Motoaki Ibuki

Pioglitazone reduces neointimal tissue proliferation after coronary stent implantation in patients with type 2 diabetes mellitus: an intravascular ultrasound scanning study

BACKGROUND It has been reported that pioglitazone reduces neointimal hyperplasia after balloon-induced vascular injury in an experimental model. METHODS To determine whether pioglitazone reduces neointimal tissue proliferation after coronary stent implantation in patients with type 2 diabetes mellitus, we studied 44 stented lesions in 44 patients with diabetes mellitus who underwent successful coronary stent implantation. Study patients were randomized into 2 groups: the pioglitazone group (23 patients with 23 lesions) and the control group (21 patients with 21 lesions). All patients underwent serial quantitative coronary angiography and serial intravascular ultrasound scanning studies. With a motorized pullback system, multiple image slices within the stent were obtained at every 1 mm. The stent area and lumen area were measured, and the neointimal area was calculated. Measurements were averaged over the number of selected image slices. The neointimal index was calculated as the averaged neointimal area divided by the averaged stent area multiplied by 100 (%). RESULTS After 6 months of treatment, angiographic in-stent restenosis (17% vs 43%, respectively, P =.0994) and target lesion revascularization (13% vs 38%, respectively, P =.0835) were less frequent in the pioglitazone group than the control group; however, these differences did not reach significance. The intravascular ultrasound scanning study demonstrated that the neointimal index in the pioglitazone group was significantly smaller than that in the control group (28% +/- 9% vs 48% +/- 15%, respectively, P <.0001). CONCLUSION A serial intravascular ultrasound scanning assessment demonstrated that pioglitazone reduces neointimal tissue proliferation after coronary stent implantation in patients with type 2 diabetes mellitus.

Simultaneous occurrence of spontaneous coronary artery dissections of the left anterior descending and right coronary arteries in acute myocardial infarction

Spontaneous coronary artery dissection (SCAD) is a rare and often fatal cause of ischemic heart disease that occurs predominantly in young or middle-aged patients who are otherwise healthy. Therefore, the accurate diagnosis of SCAD and initiation of appropriate treatment may be life-saving. Although recent case reports have described patients with SCAD who exhibited multiple coronary dissections in addition to the culprit lesion, the authors could not determine whether the multiple dissections occurred simultaneously or at different times. In this report, we describe a case involving the simultaneous occurrence of multiple SCADs in the right coronary artery and left anterior descending artery. Intravascular ultrasound helped us to confirm the diagnosis of multiple SCADs, confirm their simultaneous occurrence, and navigate the guidewire into the true lumen. <Learning objective: In general, spontaneous coronary artery dissection (SCAD) is a single-vessel disease; the left anterior descending artery is the vessel most often involved, followed by the right coronary artery. However, the possibility of other coronary dissections distant from the culprit lesion should be considered in patients who present with an acute coronary syndrome due to SCAD. A prompt diagnosis and patient-tailored management can reduce morbidity and mortality in this population.>.

A multidirectional approach to risk assessment in patients with three-vessel coronary artery disease undergoing percutaneous intervention

BACKGROUND The SYNTAX score (SS) and Clinical SYNTAX score (CSS) have demonstrated utility as risk-stratifying tools following percutaneous coronary intervention (PCI). However, useful determinants for predicting hard clinical events (HCE: death, nonfatal myocardial infarction, and stroke) in the setting of routinely-performed-angiographic follow-up have yet to be elucidated. METHODS AND RESULTS We retrospectively examined the clinical outcomes of 252 three-vessel disease (TVD) patients following PCI. The incidence of HCE at 3 years significantly differed according to CSS (High, 20.2%; Intermediate, 1.2%; and Low, 6.0%; log-rank p<0.001), but not according to SS (High, 14.0%; Intermediate, 5.8%; and Low, 7.3%; log-rank p=0.13). The incidence of repetitive revascularization at 3 years did not differ significantly both among SS (High, 45.2%; Intermediate, 36.5%; and Low, 38.2%; log-rank p=0.22) and CSS (High, 36.9%; Intermediate, 41.7%; and Low, 41.7%; log-rank p=0.88,). CONCLUSION Prediction of HCE in patients with TVD following PCI was more accurate with CSS than with SS.

TCT-322 Utility of J-Chronic Total Occlusion (CTO) Score as a Predictor of Successful Percutaneous Coronary Intervention of CTO: Comparison of Coronary Computed Tomography and Coronary Angiography

nos: 320 333 TCT-320 3D-Cardiac-gated Contrast-enhanced Multidetector Computed Tomography (3D-CCCT) Analysis Of The Native Mitral Valve Renick D. Lee, Aileen Lomarda, Bothaina abdulshakour, Bermillon S. Faderan, Swee Yaw Tan, Nicolas Foin, Jia-Lin Soon National Heart Centre Singapore, Singapore, Singapore; National Heart Centre Singapore, London, United Kingdom BACKGROUND Novel minimally invasive mitral valve interventions for dysfunctional mitral bioprosthesis are being performed through the apex of the left ventricle. This Transapical approach is also being developed to replace diseased native mitral valve using new generations of catheter-mounted prosthesis. These procedures are imagingguided in the main and do not permit direct visual assessment of the mitral valve. We postulate that Cardiac-gated Contrast-enhanced Multidetector Computed Tomography (CC-MDCT) imaging of the mitral prosthesis or native mitral valve can be accurately performed, and yields useful information to enhance procedural success. METHODS Fifty patients that have undergone CC-MDCT assessment of the aortic valve for consideration of the Transcatheter Aortic Valve Replacement (TAVR) procedure were studied. CT data sets were acquired in standard DICOM 3 format, on a 320 detector MDCT scanner using a full retrospective protocol. 100ml of omnipaque 350 non-ionic contrast were used at variable flow rates of 3.5-5ml per second. Images were reconstructed at 0.5mm thickness. A 3-dimensional (3D) image processing software was used to analyze the images. The mitral annulus is viewed at the plane of the leaflet hinge-points. This reference plane is locked so that all subsequent planes remain orthogonal to each other. A corresponding 3D reconstruction of the mitral valve is then reconstructed. The native mitral valve was ‘sized’, and the fluoroscopic angle of the true profile view of the mitral annulus or “line of perpendicularity” (LP) was established. RESULTS The mitral valve was ’sized’ showing a mean mitral annular area (a) of 792.7 183.3 mm, mean perimeter (b) of 114.3 10.9 mm, and mean maximum annular diameter (e) of 35.9 3.5 mm in systole. Interestingly, an 11.5 13.4% increment in minimum annular diameter (d) during diastole from systole was observed. The LP of the mitral annulus representative of 50 patients (expressed as mean with standard deviation) was generated. CONCLUSIONS The proposed method of 3D analysis of the native mitral valve on CC-MDCT scan can accurately ’size’ and predict the LP of the mitral annulus. The protocol was simple and reproducible. Accurate prosthesis sizing selection and the prediction of the coaxial implant angle during the procedure potentially reduce radiation exposure and improve procedural success. CATEGORIES IMAGING: Non-Invasive