Mitsunari Matsumoto

How Should We Perform Rotational Atherectomy to an Angulated Calcified Lesion

Rotational atherectomy to an angulated calcified lesion is always challenging. The risk of catastrophic complications such as a burr becoming stuck or vessel perforation is greater when the calcified lesion is angulated. We describe the case of an 83-year-old female suffering from unstable angina. Diagnostic coronary angiography revealed an angulated calcified lesion in the proximal segment of the right coronary artery. We performed rotational atherectomy to the lesion, but intentionally did not advance the rotational atherectomy burr beyond the top of the angulation. We controlled the rotational atherectomy burr and stopped it just before the top of the angulation to avoid complications. Following rotational atherectomy, balloon dilatation with a non-compliant balloon was performed, and drug-eluting stents were successfully deployed. In this manuscript, we provide a review of the literature on this topic, and discuss how rotational atherectomy to an angulated calcified lesion should be performed.

The incidence of slow flow after rotational atherectomy of calcified coronary arteries: A randomized study of low speed versus high speed.

The purpose of this randomized trial was to compare the incidence of slow flow between low‐speed and high‐speed rotational atherectomy (RA) of calcified coronary lesions.

GuideLiner Catheter Use for Percutaneous Intervention Involving Anomalous Origin of a Single Coronary Trunk Arising from the Ascending Aorta

Cases in which an anomalous single coronary trunk arises from the ascending aorta are extremely rare. In percutaneous coronary intervention for the lesion of a coronary artery anomaly, several problems may occur, including selection of a guide catheter, insufficient backup force, and difficulties of stent delivery. The GuideLiner catheter, which is a coaxial guide extension having the advantage of rapid exchange, facilitates coronary intervention for complex lesions. We report a case of angina having a lesion in the left anterior descending artery of a single coronary trunk arising from the ascending aorta. We successfully performed revascularization by using the GuideLiner catheter.

A Pitfall in the Diagnosis of Bilateral Deep Vein Thrombosis in a Young Man

A 32-year-old man with a history of bronchial asthma was referred for low back pain and bilateral femur pain. Vascular sonography revealed bilateral deep vein thrombosis (DVT) from the femoral veins to the popliteal veins. Computed tomography revealed hypoplasia of the inferior vena cava (IVC) and dilated lumbar veins, ascending lumbar veins, and azygos vein as collaterals. There was no evidence of malignant neoplasm. The results of the thrombophilia tests were within normal limits. Hypoplasia of the IVC is a rare cause of DVT. This anomaly should be considered as a cause of bilateral and proximal DVT, in particular, in young patients without major risk factors.

Transient Retinopathy in Acute Aortic Dissection

PURPOSE To explore the occurrence of transient retinopathy and its prognostic importance in patients with acute aortic dissection (AAD). DESIGN Prospective, observational study. PARTICIPANTS Sixty-four patients with Stanford type B AAD were treated with conservative medical therapy. METHODS Retinopathy findings, such as cotton-wool spots and hemorrhage, were examined. Fundus photography was performed on hospital days 9 to 14 and after 2 or 3 months. The association between the appearance of retinopathy and the subsequent cardio-cerebrovascular events was investigated. MAIN OUTCOME MEASURES The primary outcomes included the incidence of retinopathy and subsequent adverse cardio-cerebrovascular events. RESULTS Retinopathy was detected in 55% (35 of 64) of patients (cotton-wool spots alone, n = 31; dot hemorrhage alone, n = 1; and both, n = 3). These findings disappeared in all 12 patients who underwent follow-up fundus examinations. In the multivariate analysis, a history of hypertension and higher peak C-reactive protein level were independently associated with retinopathy. At a median follow-up of 911 days, adverse cardio-cerebrovascular events were reported in 11 patients, of whom those with retinopathy experienced adverse events significantly more frequently than those without retinopathy (P = 0.045). CONCLUSIONS Retinopathy occurred frequently in patients with AAD. This retinopathy was associated with a history of hypertension and higher peak C-reactive protein levels and was an important predictive factor for adverse cardio-cerebrovascular outcomes.