Dario Buccheri

Azienda Ospedaliera Fatebenefratelli e Oftalmico Milano | Fatebenefratelli · Department of Cardiology

Aims Whether patients with spontaneous coronary artery dissection (SCAD) should undergo an initial conservative management or immediate revascularization through percutaneous coronary intervention (PCI) remains debated. To investigate the frequency and predictors of choosing a strategy of immediate PCI for SCAD, and to compare the clinical outcomes...

Aims The role of antiplatelet therapy in patients with spontaneous coronary artery dissection (SCAD) undergoing initial conservative management is still a matter of debate, with theoretical arguments in favour and against its use. The aims of this article are to assess the use of antiplatelet drugs in medically treated SCAD patients and to investig...

Coronary artery fistula is a rare anatomic abnormality of the coronary arteries that affects 0.002% of the general population and represents 14% of all anomalies of coronary arteries. Its clinical relevance focuses mainly on the mechanism of the coronary steal phenomenon, causing myocardial functional ischemia, even in the absence of stenosis; ther...

Objectives This study sought to compare the performance of a novel drug-coated balloon (DCB) (Elutax SV, Aachen Resonance, Germany), with an everolimus-eluting stent (EES) (Abbott Vascular, Santa Clara, California) in patients with de novo lesions. Background Small vessel coronary artery disease (SVD) represents one of the most attractive fields o...

Spontaneous coronary artery dissection is often underdiagnosed. It accounts for a certain amount of acute coronary syndromes. Intravascular imaging, either intravascular ultrasound or optical coherence tomography, represents a relevant ally for interventional cardiologist. Here we report an intriguing case of spontaneous coronary artery dissection...

Drug-coated balloons (DCBs) are a novel development for percutaneous coronary intervention. The first successful application was in-stent restenosis but in recent years, strong evidence has been released for its use in native small-vessels disease. Additional applications such as acute myocardial infarction, chronic total occlusion and bifurcation...

Background: Coronary Aneurysms are a focal dilatation of an artery segment >1.5-fold the normal size of adjacent segments. Although some series have suggested a prevalence of 0.3-12%, data are lacking. In addition, they are not mentioned in practice guidelines. Our aim was investigate its prevalence, management and long-term outcomes. Methods and...

Drug-coated balloon (DCB) is a relatively novel device for coronary and peripheral artery disease management [1]. It consists in a conventional balloon angioplasty covered by an antiproliferative drug. This technology allows to bring high concentration of an antiproliferative drug with rapid local delivery without the implantation of an external pr...

The advent of balloon angioplasty (BA) for the treatment of coronary artery disease was performed by Andreas Grüntzig in 1977 [1] (Fig. 1.1) and represented a breakthrough in the field of cardiology: by that time, we can say that modern interventional cardiology was born.

Intrarenal hemodynamic alterations are independent predictors of cardiovascular events in different populations. It has been hypothesized that there is an association between renal hemodynamics and coronary atherosclerotic burden in patients with hypertension. Therefore, the present study examined the associations between renal hemodynamics, corona...

Objectives: This study compared the performance of major heart failure (HF) risk models in predicting mortality and examined their utilization using data from a contemporary multinational registry. Background: Several prognostic risk scores have been developed for ambulatory HF patients, but their precision is still inadequate and their use limi...

In-stent restenosis (ISR) still represents a frequent limitation of percutaneous coronary intervention despite the introduction of latest-generation drug-eluting stents (DES), drastically lowering the overall incidence of ISR. Thus, the treatment of DES ISR remains a real brainteaser for interventional cardiologists.

Coronary artery fistula (CAF) is a relatively rare anatomic abnormality of the coronary arteries that afflicts 0.002% of the general population and represents 14% of all the anomalies of coronary arteries. Its clinical relevance focusses mainly on the mechanism of “coronary steal phenomenon”, causing myocardial functional ischaemia even in the abse...

Objectives: to compare the 1-year outcome between bioresorbable vascular scaffold (BVS), everolimus-eluting stent (EES), and drug-eluting balloon (DEB) for in-stent restenosis (ISR) treatment. Background: BVS has been proposed as alternative for ISR treatment. To date a direct comparison between BVS and DES or DEB for ISR treatment is lacking....

Spontaneous coronary artery dissection (SCAD) is still today an underdiagnosed disease due to the absence of angiographic hallmarks in more than 70% of cases. In several cases, an intravascular imaging is a sole tool for recognizing a dissection. Particularly, optical coherence tomography analysis (OCT) could represent the gold standard technique o...

Spontaneous coronary artery dissection (SCAD) and takotsubo cardiomyopathy (TTS) are two non-atherosclerotic causes of myocardial infarction. They share several common features. Firstly, they have a predilection for the female gender and, in both, the exact mechanism has yet to be fully established. Both they could be responsible for an acute coron...

Background: Takotsubo syndrome (TS) is a recently described cardiac syndrome whose pathogenesis is still unclear. We investigated the characteristics of coronary microcirculatory function in patients with TS through the analysis of the TIMI frame count (TFC) compared to normal subjects and with to subjects with microvascular angina (MA). Methods:...

After the introduction of drug eluting stent (DES) the rate of in-stent restenosis (ISR) has decreased if compared to the BMS era; however, treatment of patients with ISR remained a major issue for the interventional cardiologist. DES has been largely used with good results also as second layer for the treatment of ISR, but the overall percentage o...

In the last years, the fourth revolution of interventional cardiology, represented by bioresorbable vascular scaffolds (BVS), became real. BVS’s prerogatives are a good radial force to counter back acute vessel recoil for the time needed, then a complete disappearance after few years. Latest generation drug-eluting stents (DES) showed that a reduct...

Recently Antonio Ruggiero et al. [1] published an interesting case of a young 39-year-old woman with acute chest pain following a quarrel with her mother, mimicking Takotsubo cardiomyopathy (TT), due to spontaneous coronary artery dissection (SCAD) of the left anterior descending artery (LAD) treated with three bioresorbable vascular scaffolds (BVS...

Treatment of recurrent in-stent restenosis is a real brain teaser for the interventional cardiologist who cannot resort to the guidelines to have indications about the type of treatment to be preferred. The use of intracoronary imaging may provide insights into the underlying mechanisms of this complication and use of drug coated balloons may be a...

In the treatment of stable coronary artery disease (CAD) the identification of patients who may gain the highest benefit from further invasive treatments is of pivotal importance for the healthcare system. In this setting, it has been established that an ischemia-guided revascularization strategy yields improved clinical outcomes in a cost- effecti...

The lumen diameter reduction after percutaneous coronary intervention (PCI) is well known as "restenosis". This phenomenon is due to vessel remodeling/recoil in case of no-stent strategy or, in case of stent employ, "neointimal proliferation" that consists in an excessive tissue proliferation in the luminal surface of the stent otherwise by a furth...

This is the first documented case of a drug-coated balloon strategy for the treatment of bioresorbable in-scaffold restenosis caused by diffuse neointimal proliferation. This case can provide an alternative treatment option in this setting, avoiding potential problems related to further bulky metallic stents in a patient where a different strategy...

Background: Insulin resistance (IR), constitutes an important cardiovascular risk factor and can cause ischemic heart disease. It can lead to left ventricular dysfunction with a mechanism independent of ischemic heart disease and it is closely associated with impaired vascular function. The aim of our study was to explore the impact of IR on cardi...

Bifurcation lesion management still represents a challenge for interventional cardiologists and currently there is a number of different approaches/techniques involving coronary stents. The use of a drug-coated balloon for native coronary vessel management is emerging as an alternative treatment, although in selected patient populations only. In pa...

Coronary artery fistula (CAF) is a still a challenging entity, characterized by a connection between one or more coronary arteries and a cardiac chamber (coronary-cameral fistulae) or a major blood vessel (arterio-venous fistulae) when the myocardial capillary bed is bypassed. It represents about 0.2%-0.4% of all cardiac malformations and 14% of al...

Objectives The authors sought to understand the clinical and angiographic outcomes of dissections left after drug-coated balloon (DCB) angioplasty. Background Second-generation DCB may be an alternative to stents in selected populations for the treatment of native coronary lesions. However, the use of these devices may be hampered by a certain risk...

p>The risk of ISR appears to be related to several factors which cooperate synergistically; among these factors an important role is played by: the metal struts of the stent and the consequent inflammatory stress on the vascular wall which favors an excessive neointimal proliferation that "attacking" the stent struts, progressively and critically r...

Coronary artery fistulas are rare anatomic abnormalities of the coronary arteries present in 0.002% of the general population and represent 14% of all anomalies of coronary arteries. Their clinical relevance focuses mainly on the mechanism of "coronary steal phenomenon”, causing myocardial functional ischemia even in the absence of stenosis, hence...