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Ramcharitar et al. describe the first case treated in the SECRITT I trial. The 63-year-old man presented with class II anginal symptoms and was diagnosed as having a culprit lesion in the left circumflex artery and a vulnerable plaque in the left anterior descending artery. The vulnerable plaque was treated with a self-expanding stent tailored to shield this type of plaque.

Ramcharitar and colleagues present an interesting case of a patient with drug-refractory hypertrophic obstructive cardiomyopathy and NYHA class II–III heart failure who was treated with septal coil embolization. This article demonstrates, for the first time, the acute changes in hemodynamics that occur following septal coil embolization, and shows that this treatment is a viable alternative to percutaneous coronary intervention.

Magnetically guided navigation of a wire or devicein vivocould increase the accuracy of angiographic intervention significantly, especially in tortuous or chronic occluded arteries. In this Technology Insight, Ramcharitar and colleagues examine this novel technology and provide an up-to-date analysis of what is currently possible and an insight to what the future holds.

An effective risk score for patients undergoing coronary angioplasty is yet to be established. In this article we discuss the merits of using the EuroSCORE risk model for assessing these patients, and propose a potential modification to the system.

The optimal duration and type of antiplatelet therapy after implantation of a drug-eluting stent (DES) remains uncertain. In this Review, Miyazaki et al. summarize the evidence on the duration of dual antiplatelet therapy and the risk of bleeding and adverse cardiac events after DES implantation, and describe the pitfalls of trial interpretation. Ongoing trials to test single antiplatelet therapy after DES implantation are also discussed.

In this Review, Serruys and colleagues describe the pathophysiology of unprotected left main coronary artery disease, discuss novel diagnostic approaches in light of new imaging techniques, and describe risk stratification models to help in the decision-making process for determining the best revascularization strategy in these patients.

Mechanical reperfusion in acute myocardial infarction does not always result in desirable optimal microvascular perfusion. Failure to achieve a normal myocardial blush in the infarcted region by contrast injection immediately after percutaneous coronary intervention—the 'no-reflow' phenomenon—is an ominous sign whose prognostic importance may go beyond its intimate association with infarct size.

New-generation drug-eluting stents (DES) utilize various drugs, polymers, and scaffold technologies, which have improved the safety of these stents in comparison with first-generation DES. Clinicians now have a variety of stents to choose from, and the choice can be tailored to the individual patient. Garg and colleagues present the concepts and rationale behind these new stent designs, and introduce some of the clinical data that support their use. In this Review, they aim to provide an update for general and interventional cardiologists who treat patients undergoing percutaneous coronary intervention.

Patients with coronary artery disease, who do not respond to optimal medical therapy, are candidates for revascularization. In this Review, Javaid Iqbal and colleagues discuss the evidence for CABG surgery versus percutaneous coronary intervention as the optimal revascularization method in patients with complex coronary artery disease. The choice of technique is dependent on the patient's overall medical state, and the authors highlight the most appropriate surgery in specific patient groups.

Shear stress plays an essential part in the maintenance of healthy blood vessels, and locations of low shear stress can create predilection sites for eccentric plaque growth. This review discusses the mechanobiologic mechanisms related to shear stress that might have a role in plaque rupture.

The introduction of drug-eluting stents has revolutionized interventional cardiology. The uptake of this technology has been rapid and widespread, but the long-term data are strikingly few. In this review, an overview is presented of the studies done so far and the emerging information on safety and efficacy. Future directions for this intervention are also discussed.

Shear stress plays an essential part in the maintenance of healthy vessels. If risk factors for atherosclerosis are present, low shear stress can lead to abnormalities, possibly creating predilection sites for eccentric plaque growth. The role of shear stress in the development of plaque prone to rupture is explored.

Transcatheter aortic valve implantation is increasingly being used to treat aortic valve disease in patients at high surgical risk, but data indicate an emerging association between the procedure and incident conduction abnormalities. The authors review the frequency, potential anatomical and procedural causes, and clinical consequences of these adverse effects.

The evolution of stent design has reduced the incidence of stent thrombosis, meaning that the duration of dual antiplatelet therapy after percutaneous coronary intervention (PCI) might be shortened. In this Review, the authors describe the current evidence base and ongoing clinical trials into the use of P2Y₁₂ inhibitor monotherapy after PCI.

In this Review, a panel of leading experts in antithrombotic pharmacotherapy discuss the principles guiding the role of acetylsalicylic acid (aspirin)-free strategies in the prevention and management of cardiovascular disease, along with their implications for clinical trial design and development.

Exercise is associated with reduced long-term morbidity and mortality but, in some individuals, can transiently increase the risk of fatal or nonfatal cardiac events. In this Review, Dangardt and colleagues discuss the benefits and risks of physical activity and exercise in the general population and in patients with various forms of cardiovascular disease. Strategies to promote physical activity and improve public health are proposed.