Multivessel coronary artery disease (MVD) affects approximately 40–60% of patients undergoing coronary angiography and remains a major contributor to cardiovascular morbidity and mortality worldwide. The optimal revascularization strategy—whether percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or hybrid coronary revascularization (HCR)—continues to evolve with advancements in technology, imaging, and evidence-based practice.

Objective

To evaluate contemporary revascularization strategies in multivessel coronary disease, comparing clinical outcomes, procedural characteristics, and long-term prognosis associated with PCI, CABG, and hybrid approaches.

Methods

A multicenter comparative study involving 720 patients with angiographically confirmed multivessel coronary artery disease was conducted. Patients underwent PCI (n=320), CABG (n=280), or HCR (n=120). Procedural outcomes, in-hospital events, and 24-month major adverse cardiovascular and cerebrovascular events (MACCE) were analyzed.

Results

CABG demonstrated the lowest rate of repeat revascularization (6.4%), while PCI showed shorter hospital stays and lower procedural morbidity. Hybrid revascularization provided favorable outcomes with reduced invasiveness and comparable survival. Twenty-four-month MACCE rates were 18.1% for PCI, 12.5% for CABG, and 13.3% for HCR.

Conclusion

CABG remains the preferred strategy for complex multivessel disease, particularly among diabetic patients and those with high anatomical complexity. PCI offers excellent outcomes in selected patients with less complex disease. Hybrid revascularization represents a promising alternative combining the benefits of surgical durability and minimally invasive intervention

Coronary artery perforation (CAP) is an uncommon but potentially catastrophic complication of percutaneous coronary intervention (PCI). Despite advances in device technology and operator expertise, CAP remains associated with significant morbidity and mortality. Contemporary treatment strategies have evolved considerably, incorporating covered stents, embolization techniques, and rapid pericardial intervention.

Objective

To evaluate the incidence, predictors, management approaches, and clinical outcomes of coronary artery perforation during contemporary PCI procedures.

Methods

A prospective observational study was conducted involving 8,520 consecutive PCI procedures performed between January 2022 and December 2024 at three tertiary cardiac centers. Patients who developed coronary artery perforation were identified and analyzed. Clinical, angiographic, procedural, and outcome data were collected.

Results

Coronary perforation occurred in 52 patients (0.61%). The majority were Ellis Type II (42.3%) and Type III (34.6%) perforations. Independent predictors included severe calcification, chronic total occlusion (CTO), rotational atherectomy, and hydrophilic guidewire use. Covered stents were utilized in 36.5% of cases, coil embolization in 13.5%, and prolonged balloon inflation in 65.4%. Cardiac tamponade developed in 25.0% of patients. Overall in-hospital mortality was 7.7%.

Conclusion

Coronary artery perforation remains a rare but life-threatening complication of PCI. Early recognition, immediate hemostatic measures, and availability of contemporary bailout devices significantly improve patient outcomes.

Dual antiplatelet therapy (DAPT) consisting of aspirin and a P2Y12 receptor inhibitor remains the cornerstone of pharmacological management following percutaneous coronary intervention (PCI). Ticagrelor, a potent reversible P2Y12 inhibitor, has demonstrated superior platelet inhibition compared with clopidogrel. However, concerns regarding bleeding complications, dyspnea, and cost continue to influence clinical decision-making.

Objective

To compare the effectiveness and safety of ticagrelor versus clopidogrel in patients undergoing PCI for acute coronary syndrome (ACS) and stable coronary artery disease.

Methods

A prospective multicenter observational study included 1,200 patients undergoing PCI between January 2020 and December 2024. Patients received either ticagrelor-based DAPT (n=620) or clopidogrel-based DAPT (n=580). Primary outcomes included major adverse cardiovascular events (MACE), myocardial infarction (MI), stent thrombosis, stroke, mortality, and bleeding complications during 12-month follow-up.

Results

Ticagrelor significantly reduced MACE compared with clopidogrel (7.4% vs. 11.2%, p=0.018). Rates of myocardial infarction and definite stent thrombosis were lower in the ticagrelor group. However, major bleeding occurred more frequently among ticagrelor-treated patients (4.0% vs. 2.1%, p=0.041). All-cause mortality was significantly reduced with ticagrelor (2.4% vs. 4.1%, p=0.033).

Conclusion

Ticagrelor demonstrated superior ischemic protection and lower mortality compared with clopidogrel after PCI, albeit with a modest increase in bleeding risk. These findings support the preferential use of ticagrelor in patients at high ischemic risk and acceptable bleeding risk.

Dual antiplatelet therapy (DAPT), consisting of aspirin combined with a P2Y12 receptor inhibitor, remains a cornerstone of post-percutaneous coronary intervention (PCI) management following drug-eluting stent (DES) implantation. While prolonged DAPT reduces ischemic complications, it increases bleeding risk. The optimal duration remains a subject of ongoing investigation.

Objective

To review contemporary evidence regarding DAPT duration following DES implantation, evaluate clinical outcomes associated with short-, standard-, and extended-duration DAPT, and discuss individualized treatment strategies.

Methods

A comprehensive review of randomized controlled trials, meta-analyses, international guidelines, and observational studies published between 2010 and 2025 was performed. Clinical outcomes including stent thrombosis, myocardial infarction, bleeding events, and mortality were analyzed.

Results

Advances in second- and third-generation DES technology have enabled shorter DAPT regimens without significantly increasing stent thrombosis risk in selected patients. Short-duration DAPT (1–3 months) is increasingly favored in patients at high bleeding risk, while extended DAPT beyond 12 months may benefit selected high ischemic-risk populations. Individualized treatment guided by ischemic and bleeding risk scores provides the most effective strategy.

Conclusion

Modern DES platforms have transformed antiplatelet management following PCI. Personalized DAPT duration based on patient characteristics, procedural complexity, and risk stratification tools optimizes clinical outcomes while minimizing adverse events.

Complex percutaneous coronary intervention (PCI) requires careful anticoagulation to prevent thrombotic complications while minimizing bleeding risk. Patients undergoing left main PCI, bifurcation stenting, chronic total occlusion intervention, atherectomy-assisted PCI, multivessel PCI, and long-stent procedures often have prolonged procedural time, increased device manipulation, higher thrombus risk, and greater bleeding vulnerability. This article reviews contemporary anticoagulation strategies during complex PCI, including unfractionated heparin, bivalirudin, glycoprotein IIb/IIIa inhibitors, anticoagulation monitoring, reversal considerations, and management of high-risk patient groups.