Akitsugu Oida

Computed Tomographic Angiography–Verified Plaque Characteristics and Slow-Flow Phenomenon During Percutaneous Coronary Intervention

OBJECTIVES This study sought to identify whether computed tomographic angiographic (CTA) plaque characteristics are associated with slow-flow phenomenon (SF) during percutaneous coronary intervention (PCI). BACKGROUND SF during PCI is associated with myocardial damage and prolonged hospitalization. Intracoronary ultrasound-verified large echolucent lesions have been reported to predict SF. METHODS The authors evaluated pre-PCI CTA plaque characteristics in 40 consecutive patients (male/female, 31/9; age, 69 ± 10 years) with stable angina pectoris who developed SF during PCI; patients with ≥ 600 Agatston coronary artery calcium score were not included. They were compared with 40 age-, sex-, and culprit coronary artery-matched patients (male/female, 31/9; age, 69 ± 9 years) who underwent PCI during the same period and did not develop SF. Plaque characteristics, including vascular remodeling, plaque consistency, including low-attenuation plaques representing lipid-rich lesions and high-attenuation plaque patterns of calcium deposition, were analyzed. RESULTS Calcium deposition in the perimeter of a plaque, or circumferential plaque calcification (CPC), was significantly more frequent in the SF group (25 of 40, 63%) than the no-SF group (2 of 40, 5.0%) (p < 0.001). Presence of CPC on CTA was confirmed at the same location in the nonenhanced CT during Agatston coronary artery calcium score calculation. The positive remodeling index was significantly higher (1.5 [1.3 to 1.8] vs. 1.2 [1.0 to 1.5]; p < 0.001) and plaque density significantly lower (23.5 [9.5 to 40] HU vs. 45 [29 to 86] HU; p = 0.001) in the SF group. The conditional logistic regression analysis revealed that CPC, plaque density, and dyslipidemia were the predictors of SF, with CPC being the strongest (odds ratio: 79; 95% confidence interval: 8 to 783, p < 0.0001). CONCLUSIONS CTA-verified CPC with low-attenuation plaque and positive remodeling were determinants of SF during PCI. If CTA findings are available in patients undergoing PCI, the interventionists should be aware of the likelihood of SF.

Prevalence of anomalous origin of coronary artery detected by multi-detector computed tomography at one center

BACKGROUND Anomalous origin of coronary artery (AOCA) has been described by coronary angiography or autopsy. However the actual prevalence of such abnormalities is unknown. Multi-detector computed tomography (MDCT) offers the possibility to visualize AOCA non-invasively. The purpose of this study was to report the prevalence AOCA by MDCT. METHODS AND RESULTS In 5869 consecutive subjects who underwent coronary MDCT (Aquilion 64, Toshiba Medical Systems Corporation, Otowara, Japan) at one center, the prevalence of AOCA was 89 (1.52%) patients. The most common abnormality (33 cases, 0.56%) was the origin of the coronary artery or branch from the opposite or non-coronary sinus. The right coronary arteries (RCA) arising from the left coronary artery sinus (LCS) was observed in 27 cases (0.46%). Vascular cross-sectional area of such RCA arising from LCS was significantly smaller in 11 patients with angina than in 10 patients without symptoms [3.02 (1.68-7.67) mm² vs 5.93 (2.54-12.04) mm² p < 0.05]. The left coronary artery arising from the non-coronary sinus was observed in 2 cases (0.03%), and the left anterior descending coronary artery (LAD) or left circumflex coronary artery (LCX) arising from the right coronary sinus was observed in 4 cases (0.07%). Single coronary arteries were found in 5 cases (0.09%). Fifteen patients (0.26%) presented multiple coronary ostia, all of 15 (0.26%) had the LAD and LCX separately arising from the left coronary sinus. High take off was found in 36 cases (0.60%). CONCLUSION MDCT can accurately detect and characterize the type of AOCA.

Comparison of percutaneous coronary intervention for chronic total occlusion outcome according to operator experience from the Japanese retrograde summit registry

This study was performed to evaluate the acute outcomes of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) based on operator experience.

Complications during retrograde approach for chronic coronary total occlusion: Sub-analysis of Japanese multicenter registry.

This study was performed to determine the complications occurring during retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) based on analysis of the multicenter, prospective, nonrandomized Retrograde Summit registry.

Independent predictors of retrograde failure in CTO-PCI after successful collateral channel crossing.

To evaluate factors for predicting retrograde CTO‐PCI failure after successful collateral channel crossing. Background: Successful guidewire/catheter collateral channel crossing is important for the retrograde approach in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).

INDEPENDENT PREDICTIVE FACTOR FOR RETROGRADE PROCEDURE FAILURE IN PERCUTANEOUS CORONARY INTERVENTION OF CHRONIC TOTAL OCCLUSION AFTER SUCCESSFUL COLLATERAL CHANNEL CROSSING: SUBANAYSIS OF 1646 CASES FROM JAPANESE MULTICENTER REGISTRY

Methods: Total 1,646 retrograde cases in CTO-PCI were collected from 2009 to 2012 in 44 centers in Japan. Retrograde procedure success was 70.0% and successful collateral channel crossing with wire and any support catheter was achieved in 80.8% (1330) and 76.5% (1260) respectively. Univariate and multivariate analyses were conducted to investigate independent predictors for retrograde procedural failure even after successful collateral channel crossing of any support catheter.

COMPARISON OF PROCEDURE OUTCOME BY THE VOLUME OF PERCUTANEOUS CORONARY INTERVENTION FOR CHRONIC TOTAL OCCLUSIONS: JAPANESE MULTICENTER REGISTRY WITH TWO YEARS DATA

The serial procedure data of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) have been collected since 2012 by Retrograde Summit using a web registry system. Total of 3229 eligible subjects who received CTO-PCI were enrolled between January 2012 and December 2013 from 56

ARE CORONARY ARTERY CALCIUM SCORE AND/OR CT ANGIOGRAPHY APPROPRIATE FOR ASYMPTOMATIC PATIENTS WITH HIGH PRETEST PROBABILITY?

Coronary artery calcium score (CACS) and/or CT angiography (CTA) do not find a place in the Appropriate Use Criteria for Cardiac CT 2010 in asymptomatic patients with high pretest probability. The purpose was to evaluate the role of CACS and/or CTA in this patient group. CACS and CTA were performed