Hiroyuki Omori

The utility of a jailed pressure wire technique for the treatment of coronary bifurcation lesion in a patient with chronic kidney disease.

A 56-year-old male was admitted to our hospital complaining of chest pain. The patient had chronic kidney disease requiring a minimum contrast procedure when performing percutaneous coronary intervention. A jailed wire technique is known to reduce the risk of side branch occlusion. We report a case measuring the presence of ischemia in the side branch (SB) by a jailed Opto Wire (Opsens, Quebec) after implantation of a stent in the main vessel for the treatment of a bifurcation lesion. This method provides for a decrease in usage of contrast without leaving the side branch at risk of ischemia.

CRT-300.02 Longitudinal Distribution of Lipid-rich Plaque Components in Culprit Lesions: A Near-infrared Spectroscopy Study

The near-infrared spectroscopy (NIRS) catheter system identifies lipid core-containing coronary plaques (LCP) of interest in the coronary arteries. We sought to evaluate axial distance in location between the maximum LCP site and the site that had the most luminal-narrowing as assessed by NIRS

Residual pressure gradient across the implanted stent: An important factor of post-PCI physiological results

BACKGROUND Instantaneous wave-free ratio (iFR) has the potential to improve the accuracy of the prediction of the physiological result of percutaneous coronary intervention (PCI). The aim of this study was to evaluate the accuracy of iFR to predict the final physiological results following PCI, and investigate the factors for failed prediction. METHODS In 73 lesions, iFR pullback recordings were measured and comparisons were made between the predicted improvement following PCI and the observed result. RESULTS iFR predicted-observed difference was 0.036±0.037. Multivariate analysis showed residual iFR pressure gradient across the implanted stent (odds ratio, 2.329; 95% confidence interval, 1.408-3.853; p=0.0010) as an independent risk factor for error in iFR prediction. CONCLUSIONS iFR predicted-observed difference was 0.036±0.037. Residual in-stent iFR pressure gradient following PCI is the only independent risk factor for failed prediction.

Postocclusional Hyperemia for Fractional Flow Reserve After Percutaneous Coronary Intervention

Background— Postocclusional hyperemia caused by balloon occlusion is a potential alternative method of inducing hyperemia for measuring post-percutaneous coronary intervention fractional flow reserve (FFR). The aim of this study was to investigate postocclusional hyperemia as a method of inducing hyperemia. Methods and Results— FFR measured by postocclusional hyperemia (FFRoccl) caused by balloon occlusion after percutaneous coronary intervention was compared with FFR measured by drug-induced hyperemia (FFR measured by intravenous ATP; and FFR measured by intracoronary papaverine injection [FFRpap]) in 98 lesions from 98 patients. The hyperemia duration was also measured for FFRoccl and FFRpap. The correlation coefficient between FFRoccl, FFR measured by intravenous ATP (r=0.973; P<0.01), and FFRpap (r=0.975; P<0.01) showed almost identical values to those obtained for the correlation coefficient between FFR measured by intravenous ATP and FFRpap (r=0.967; P<0.01). No clear difference was observed on Bland–Altman analysis. Hyperemia duration was significantly longer with FFRoccl than with FFRpap (70±22 versus 51±25 s; P<0.01). Conclusions— Strong correlations were found between FFRoccl and FFR measured by intravenous ATP and FFRoccl and FFRpap. Hyperemia caused by FFRoccl was significantly longer than that caused by FFRpap.

TCT-593 The Impact of Coronary Plaque Composition on Fractional Flow Reserve Improvement after Percutaneous Coronary Intervention: An Integrated-backscatter Intravascular Ultrasound Study

RESULTS L-ISR group had more frequently heterogeneous intima and less frequently homogeneous than E-ISR group (96.0% vs. 77.1% and 4.0% vs. 22.9%, p<0.01). L-ISR group had more frequently TCFA, neovascularization and macrophage findings than E-ISR group (28.0% vs. 2.9%, p<0.01; 54.2% vs. 11.4%, p<0.01; 72.0% vs. 25.7%, p<0.01), whereas PLIA detected in L-ISR group were lower in E-ISR group (6.4% vs. 19.0%, p1⁄40.01). Thrombus and intimal disruption were not significant different between the 2 groups.