Drug eluting stent and coronary chronic total occlusions

Chronic total occlusion (CTO) is a common finding on diagnostic coronary angiography and represents one of the most challenging lesion subset in interventional cardiology. The introduction of dedicated guidewires and the development of new techniques have led to improve the success rate in the crossing of CTO lesion while the use of bare metal stent first, and, then, the use of drug eluting stent (DES) have significantly reduced the occurrence of restenosis and the need for target lesion revascularization in short and mid-term follow-up after CTO recanalization. However, new unsolved issues about the use of DES in CTO, that might impact long-term outcome, are emerging. The aim of this article is to review the current stage of knowledge on the application of stents in the treatment of CTO, with a particular attention to DES use and to DES-related challenges

Infections, immunity and atherosclerosis: Pathogenic mechanisms and unsolved questions

The role of inflammation and immunity in the pathogenesis and clinical manifestations of atherosclerotic disease has been widely studied. Common infectious diseases can be associated with a chronic inflammatory state which is the hallmark of atherosclerosis, thus suggesting a possible link between the two pathological conditions. Therefore, a great number of studies have tested the "infection hypothesis", but their results are conflicting. Nevertheless, several molecular and biological mechanisms possibly involved in the complex relationship between infections, immune response, vascular wall damage and atherosclerosis onset and progression have been described. The purpose of this article is to offer an overview of the principal mechanisms and molecular pathways that probably constitute the most relevant biological substrate on which the infection hypothesis is founded; some of these mechanisms are not fully understood yet. Nevertheless, their comprehension could be essential for the development of new preventive and therapeutic strategies

Drug eluting stent and coronary chronic total occlusions

Chronic total occlusion (CTO) is a common finding on diagnostic coronary angiography and represents one of the most challenging lesion subset in interventional cardiology. The introduction of dedicated guidewires and the development of new techniques have led to improve the success rate in the crossing of CTO lesion while the use of bare metal stent first, and, then, the use of drug eluting stent (DES) have significantly reduced the occurrence of restenosis and the need for target lesion revascularization in short and mid-term follow-up after CTO recanalization. However, new unsolved issues about the use of DES in CTO, that might impact long-term outcome, are emerging. The aim of this article is to review the current stage of knowledge on the application of stents in the treatment of CTO, with a particular attention to DES use and to DES-related challenges

Identification of unique adaptive immune system signature in acute coronary syndromes

Several studies have consistently demonstrated that inflammation plays a key role in the pathogenesis of acute coronary syndromes (ACS). More recent studies have highlighted the importance of adaptive immunity in ACS. In particular, profound abnormalities have been observed in specific subsets of T-cells, including CD4+CD28nullT-cells, a subset of cytotoxic CD4+T-lymphocytes producing large amount of interferon-\u3b3 (IFN-\u3b3), naturally occurring regulatory T-cells (Treg)and interleukin (IL)-17-producing T-cells (Th17). Our group systematically investigated the clinical relevance of adaptive immunity alterations, in a sizeable population of patients with non-ST elevation (NSTE)-ACS (n = 95), as compared with patients presenting chronic stable angina (SA) (n = 80) and individuals without overt cardiovascular diseases (controls) (n = 70). Our data show for the first time that about half of patients with ACS exhibit a unique immune profile, associated with a worse outcome at 1-year follow-up, which is very rarely found in SA and never in healthy controls. In this subset of ACS patients, the failure to mount a counter regulatory response to the activation of aggressive T-cells might play a key pathogenetic role and might represent an attractive therapeutic target [17]. The remaining half of ACS patients consisted of a small subset with an immune profile similar to that found in SA and in controls, and of a larger subset exhibiting a heterogeneous immune profile. In these subsets, coronary instability is unlikely to be caused by an inflammatory outburst