Purpose Inclisiran is a long-acting small interfering RNA (siRNA) which prevents the synthesis of PCSK9 in hepatocytes, reducing LDL-C concentration. Only limited data are available in the literature regarding its use in real-world settings. Methods In this observational multicenter registry, we included high cardiovascular risk patients from 12 lipid clinics in the Veneto region of Italy who started inclisiran therapy between October 2022 and February 2024. Primary endpoint was changes in LDL-C concentrations at 3 months of follow-up after inclisiran administration. Secondary endpoints were changes in LDL-C concentrations at 9 months of follow-up, safety, percentage of patients reaching LDL-C targets and efficacy of inclisiran according to background therapy and clinical characteristics of the population. Results Mean LDL-C levels at baseline (n = 240) were 118.7 ± 48.7 mg/dl, then they significantly fell to 56.7 ± 40.4 mg/dl (-52.3 ± 24.3%; p < 0.001) at 3 months (n = 238) and to 60.5 ± 40.1 mg/dl (-50.0 ± 22.7%; p < 0.001) at 9 months (n = 138). Three (1.3%) patients reported mild injection-site side effects. LDL-C target achievement according to ESC/EAS 2019 guidelines was 64.7% at 3 months and 62.3% at 9 months. Patients on statin therapy had a greater LDL-C reduction compared to patients with statin intolerance. At 3 months across we observed greater LDL-C reduction in patients with diabetes (59.9 ± 23.2% vs 49.7 ± 24.1%; p = 0.004). In the multivariable analysis diabetes mellitus (p = 0.006) and background statin therapy (p = 0.034) were independent predictors for greater LDL-C reduction. Conclusion This real-world multicenter registry supports inclisiran as an effective, well-tolerated option for managing hypercholesterolemia in high cardiovascular risk patients. Graphical Abstract Key findings and basal characteristics of the population studied (LDL-C, low-density lipoprotein cholesterol; LLT, lipid-lowering therapy; CV, cardiovascular; ASCVD, atherosclerotic cardiovascular disease; DM, diabetes mellitus; FH, familial hypercholesterolemia).

Accurate evaluation of stent implantation during percutaneous coronary intervention (PCI) is essential to reduce both early and late adverse events, including stent thrombosis and in-stent restenosis. Although conventional coronary angiography remains the standard imaging modality, its spatial resolution is often insufficient to detect subtle mechanical abnormalities of implanted stents. Enhanced stent visualization (ESV) is an X-ray-based post-processing technique that enhances delineation of stent struts using routine fluoroscopic images, without requiring additional contrast administration or intracoronary instrumentation. We describe a case series of five patients undergoing complex PCI in whom ESV proved crucial for the detection of mechanical complications that were not readily evident on angiography alone. The procedures involved challenging anatomical and clinical settings, including left main coronary artery treatment, bifurcation lesions, multivessel coronary disease, and acute coronary syndromes. In each case, ESV offered incremental diagnostic insight, enabling prompt identification of complications. These findings directly influenced procedural strategy and facilitated appropriate bailout interventions. This case series underscores the potential clinical utility of ESV as an adjunctive imaging tool to standard angiography and intravascular imaging techniques. Given its simplicity, broad accessibility, and negligible effect on procedure duration, ESV represents a feasible option during PCI. In selected complex interventions, its use may enhance mechanical optimization and procedural safety. Further large-scale prospective investigations are needed to corroborate the implementation of ESV in clinical practice.

Background: Accurate evaluation of stent implantation during percutaneous coronary intervention (PCI) is essential to reduce both early and late adverse events. Conventional coronary angiography, although routinely used, has limited spatial resolution and may fail to detect subtle mechanical abnormalities in implanted stents. Enhanced stent visualization (ESV) is an X-ray-based post-processing technique that improves delineation of stent struts without additional contrast or intracoronary instrumentation. Methods: We report a retrospective case series of five patients who underwent complex PCI where ESV was used as an adjunctive imaging modality. Clinical scenarios included left main interventions, bifurcation lesions, multivessel disease, and acute coronary syndromes. The ability of ESV to detect mechanical complications not evident on angiography was assessed. The impact of ESV on procedural decision-making was also assessed. Results: ESV enabled identification of mechanical complications in all cases, including stent fracture, stent loss, stent dislodgement, stent underexpansion, and geographical miss. These findings were not clearly appreciable when using angiography alone. In each case, ESV directly influenced intraprocedural management, prompting immediate corrective actions such as additional stent implantation, stent retrieval, or further optimization with post-dilatation or intravascular lithotripsy. This resulted in improved procedural outcomes and optimized stent deployment. Conclusions: In this small retrospective case series, ESV provided incremental diagnostic value over conventional angiography by detecting otherwise unrecognized mechanical complications and guiding real-time procedural optimization. While these findings suggest a potential role for ESV in complex PCIs, larger prospective studies are required to confirm its clinical impact.