Robert L. Wilensky

Performance of percutaneous coronary intervention (PCI) is associated with several occupational hazards including radiation exposure and musculoskeletal injury. Current methods to mitigate these risks range from suspended radiation suits to adjustable lead‐lined glass shields. Robotic‐assisted PCI is a novel approach to PCI that utilizes remote‐controlled technology to manipulate catheters thereby significantly reducing radiation exposure to the operator and catheterization laboratory staff. Although limited, current evidence indicates that robotic‐assisted PCI is associated with a high technical success rate and may have additional advantages over conventional PCI, such as a decreased incidence of geographical miss. However, as the technology is nascent, further studies including larger, randomized controlled trials are needed to expand on the long‐term clinical and safety outcomes.

Background—: Women P =0.003), driven largely by higher rates of repeat revascularizations for target vessel or target lesion failure (coronary artery bypass graft surgery: 8.9% versus 3.9%, P P =0.005, adjusted hazard ratio 1.6, 95% confidence interval 1.2–2.2). At 5 years, young women remained at higher risk for repeat procedures (coronary artery bypass graft surgery: 10.7% versus 6.8%, P =0.04, adjusted hazard ratio 1.71, 95% confidence interval 1.01–2.88; repeat PCI [target vessel]: 19.7% versus 11.8%, P =0.002, adjusted hazard ratio 1.8, 95% confidence interval 1.24–2.82). Compared with older women, younger women remained at increased risk of major adverse cardiovascular events, whereas all outcome rates were similar in older women and men. Conclusions—: Young women, despite having less severe angiographic coronary artery disease, have an increased risk of target vessel and target lesion failure. The causes of this difference deserve further investigation. Clinical Trial Registration—: URL: http://www.clinicaltrials.gov . Unique identifier: NCT00005677.

Background: Despite systemic exposure to risk factors, the circulatory system develops varying patterns of atherosclerosis for unclear reasons. In a porcine model, we investigated the relationship between site‐specific lesion development and inflammatory pathways involved in the coronary arteries ( COR s) and distal abdominal aortas ( AA s). Methods and Results: Diabetes mellitus ( DM ) and hypercholesterolemia ( HC ) were induced in 37 pigs with 3 healthy controls. Site‐specific plaque development was studied by comparing plaque severity, macrophage infiltration, and inflammatory gene expression between COR s and AA s of 17 DM / HC pigs. To assess the role of lipoprotein‐associated phospholipase A ₂ (Lp‐ PLA ₂ ) in plaque development, 20 DM / HC pigs were treated with the Lp‐ PLA ₂ inhibitor darapladib and compared with the 17 DM / HC untreated pigs. DM / HC caused site‐specific differences in plaque severity. In the AA s, normalized plaque area was 4.4‐fold higher ( P P =0.004), while normalized macrophage staining area was 1.5‐fold higher ( P =0.011) compared with COR s. DM / HC caused differential expression of 8 of 87 atherosclerotic genes studied, including 3 important in inflammation with higher expression in the COR s. Darapladib‐induced attenuation of normalized plaque area was site‐specific, as COR s responded 2.9‐fold more than AA s ( P =0.045). Conclusions: While plaque severity was worse in the AA s, inflammatory genes and inflammatory pathways that use Lp‐ PLA ₂ were more important in the COR s. Our results suggest fundamental differences in inflammation between vascular sites, an important finding for the development of novel anti‐inflammatory therapeutics.

The concept of the vulnerable atherosclerotic plaque first developed through histological evaluation of post-mortem coronary arteries has been significantly advanced in recent years by new imaging modalities. Imaging has: 1) verified histological findings, 2) identified features that are associated with unstable plaque, 3) followed plaques over time to study the dynamic nature of vulnerable plaque, 4) predicted clinical events based on imaging features, 5) tested the impact of medical interventions on plaque morphology. This review will summarize the major findings of imaging studies with a focus on how the knowledge base of vulnerable plaque has been advanced.

Animal models of atherosclerosis have proven to be an invaluable asset in understanding the pathogenesis of the disease. However, large animal models may be needed in order to assess novel therapeutic approaches to the treatment of atherosclerosis. Porcine models of coronary and peripheral atherosclerosis offer several advantages over rodent models, including similar anatomical size to humans, as well as genetic expression and development of high-risk atherosclerotic lesions which are similar to humans. Here we review the four models of porcine atherosclerosis, including the diabetic/hypercholesterolemic model, Rapacz-familial hypercholesterolemia pig, the (PCSK9) gain-of-function mutant pig model, and the Ossabaw miniature pig model of metabolic syndrome. All four models reliably represent features of human vascular disease.

Objective—To prospectively evaluate whether the development of fibroatheromas exhibiting features of potential instability can be detected and predicted by serial invasive imaging. Methods and Results—Multivessel intravascular ultrasound and near infrared spectroscopy (NIRS) were performed in diabetic/hypercholesterolemic pigs 3, 6, and 9 months after induction. Animals were euthanized at 9 months and histological/immunohistochemical evaluation of the arteries was performed (n=304 arterial segments). Intravascular ultrasound demonstrated, over time, a progressive increase in plaque + media and necrotic core areas and positive vascular remodeling. By histology, NIRS+ lesions were significantly more likely to be a high-risk fibroatheroma (P=0.0001) containing larger plaque (P<0.0001) and necrotic core areas (P<0.0019) and thinner fibrous caps (P=0.04). NIRS + fibroatheromas possessed a greater concentration of inflammatory cells demonstrating protease activity (P=0.006), and proliferating (P=0.016), and apo...