Over the last decade, care for cardiogenic shock has evolved from early recognition to timely mechanical support and escalation. A central driver of improvements has been the adoption of best-practice protocols and the formation of dedicated shock teams. Recent studies show that protocolized care improves outcomes by enabling rapid identification of patients at risk of deterioration, delivering appropriate support, revascularization with or without mechanical support, and ensuring swift transfer to a tertiary center when escalation is necessary.
The effective and safe delivery of drugs to arterial targets via endovascular devices is governed by several key principles. These include the concepts of dissolution, diffusion and convection, drug binding (specific and nonspecific), the presence of barriers to absorption, mechanically driven delivery, and finally, the interaction between the drug, delivery vehicle, and the accepting arterial wall. Though the understanding of stent-based drug delivery is vast, more work is needed to better define the drivers of balloon-based delivery.
Despite advances in stent platform technologies and procedural techniques, stent failure remains a critical clinical consideration, accounting for approximately 10% of invasive coronary procedures. Various mechanisms underlying stent failure can now be readily identified using intracoronary imaging modalities, including neointimal hyperplasia and neoatherosclerosis, stent thrombosis, stent fracture, and stent recoil. This review provides an overview of these etiologies in contemporary practice.
Endovascular implants, such as stents, flow diverters, and endografts, have reshaped cardiovascular therapy but still face trade-offs in restenosis, thrombosis, sizing, and fatigue. Conventional, prototype-driven development is expensive and ill-suited to broad design spaces or inter-patient variability. Emerging digital-twin (DT) approaches, combining imaging, FEA, CFD, and machine learning, enable patient-specific in-silico deployment, prediction of device-tissue interactions, and virtual trials. This review summarizes key design parameters, critiques the traditional pipeline, and surveys DT frameworks for stents and endografts, including reconstruction, simulation, and verification/validation. We outline opportunities for computational optimization, artificial intelligence, and additive manufacturing in personalized therapy.
Covered stents have been utilized in percutaneous coronary interventions (PCIs) for over 2 decades. They are an essential part of the PCI toolbox, especially for the management of complications. Over the last decade, covered stents have been additionally utilized for various other coronary indications with mixed results. The overall design of covered stents has continued to evolve improving the ease, the deliverability, and removing some of the challenges that were faced before in view of the bulky design. These advances can facilitate further use in the future with potentially better long-term outcomes.
In-stent restenosis (ISR) remains a major clinical issue despite the widespread use of new-generation drug-eluting stents (DESs). Although DESs are effective in reducing neointimal hyperplasia, delayed endothelial healing and neoatherosclerosis are key complications of ISR that remain unresolved. Recent advances in noninvasive and intravascular imaging techniques have improved lesion assessment, while treatment options such as additional DES implantation and drug-coated balloons have become more widely available. Understanding ISR pathophysiology, together with the appropriate use of imaging modalities, is essential for selecting optimal therapies and guiding future development of ISR treatments and next-generation DESs.
Coronary and peripheral endovascular revascularization has advanced far beyond plain old balloon angioplasty and bare metal stents. Modern revascularization approaches now utilize new-generation antiproliferative drugs that are delivered from drug-eluting stents and balloons using complex nanotechnology. Despite these contemporary approaches, neointimal hyperplasia continues to pose challenges in the form of stent thrombosis and in-stent restenosis, infrequently requiring reintervention. Fortunately, there is tireless ongoing work aiming to improve our current anti-restenosis agents and drug delivery platforms. This review aims to summarize the state of our therapeutics and drug delivery systems while also highlighting promising areas of next-generation technological development.
This article reviews the evolution and current development of stent platforms for pediatric and congenital heart disease. It highlights limitations of off-label use of adult stents, the emergence of growth-compatible technologies such as the Renata Minima, and the promise and challenges of bioresorbable scaffolds. Emphasis is placed on engineering strategies-including , computational modeling, material biocompatibility, and patient-specific design-that are accelerating innovation in this field. The review synthesizes recent progress across multiple platforms and provides clinical insights into optimizing stent selection and future integration into pediatric interventional strategies.
Drug-eluting resorbable scaffolds represent a transformative advancement in percutaneous vascular intervention, integrating the benefits of balloon angioplasty and drug-eluting stents into a single, transient device. These scaffolds are engineered to "leave nothing behind" by providing temporary mechanical support, facilitating vascular healing, and ultimately degrading benignly while restoring natural vessel function. Tailoring material degradation kinetics to align with specific physiologic demands is key. Clinical studies have been performed for both coronary and peripheral artery disease, and learnings from early device design have contributed to improvements in second-generation devices which are now either under clinical evaluation or approved for use.
Takotsubo cardiomyopathy is seen after intense emotional or physical triggers. The authors present a 72-year-old woman who experienced acute substernal chest pain and dyspnea after an acupuncture session. Electrocardiogram revealed anterolateral ST elevations, and chest radiograph revealed pneumothorax.
