Background: Patient-reported outcomes are integral to chronic coronary syndrome (CCS) care. The Seattle Angina Questionnaire (SAQ) is validated and prognostic, yet its clinical integration in Bulgaria is undefined. Aim: The aim of this study was to provide a structured, clinically oriented framework for integrating the SAQ into the full CCS care pathway—from screening and phenotyping (obstructive vs. ANOCA/INOCA endotypes) to diagnostics, mechanism-tailored therapy, and follow-up—while outlining a pragmatic roadmap for Bulgarian implementation. Methods: We conducted a semi-structured narrative review (1995–2024) of SAQ’s validation, prognostic utility, and implementation in the literature, augmented with guideline-based frameworks for CCS/ANOCA care. Results: The SAQ (and SAQ-7) shows strong reliability and responsiveness and independently predicts health status and clinical outcomes. Embedding the SAQ at baseline, at 4–12 weeks after therapy changes, and after 6–12 months enables symptom-guided decision-making. A phenotype-guided pathway is proposed that couples the SAQ with CAD burden assessment and—where indicated—ANOCA diagnostics (CFR/IMR, vasoreactivity testing). Mechanism-tailored therapy maps to endotypes (e.g., VSA → CCB ± nitrates; MVA → beta-blocker/ACEi/statin ± ranolazine; obstructive CADGDMT ± PCI/CABG). A minimum dataset, metrics, and registry fields are specified for Bulgarian deployment. Conclusions: A clinically structured framework clarifies how the SAQ adds value beyond description—by informing triage, treatment selection, and follow-up across CCS phenotypes. This approach provides educational guidance and a practical blueprint for pilot implementation in Bulgaria.

A major feature of the atherosclerotic process is its systemic and progressive character. The plaque pathogenetic mechanisms, morphology, evolution, and predilection site (bifurcation zones) determine the frequent coincidence of carotid and coronary atherosclerosis in the same patient. The present overview chronologically traces the history, effectiveness, and benefit of surgical and continuously improving interventional carotid revascularization. It thereby analyzes the indications, results, and complications based on a number of randomized clinical trials, industry-sponsored registries, and large single-center series in the last 3 decades. Carotid endarterectomy (CEA) and percutaneous carotid angioplasty (CAS) have evolved from ‘dubious’ procedures to a modern strategy resulting in a significantly lower incidence of stroke and death compared to medical treatment only. Although almost every second patient with carotid stenosis and indications for CAS has coronary atherosclerosis, studies on therapeutic modeling in such a combination are few, showing controversial results. Having both CHD and CS doubles the risk of myocardial infarction, stroke, HF, and death. An isolated revascularization approach compromises the results of therapeutic strategies and worsens patient survival. The high risk associated with coronary heart disease in CAS and CEA is a fact and minimization requires both an individualized and uniform stepwise revascularization strategy.

Gorlin–Goltz syndrome, also known as nevoid basal cell carcinoma syndrome (NBCCS), is a rare, inherited autosomal dominant disorder primarily caused by mutations in the PTCH1 gene, which regulates the Hedgehog signaling pathway. This genetic defect leads to the uncontrolled proliferation of basal cells, resulting in the formation of multiple basal cell carcinomas (BCCs) and odontogenic keratocysts (OKCs). This study aims to present a complex clinical case of a patient with Gorlin–Goltz syndrome who developed multiple recurrent metastatic basal cell carcinomas on the facial region, detailing the multidisciplinary treatment strategies employed and the challenges encountered during the management of the disease. The patient, diagnosed with a pathogenic PTCH1 gene mutation, underwent a series of treatment interventions over several years. These included multiple surgical excisions aimed at tumor removal, diverse radiotherapy approaches for residual or inoperable lesions, and systemic targeted therapy with Hedgehog pathway inhibitors to control tumor progression. The recurrent and aggressive nature of the basal cell carcinomas resulted in extensive facial tissue loss, posing significant challenges for radical tumor excision and subsequent reconstructive procedures. Multimodal therapeutic strategies, including Mohs micrographic surgery for precise tumor clearance and targeted systemic therapy with vismodegib, were implemented. However, the aggressive progression of lesions required ongoing surgical interventions, highlighting the limitations of current treatment modalities in achieving long-term disease control. This case underscores the critical need for a comprehensive, multidisciplinary approach to managing Gorlin–Goltz syndrome. Successful management requires close collaboration between dermatologists, oncologists, maxillofacial surgeons, and plastic surgeons to balance effective tumor control with optimal functional and aesthetic outcomes. The integration of advanced surgical techniques and targeted molecular therapies shows promise in improving patient outcomes. Nonetheless, early diagnosis, rigorous follow-up, and patient education remain essential components in minimizing disease progression and enhancing the quality of life for affected individuals.

With the development of specialized equipment and the retrograde technique, success rates for percutaneous coronary intervention of chronic total occlusions have increased from 60 to 90% in the past 10 years. Performing percutaneous coronary intervention via a collateral channel from the contralateral artery, using two guiding catheters, is usually the preferred approach to retrograde chronic total occlusion-percutaneous coronary intervention. In the case described in this report, we performed successful retrograde revascularization of chronic total occlusion of dominant left circumflex artery via the ipsilateral septal collateral artery from the left anterior descending artery. The procedure was performed successfully through radial artery access using a single guiding catheter. An 85-year-old white Bulgarian Caucasian male patient, with a history of lateral and inferior myocardial infarction 20 years ago and previous percutaneous coronary intervention, underwent a planned coronary arteriography owing to his complaints of typical angina symptoms. Coronary angiography revealed three-vessel coronary artery disease with patent implanted drug-eluting stents in the mid-left anterior descending artery and in the proximal right coronary artery and chronic total occlusion of dominant left circumflex artery. A septal branch in the midsegment of left anterior descending artery was supplying the distal left circumflex artery retrogradely. After repeated failed attempts at antegrade percutaneous coronary intervention for the left circumflex artery's chronic total occlusion, the retrograde approach was tried. This intervention finally succeeded through the ipsilateral septal collateral. It was performed via a single radial artery access throughout the whole process. Postoperatively, the patient had no complications and was stable at the 6-month follow-up. The transradial approach to retrograde percutaneous coronary intervention for chronic total occlusions via an ipsilateral septal collateral using a single guiding catheter is feasible and safe in appropriately selected cases.

Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains among the most complex procedures in interventional cardiology, with variable technical success and heterogeneous long-term outcomes. Conventional angiographic scores such as J-CTO and PROGRESS-CTO provide only modest predictive accuracy and neglect critical patient and operator-related factors. Artificial intelligence (AI) and machine learning (ML) have emerged as transformative tools, capable of integrating multimodal data and offering enhanced diagnostic, procedural, and prognostic insights. Methods: We performed a structured narrative review of the literature between January 2010 and September 2025 using PubMed, Scopus, and Web of Science. Eligible studies were peer-reviewed original research, reviews, or meta-analyses addressing AI/ML applications in CTO PCI across imaging, procedural planning, and prognostic modeling. A total of 330 records were screened, and 33 studies met the inclusion criteria for qualitative synthesis. Results: AI applications in diagnostic imaging achieved high accuracy, with deep learning on coronary CT angiography yielding AUCs up to 0.87 for CTO detection, and IVUS/OCT segmentation demonstrating reproducibility > 95% compared with expert analysis. In procedural prediction, ML algorithms (XGBoost, LightGBM, CatBoost) outperformed traditional scores, achieving AUCs of 0.73–0.82 versus 0.62–0.70 for J-CTO/PROGRESS-CTO. Prognostic models, particularly CatBoost and neural networks, achieved AUCs of 0.83–0.84 for 5-year mortality in large registries (n ≈ 3200), surpassing regression-based methods. Importantly, comorbidities and functional status emerged as stronger predictors than procedural strategy. Future Directions: AI integration holds promise for real-time guidance in the catheterization laboratory, robotics-assisted PCI, federated learning to overcome data privacy barriers, and multimodality fusion incorporating imaging, clinical, and patient-reported outcomes. However, clinical adoption requires prospective multicenter validation, harmonization of endpoints, bias mitigation, and regulatory oversight. Conclusions: AI represents a paradigm shift in CTO PCI, providing superior accuracy over conventional risk models and enabling patient-centered risk prediction. With continued advances in federated learning, multimodality integration, and explainable AI, translation from research to routine practice appears within reach.

Objective: To compare the effects of two nutritional supplementation strategies Amendcor® (Creatine, D-ribose, coenzyme Q10, and vitamin E) vs. Ubiquinol+D-ribose, combined with a 12-wk group-based high-intensity aerobic interval training (GB-HIAIT) on functional exercise capacity (FEC), health-related quality of life (HRQoL), left ventricular ejection fraction (LVEF), and perceived exertion (PE), in patients with heart failure with reduced ejection fraction (HFrEF). Design: 68 patients with HFrEF were randomly assigned to a Creatine + D-ribose + CoQ10 + Vit. E) ( n = 35) or a Ubiquinol + D-ribose group ( n = 33) and performed GB-HIAIT. The primary outcome was FEC, assessed via the 6-minute walk test (6MWT), peak VO₂, and peak respiratory exchange ratio (RER). Secondary outcomes included HRQoL, LVEF, and PE. Results: Study participants supplemented with Creatine + D-ribose + CoQ10 + Vit. E demonstrated significantly greater improvements in FEC (6MWT: +19.88%, VO₂ peak: +25.46%, PE: -38.53%), HRQoL: -25.64%, LVEF: +40.94%, compared with subjects supplemented with Ubiquinol + D-ribose (P < 0.05). Conclusions: Patients with HFrEF who received multi-ingredient supplementation combined with GB-HIAIT demonstrated superior improvements in FEC, HRQoL, LVEF, and PE, compared with those supplemented with Ubiquinol + D-ribose.