Kazuo Misumi

Upfront thrombus aspiration in primary coronary intervention for patients with ST-segment elevation acute myocardial infarction: report of the VAMPIRE (VAcuuM asPIration thrombus REmoval) trial.

OBJECTIVES This study evaluated safety and efficacy of upfront thrombus aspiration during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND Distal embolization during primary PCI results in reduced myocardial perfusion and poor clinical outcomes. METHODS The VAMPIRE (VAcuuM asPIration thrombus REmoval) study was a prospective, randomized, controlled multicenter trial conducted in 23 institutions. Patients (N = 355) presenting within 24 h of STEMI symptoms onset were randomized to primary PCI with (n = 180) or without (n = 175) upfront thrombus aspiration using Nipros TransVascular Aspiration Catheter (Osaka, Japan). RESULTS The TransVascular Aspiration Catheter reached the lesion in 100% of cases. It successfully crossed the target obstruction in 86% without any delay in procedure time or time to reperfusion; whereas macroscopic thrombi were removed in 75% of the cases. Procedure success was similar between groups (98.9% vs. 98.3%). There was a trend toward lower incidence of slow or no reflow (primary end point-defined as a Thrombolysis In Myocardial Infarction flow grade <3) in patients treated with aspiration versus conventional primary PCI (12.4% vs. 19.4%, p = 0.07). Rate of myocardial blush grade 3 was higher in the aspiration group (46.0% vs. 20.5%, p < 0.001). Aspiration was most effective in patients presenting after 6 h of symptoms onset (slow flow rate: 8.1% vs. 37.6%, p = 0.01). CONCLUSIONS This study suggested the safety of primary PCI with upfront thrombectomy using a novel device in patients with STEMI. The study showed a trend toward improved myocardial perfusion and lower clinical events in patients treated with aspiration. Patients presenting late after STEMI appear to benefit the most from thrombectomy.

Reduced distal embolization with transluminal extraction atherectomy compared to balloon angioplasty for saphenous vein graft disease

Extraction atherectomy utilizes suction aspiration as an attempt to limit distal emboli during atherectomy. We sought to test the hypothesis that extraction atherectomy produces less distal embolization than balloon angioplasty when treating saphenous vein grafts. Among 163 consecutive, nonrandomized patients, 103 patients underwent transluminal extraction catheter (TEC) atherectomy with or without adjunctive balloon angioplasty, and 60 patients had conventional balloon angioplasty. Both groups showed comparably high procedural success rates (TEC 90.3%, angioplasty 83.3%, P = NS). TEC cases had a significantly lower incidence of angiographic distal embolization, compared with angioplasty (3.9% vs. 16.7%, P = 0.005). In cases with angiographic evidence of thrombus in the grafts, TEC maintained a significantly lower incidence of distal embolization than angioplasty (5.6% vs. 31.8%, P = 0.004). There were no statistical differences between the two groups regarding the incidence of other procedure-related complications, including death, myocardial infarction, or emergency coronary artery bypass grafting. TEC atherectomy appears to have a significantly lower incidence of distal embolization than balloon angioplasty when treating saphenous vein grafts, particularly in the presence of angiographically apparent thrombus.

TCT-662 Angioscopic Follow-up after Drug-Eluting Stents Implantation for Stable Coronary Artery Diseases

The 2016 ACC/AHA guideline and 2017 ESC guideline on DAPT duration after DES implantation for stable coronary artery disease are arbitrary. Optimal DAPT duration after DES implantation for stable coronary artery disease is debatable. Patients with drug-eluting stents were evaluated via coronary

Effectiveness and Luminal Changes of Rotablator without Adjunctive PTCA for Calcified Stenosis Associated with Coronary Aneurysm of Kawasaki Disease

Background; Highly calcified stenosis associated with coronary aneurysm is often noted in Kawasaki disease.These lesions are difficult to treat by balloon angioplasty or stenting because of their anatomical characteristics. The porpose of this study is to evaluate the efficacy of Rotablator without additional balloon angioplasty to avoid vessel damage. Method; 11lesions of 7 patients (LMT 1, LAD 10;12.3 ±2.1yrs;male 6, female 1) were treated by Rotablator without additional balloon angioplasty. All cases were evaluated postoperatevely,3,6,and12months later by angiography and IVUS. Results; All procedures were successful. No angiographic or clinical restenosis was noted in the follow-up period (8.6 ±4.4months). Final burr size is 2.0±0.2mm. Angiographic result is summerized as Table 1. Conclusion; Rotablator without additional balloon angioplasty would be an effective to treat highly calcified stenosis associated with coronary aneurysm in Kawasaki disease,providing no angiographic or clinical restenosis in 12 months after the procedureTable 1Angiographic Result

Salvage atherectomy: Using retrieved tissue to determine the etiology of acute closure

Directional coronary atherectomy was successfully performed in the mid-left anterior descending artery at the site of failed balloon angioplasty. We presumed that intracoronary thrombus had resulted in acute vessel closure following balloon angioplasty, due to the angiographic appearance of the lesion and the clinical situation. However, examination of the extracted specimen from the atherectomy device revealed predominantly atheromatous tissue with minimal thrombus.