Despite ongoing progress in stent technology and deployment techniques, in-stent restenosis (ISR) still remains a major issue following percutaneous coronary intervention (PCI) and accounts for 10.6% of all interventions in the United States. With the continuous rise in ISR risk factors such as obesity and diabetes, along with an increase in the treatment of complex lesions with high-risk percutaneous coronary intervention (CHIP), a substantial growth in ISR burden is expected. This review aims to provide insight into the mechanisms, classification, and management of ISR, with a focus on exploring innovative approaches to tackle this complication comprehensively, along with a special section addressing the approach to complex calcified lesions.

Background: Coronary perforation is a life‐threatening complication of acute percutaneous coronary intervention (PCI) for chronic total occlusions (CTO), but data on midterm outcomes are limited. Methods and Results: Data from LATAM (Latin American)‐CTO Registry (57 centers; 9 countries) were analyzed. We assessed the risk of 30‐day, 1‐year major adverse cardiac events of coronary perforation using time‐to‐event and weighted composite end point analysis having CTO PCI without perforation as comparators. Additionally, we studied the independent predictors of perforation in these patients. Of 2054 patients who underwent CTO PCI between 2015 and 2018, the median Multicenter CTO Registry in Japan and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention‐Chronic total occlusions scores were 2.0 (1.0–3.0) and 1.0 (0.0–2.0), respectively. The perforation rate was 3.7%, of which 55% were Ellis class 1. After 1‐year coronary perforation had higher major adverse cardiac events rates (24.9% versus 13.3%; P <0.01). Using weighted composite end point, perforation was associated with increased bleeding and ischemic events at 6 months ( P =0.04) and 1 year ( P <0.01). We found as independent predictors associated with coronary perforation during CTO PCI: maximum activated clotting time ( P <0.01), Multicenter CTO Registry in Japan score ≥2 ( P =0.05), antegrade knuckle wire ( P =0.04), and right coronary artery CTO PCI ( P =0.05). Conclusions: Coronary perforation was infrequent and associated with anatomical and procedural complexity, resulting in higher risk of hemorrhagic and ischemic events. Landmark and weighted analysis showed a sustained burden of major events between 6 months and 1 year follow‐up.

Fractional flow reserve has become the mainstay of functional hemodynamic assessment and is considered the gold standard to identify ischemic coronary stenoses. However, adopting the method into daily practice has been limited. Indeed, it requires the use of a costly pressure wire and the administration of a hyperemic agent. Vessel fractional flow reserve is a 3D-QCA based fractional flow reserve, using CAAS Workstation (version 8.4; Pie Medical Imaging, Maastricht, the Netherlands). It is a non-invasive method that does not require pressure wire or hyperemic agent; therefore it is time saving and easy to use. This is the first case performed in Brazil and demonstrates the correlation between fractional flow reserve and vessel fractional flow reserve performed in the same lesion, and the feasibility of calculation of vessel fractional flow reserve using 3D QCA-based software. We report the case of a 61-year-old male, who was admitted for typical chest pain. Coronary angiography revealed serial intermediate lesions in the mid- and distal left anterior descending. We evaluated left anterior descending lesions initially by fractional flow reserve then by vessel fractional flow reserve. Fractional flow reserve in distal left anterior descending was 0.65. Then, vessel fractional flow reserve value was calculated at 0.61. In our case, the correlation was adequate and the feasibility with offline calculation was excellent and fast. To the best of our knowledge, this is the first case of vessel fractional flow reserve performed in Latin America. Therefore, we expect vessel fractional flow reserve to be a game changer in management of coronary artery disease patients, particularly those with intermediate lesions.

Background: The ridaforolimus-eluting stent (RES) is a new-generation drug-eluting stent (DES) featuring thin struts and a durable polymer, designed to provide a high therapeutic-to-toxicity margin. However, its long-term clinical performance remains uncertain. Methods: We conducted a systematic review and meta-analysis following Cochrane and PRISMA guidelines. PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) and prospective non-RCT studies evaluating RES in patients with coronary artery disease (CAD). Outcomes were expressed as event rates using a generalized [...] Abstract Background: The ridaforolimus-eluting stent (RES) is a new-generation drug-eluting stent (DES) featuring thin struts and a durable polymer, designed to provide a high therapeutic-to-toxicity margin. However, its long-term clinical performance remains uncertain. Methods: We conducted a systematic review and meta-analysis following Cochrane and PRISMA guidelines. PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) and prospective non-RCT studies evaluating RES in patients with coronary artery disease (CAD). Outcomes were expressed as event rates using a generalized