Masanori Tsurugida

Efficacy of cilostazol after endovascular therapy for femoropopliteal artery disease in patients with intermittent claudication.

OBJECTIVES The purpose of this study was to investigate whether cilostazol reduces restenosis and revascularization after endovascular therapy (EVT) for femoropopliteal lesions. BACKGROUND Cilostazol improves walking distance in patients with intermittent claudication and reduces restenosis after coronary intervention, but its efficacy remains unclear after EVT for femoropopliteal disease. METHODS This study was performed as a multicenter, randomized, open-label clinical trial. Eighty patients (mean age 70.7 +/- 6.2 years, 84% men) with intermittent claudication due to a femoropopliteal lesion were randomly assigned to receive or not receive cilostazol in addition to aspirin. The primary end point was freedom from target vessel revascularization, and the secondary end points were the rate of restenosis and freedom from target lesion revascularization and major adverse cardiovascular events, defined as all-cause death, myocardial infarction, stroke, repeat revascularization, and leg amputation. RESULTS Clinical follow-up information was obtained in all patients. Patient, lesion, and procedural characteristics did not differ significantly between the 2 groups. Stenting was performed in 36 patients (cilostazol, 16; control, 20; p = 0.36). Freedom from target vessel revascularization at 2 years after EVT was significantly higher compared with the control group (84.6% vs. 62.2%, p = 0.04). The rate of restenosis was lower in the cilostazol group (43.6% vs. 70.3%, p = 0.02), and freedom from target lesion revascularization and major adverse cardiovascular events was higher in the cilostazol group (87.2% vs. 67.6%, p = 0.046, 76.8% vs. 45.6%, p = 0.006, respectively). There was no major bleeding in either group during follow-up period. CONCLUSIONS Cilostazol reduced restenosis and repeat revascularization after EVT in patients with intermittent claudication due to femoropopliteal disease.

Noninvasive evaluation of coronary reperfusion by transthoracic Doppler echocardiography in patients with anterior acute Myocardial Infarction before coronary intervention

Background—Transthoracic Doppler echocardiography (TTDE) enables evaluation of distal left anterior descending coronary artery (LAD) flow. The purpose of this study was to test whether TTDE can differentiate coronary reperfusion with Thrombolysis in Myocardial Infarction (TIMI) grade 3 from TIMI grade ≤2 in patients with anterior acute myocardial infarction (AMI). Methods and Results—In 46 consecutive patients with a first anterior AMI in the acute phase before emergent coronary intervention, the presence of antegrade distal LAD flow and its diastolic peak velocity were evaluated by color and pulsed TTDE and compared with TIMI grades by subsequent coronary angiography performed 29±12 minutes later. Nineteen patients had TIMI 0 reperfusion, 4 had TIMI 1, 10 had TIMI 2, and 13 had TIMI 3. Visual antegrade distal LAD flow was present in 22 of the 46 patients. TIMI 2 and 3 reperfusions were both generally visualized by color TTDE. However, peak distal LAD flow velocity by pulsed TTDE was significantly greater in patients with TIMI 3 compared with those with TIMI 2 (40±10 vs 20±6 cm/s, P <0.0001). The diagnosis of TIMI 3 based on diastolic peak distal LAD flow velocity ≥25 cm/s by TTDE had a sensitivity, specificity, and accuracy of 77%, 94%, and 89%, respectively. Conclusion—TTDE enables noninvasive differentiation of TIMI 3 from TIMI ≤2 coronary reperfusion in patients with AMI in the acute phase before emergent coronary intervention.

Attenuated early diastolic interventricular septum bulging by pulmonary hypertension due to later developed aortic regurgitation

A woman was admitted due to dyspnea. She had familial pulmonary arterial hypertension and typical echocardiographic findings including early diastolic bulging of the interventricular septum toward the left ventricular cavity. Her symptoms improved with medication. Five months later, she was hospitalized again due to severe dyspnea. Echocardiography demonstrated aortic valve vegetation and its regurgitation. Echocardiography also showed attenuation of early diastolic compression of the interventricular septum, however, the peak tricuspid regurgitant flow velocity did not improve. It is likely that development of left-sided heart failure attenuated abnormal interventricular septal motion due to pulmonary hypertension.

TCTAP C-239 Transdermal Balloon Puncture for Extracting Remained Un-deflated Balloon Below-the-Knee Lesion

### Patient initials or identifier number 8091 ### Relevant clinical history and physical exam A 65 year-old-female referred to our hospital because of a right lower limb ulceration. Past medical history included chronic renal failure and hemodialysis. A clinical examination showed her right leg

TCTAP C-202 Coil Embolization for Peripheral Vessel Perforation

PTA lesion, a 0.014 inch guide wire with micro-catheter was further advanced intodorsalis pedis artery (DPA) retrogradely. However, occlusion site of DPA was so hard that a stiff wire could easily advanced into subintimal space. We advanced another guide wire into ATA antegradely. Wire rendezvous technique was performed in the proximal DPA, followed by balloon angioplasty. Finally, complete revascularization of ATA and PTA including pedal arch was achieved. Case Summary. Re-vascularization of below-the-knee (BTK) including BTA lesion has been reported to be helpful for limb salvage inpatients with critical limb ischemia (CLI). On the other hand, the efficacy of endovascular therapy (EVT) for collagen-vascular disease might be controversial. In this case, complete re-vascularization of BTA lesions might be effective for limb salvage of a collagen-vascular disease patient.

THE EFFECT OF CORONARY FLOW RESERVE AFTER REPERFUSION OF ACUTE MYOCARDIAL INFARCTION ON LEFT VENTRICULAR REMODELING AND FUNCTION

Coronary flow reserve (CFR) reflects the degree of coronarystenosis without microvascular dysfunction. On the other hand, CFR reflects thedegree of microvascular function without coronary stenosis. The relationshipbetween CFR and left ventricular (LV) remodeling in patients with acute myocardial