A revolutionary non-invasive method for the thorough evaluation of coronary artery disease (CAD) is fractional flow reserve (FFR) obtained from coronary computed tomography angiography (CCTA). Computed tomography-derived FFR (FFR_CT) assesses both the anatomical and functional significance of coronary lesions simultaneously by utilizing sophisticated computational models, including computational fluid dynamics, machine learning (ML), and Artificial Intelligence (AI) methods. The technological development, validation research, clinical uses, and real-world constraints of FFR_CT are compiled in this review. Large multicenter trials and registries consistently show that FFR_CT is a reliable gatekeeper to invasive coronary angiography (ICA) and increases diagnostic accuracy significantly when compared to coronary Computed Tomography Angiography (CTA) alone, especially in patients with intermediate-risk anatomy. Additionally, FFR_CT has demonstrated benefits in populations with in-stent restenosis (ISR) and in virtual procedural planning. Notwithstanding its advantages, the technique still requires high-quality imaging, and its practical application is constrained by expenses, processing requirements, and image distortions. Continuous developments in automation and deep learning should improve accessibility, effectiveness, and workflow integration in clinical settings. FFR_CT is expected to become more and more important in the individualized treatment of CAD by minimizing unnecessary invasive procedures and improving patient selection for revascularization.

Kounis syndrome is defined as the occurrence of acute coronary events in the setting of allergic, hypersensitivity, or anaphylactic reactions. It is mediated by mast cell activation and the interaction of inflammatory cells, including T lymphocytes and macrophages. This process leads to the release of multiple inflammatory mediators, such as platelet-activating factor, histamine, neutral proteases (tryptase and chymase), arachidonic acid metabolites, cytokines, and chemokines. Kounis syndrome represents a unique form of acute vascular disorder that may involve not only the coronary arteries but also peripheral, cerebral, and mesenteric vessels as well as the venous system. Contrast media are widely used in diagnostic imaging to enhance visualization and characterization of pathological conditions. These agents can be administered via several routes, including oral, intravenous, intra-arterial, or rectal administration. Although most hypersensitivity reactions to contrast media are mild to moderate, severe complications such as anaphylaxis, cardiac arrest, and Kounis syndrome may occur. In particular, contrast media-induced Kounis syndrome has been associated with significant clinical consequences, including an increased risk of life-threatening cardiac events.

Background and Objectives: Drug-coated balloon (DCB) angioplasty is a brief-contact endovascular drug-delivery technology in which efficacy must be generated during a single balloon inflation. Unlike drug-eluting stents (DES), DCBs have no permanent scaffold or polymer reservoir; they must preserve coating integrity during delivery, release drug at balloon-vessel contact, transfer drug into the arterial wall, and sustain biologically meaningful mural exposure after device removal. This review examines coronary DCBs as engineered platforms in which drug physicochemistry, excipient function, coating morphology, mechanical stability, balloon-vessel contact, tissue pharmacokinetics, and lesion substrate jointly shape angiographic and imaging response. Materials and Methods: By integrating bench coating-stability studies, computational delivery models, porcine pharmacokinetic and downstream-response studies, intravascular imaging, randomized clinical trials, and meta-analyses, this review proposes a platform-focused mechanistic framework. Results: DCB performance should not be interpreted as a simple drug-class effect. Devices carrying the same antiproliferative agent may differ because of coating cohesion, particle loss, excipient chemistry, adhesion switching, carrier design, dose density, release trigger, and temporary tissue-reservoir formation. Paclitaxel has physicochemical features favorable for brief-contact delivery, whereas limus-based balloons generally require more explicit delivery engineering through crystalline, nanoparticle, phospholipid, porous-infusion, or micro-reservoir architectures. Coating survival during tracking, triggered release, wall apposition, tissue deposition, intramural distribution, retention kinetics, and lesion preparation are treated as upstream determinants of late lumen loss, binary restenosis, late lumen enlargement, remodeling, and repeat revascularization. Conclusions: However, performance remains platform-specific rather than drug-class determined. The aim is not to provide a clinical algorithm, but to clarify how device engineering and lesion context shape the angiographic and imaging phenotype of contemporary coronary DCB therapy.

Background and Objectives: Coronary drug-coated balloons (DCBs) deliver antiproliferative therapy during a single inflation without leaving a permanent scaffold or implanted drug reservoir. Their performance therefore depends on preservation of the coating during delivery, efficient vessel-wall transfer, and sufficient tissue exposure after balloon removal. This review critically examines the evidence for platform engineering, tissue exposure, and angiographic or intravascular imaging response. Materials and Methods: This narrative review synthesized English-language experimental, pharmacokinetic, imaging, and clinical evidence identified through the original PubMed, Scopus and Google Scholar searches and a documented PubMed search during revision on 9 September 2026. Exact queries, record dispositions and descriptive study appraisals are supplied; conference abstracts, preprints and unpublished data were excluded. Results: DCB performance is platform-specific rather than determined by drug class alone. Within both paclitaxel- and limus-based devices, excipient chemistry, coating or carrier architecture, release behavior, and retention strategy may influence drug delivery. Bench and computational studies identify potential transfer and drug-loss pathways, pharmacokinetic studies measure tissue exposure, and imaging and clinical studies assess morphology and outcomes separately. The cited human studies do not quantify coronary tissue drug exposure. Findings from unrelated platforms and models cannot establish a causal delivery-to-outcome pathway. Conclusions: Coronary DCBs should be evaluated as integrated, device-specific drug-delivery platforms. Standardized studies linking engineering performance and tissue exposure with imaging and clinical outcomes are needed.

Heart failure remains a major cause of morbidity and mortality despite advances in guideline-directed medical therapy and device-based treatment. Cardiac resynchronization therapy delivered by conventional biventricular pacing constitutes an established therapeutic strategy for selected patients with heart failure with reduced ejection fraction and electrical desynchrony. Left bundle branch area pacing has emerged as a physiological pacing strategy that directly engages the conduction system, providing more effective electrical and mechanical resynchronization. Current evidence from observational studies, randomized pilot trials, and recent multicentre data suggest that left bundle branch pacing may achieve greater QRS narrowing, more favourable pacing thresholds, improved left ventricular ejection fraction, and reduced heart failure hospitalizations compared with conventional biventricular pacing in selected patients. This review summarizes the rationale, implantation criteria, patient selection, and current clinical evidence supporting left bundle branch pacing as an alternative pacing modality in heart failure patients. Despite encouraging available data, larger randomized trials with longer follow-up and broader patient populations are required to clarify long-term safety and to determine whether left bundle branch pacing should be adopted as a routine alternative to conventional cardiac resynchronization therapy. From a personalized medicine perspective, the choice between conduction system pacing and conventional biventricular pacing should be guided by individual patient characteristics, including conduction phenotype, QRS morphology and duration, myocardial scar burden, heart failure aetiology, coronary venous anatomy, and the chance of achieving confirmed conduction-system capture. This review therefore renders left bundle branch pacing within an individualized, phenotype-guided resynchronization strategy rather than as a universal replacement for biventricular pacing.