13are common morphological findings in fatal cases of LST after DES.9-14 DES can interfere with this physiological healing process through different mechanisms: first, the antiproliferative drug released by the device prevents the cellular mitosis required to restore the endothelial continuity; second, the polymer carrying the drug exerts a proinflammatory effect itself 15 ; finally, in Background-Lack of re-endothelialization and neointimal coverage on stent struts has been put forward as the main underlying mechanism leading to late stent thrombosis. Incomplete stent apposition (ISA) has been observed frequently in patients with very late stent thrombosis after drug eluting stent implantation, suggesting a role of ISA in the pathogenesis of this adverse event. The aim of this study was to evaluate the impact of different degrees of ISA severity on abnormal shear rate and healing response with coverage, because of its potential implications for stent optimization in clinical practice. Methods and Results-We characterized flow profile and shear distribution in different cases of ISA with increasing strutwall detachment distance (ranging from 100 to 500 μm). Protruding strut and strut malapposed with moderate detachment (ISA detachment distance <100 μm) have minimal disturbance to blood flow as compared with floating strut that has more significant ISA distance. In vivo impact on strut coverage was assessed retrospectively using optical coherence tomography evaluation on 72 stents (48 patients) sequentially at baseline and after 6-month follow-up. Analysis of coverage revealed an important impact of baseline strut-wall ISA distance on the risk of incomplete strut coverage at follow-up. Malapposed segments with an ISA detachment <100 μm at baseline showed complete strut coverage at follow-up, whereas segments with a maximal ISA detachment distance of 100 to 300 μm and >300 μm had 6.1% and 15.7% of their struts still uncovered at follow-up, respectively (P<0.001). Conclusions-Flow disturbances and risk of delayed strut coverage both increase with ISA detachment distance. Insights from this study are important for understanding malapposition as a quantitative, rather than binary phenomenon (present or absent) and to define the threshold of ISA detachment that might benefit from optimization during stent implantation. (Circ Cardiovasc Interv. 2014;7:180-189.)

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When conventional NC balloons fail, the new OPN NC dedicated high-pressure balloon provides an effective and safe alternative strategy for the dilatation of resistant coronary lesions.

Advanced CTO techniques and equipment have resulted in an increase in the successful treatment of highly complex lesions. Total success rate did not substantially improve, as it was counterbalanced by the increased rate at which complex lesions were attempted.

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In experienced centers, MitraClip treatment can be performed safely and effectively in both central and noncentral dMR.

Based on OCT, the BVS showed similar post-procedure area stenosis, minimal lumen area, and eccentricity index as second-generation DES. The different approach for lesion preparation and routine use of OCT guidance during BVS expansion may have contributed to these results.

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