field over extended incubation periods. Notably, exposure to a static magnetic field alone also influenced gene expression, indicating that magnetic field effects must be considered when interpreting biological outcomes. Collectively, these findings demonstrate the feasibility of magnetically responsive PLGA-MNPs as a stent-targeted drug delivery platform. Further studies under physiological flow conditions and in vivo vascular injury models will be required to establish safety, targeting efficiency, and therapeutic efficacy.

Covered stent implantation for hepatic artery stenosis following liver transplantation with coronary devices.

Malina Mateusz M, Milnerowicz Artur A, Milnerowicz Aleksandra A, Doroszko Adrian A et al.