Noriaki Moriyama

Transradial Coronary Interventions for Complex Chronic Total Occlusions

OBJECTIVESnThe aims of this study were to assess whether the transradial approach can be applied to treat complex chronic total occlusion (CTO) and to determine the predictors of transradial percutaneous coronary intervention (PCI) failure.nnnBACKGROUNDnConsistent data on the outcomes of transradial PCI for treating CTO are scarce.nnnMETHODSnConsecutive patients who were not receiving hemodialysis and had undergone PCI for CTO were enrolled. The clinical and angiographic characteristics, procedural details, and outcomes of the transradial and transfemoral procedures were examined.nnnRESULTSnIn total, 280 and 305 CTO PCI procedures involved transradial and transfemoral access, respectively. The technical success rates did not significantly differ in the entire cohort analysis and the propensity score-matched analysis (74.6% vs. 72.5%; pxa0= 0.51 and 70.6% vs. 73.3%; pxa0= 0.57). When only cases with J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) scores ofxa0≥3 were examined, the transradial group had a significantly lower success rate than the transfemoral group (35.7% vs. 58.2%; pxa0= 0.04). The use of guiding catheter sizexa0<7 F (odds ratio [OR]: 5.50; pxa0= 0.008), calcification (OR: 3.20; pxa0= 0.001), occlusion lengthxa0>20xa0mm (OR: 2.97; pxa0< 0.001), and age (OR: 1.04; pxa0=xa00.03) were associated with transradial CTO PCI failure.nnnCONCLUSIONSnTransradial PCI for CTO may be feasible in noncomplex cases, although complex cases still pose a challenge. In cases of transradial PCI for CTO, if possible, guiding catheter sizexa0≥7 F should be selected regardless of lesion morphology. Furthermore, the transfemoral approach should be preferentially considered for complex CTO, particularly in cases with calcification.

Early development of acute kidney injury is an independent predictor of in-hospital mortality in patients with acute myocardial infarction

BACKGROUNDnAcute kidney injury (AKI) often occurs in patients with acute myocardial infarction (AMI), and is associated with adverse outcomes. However, it remains unclear how timing of AKI affects it. This study assessed impact of timing of AKI on prognosis after AMI.nnnMETHODSnThis study consisted of 760 patients with AMI who were admitted within 48h after symptom onset. AKI was diagnosed as increase in creatinine ≥0.3mg/dl or ≥50% within any 48h after admission. Patients were classified into 3 groups according to the occurrence and timing of AKI: no-AKI, early-AKI (within 48h after admission) and late-AKI (>48h). Early-AKI was classified into transient early-AKI, defined as creatinine returning to the level below the criteria of AKI, and persistent early-AKI.nnnRESULTSnEarly-AKI occurred in 64 patients (9%) and late-AKI in 32 patients (4%). Patients with early-AKI had significantly higher mortality (35%) than those with late-AKI (7%, p<0.001) and no-AKI (3%, p<0.001). Multivariate analysis showed early-AKI was an independent predictor of in-hospital mortality (OR: 3.38, 95% CI: 1.30-8.76, p=0.013), but late-AKI was not. Among patients with early-AKI, mortality was significantly higher even if AKI was transient (23%, p<0.001). Patients with persistent early-AKI had the highest mortality (66%, p<0.001).nnnCONCLUSIONSnEarly-AKI was associated with worse outcome. Even if renal function once returned to baseline level, patients with early-AKI tended to be at high risk of mortality.

Neoatherosclerosis 5 Years After Bioresorbable Vascular Scaffold Implantation

BACKGROUNDnData regarding neoatherosclerosis after everolimus-eluting bioresorbable vascular scaffold (BVS) (ABSORB BVS Rev. 1.1, Abbott Vascular, Santa Clara, California) implantation are limited.nnnOBJECTIVESnThis study investigated the findings of neoatherosclerosis at 5 years after BVS 1.1 implantation by using multi-imaging modalities, including optical coherence tomography (OCT).nnnMETHODSnPatients included in the ABSORB EXTEND (ABSORB EXTEND Clinical Investigation) trial at Shonan Kamakura General Hospital underwent OCT at baseline after the index procedure and at 1 and 5 years. Intimal plaque distributions in the in-scaffold and out-scaffold segments were analyzed.nnnRESULTSnTwenty patients (22 lesions) with stable angina pectoris were enrolled. The median follow-up duration was 67xa0months (interquartile range: 65 to 69xa0months), and the mean age was 69 ± 8 years. Patients with diabetes mellitus (25%) were included. Based on the baseline angiogram, 10 (46%) lesions were type B2/C lesions. At 1 and 5 years of follow-up, significant differences in the prevalence of in-scaffold lipid-laden neointima (17% vs. 61%; pxa0=xa00.04), calcification (28% vs. 94%; pxa0< 0.01), neovascularization (6% vs. 78%; pxa0< 0.01), and thin-cap fibroatheroma (0% vs. 22%; pxa0=xa00.02) were found. In the out-scaffold segments, no significant difference in the plaque prevalence between 1 and 5 years was noted.nnnCONCLUSIONSnThe occurrence and progression of in-scaffold neoatherosclerosis with luminal narrowing was observed at 5 years after BVS 1.1 implantation. The small size of the current study warrants confirmation in larger study. (ABSORB EXTEND Clinical Investigation [ABSORB EXTEND]; NCT01023789).

Persistent Bioresorbable Vascular Scaffold by Optical Coherence Tomography Imaging at 5 Years

A 74-year-old man included in the ABSORBxa0EXTEND Clinical Investigation ([NCT01023789][1]) underwent percutaneous coronary intervention with an everolimus-eluting bioresorbable vascular scaffold (BVS) (Absorb BVS1.1, Abbot Vascular, Santa Clara, California) 3.0xa0× 18 mm in proximal right coronary

Instantaneous Wave-Free Ratio for the Assessment of Intermediate Coronary Artery Stenosis in Patients With Severe Aortic Valve Stenosis: Comparison With Myocardial Perfusion Scintigraphy

OBJECTIVESnThis study investigated the diagnostic performance of instantaneous wave-free ratio (iFR) in patients with aortic valve stenosis (AS).nnnBACKGROUNDnThe iFR was introduced as a new, nonpharmacologic stress index of coronary stenosis severity. However, the diagnostic performance of iFR has not been sufficiently explored in patients with severe AS.nnnMETHODSnWe analyzed 95 consecutive patients with AS (57 women) demonstrating intermediate coronary artery stenosis (116 vessels), and compared the iFR values with fractional flow reserve (FFR) values and with adenosine-stress myocardial perfusion imaging as indicators of myocardial ischemia.nnnRESULTSnThe median value and interquartile range (first quartile [Q1], third quartile [Q3]) of the iFR was 0.86 (Q1 to Q3 range, 0.76 to 0.93), and that of the FFR was 0.84 (Q1 to Q3 range, 0.76 to 0.91). The iFR values correlated well with the FFR values (Rxa0= 0.854; pxa0< 0.0001). A receiver operating characteristic analysis demonstrated an optimal cutoff of 0.82 for the iFR to indicate an FFRxa0≤0.75, with an area under the curve of 0.92. The optimal iFR cutoff value indicating myocardial ischemia on perfusion scintigraphy was 0.82 (area under the curve: 0.84).nnnCONCLUSIONSnIn patients with severe AS, a good correlation exists between iFR and FFR. Both the iFR and FFR values exhibit good correlation with perfusion scintigraphy-identified myocardial ischemia. The iFR could be a safe diagnostic tool for patients with severe AS. (The Impact of FFR and iFR in Patients with Severe Aortic Stenosis; UMIN000024479).

Bailout polytetrafluoroethylene-covered stent implantation for left main bifurcation perforation using the kissing stent technique.

Coronary artery perforation during percutaneous coronary intervention is a rare, but potentially lethal complication. Immediate balloon expansion at the perforation site can halt the bleeding. Implantation of a coronary polytetrafluoroethylene (PTFE)‐covered stent enables the efficient endovascular repair of a coronary artery perforation. However, if the perforation occurs at a bifurcation, a PTFE‐covered stent may jail the side branch. We report a difficult case of blowout coronary perforation (Ellis type III) at a left main coronary artery bifurcation, which was successfully sealed with a PTFE‐covered stent without interference with the side branch coronary artery circulation. This new strategy might represent a useful salvage option for some patients with a coronary bifurcation perforation.

Active cardiac sarcoidosis in a patient with adult-onset Kawasaki disease

Adult-onset Kawasaki disease is a rare condition. Cardiac sarcoidosis is an uncommon cardiomyopathy which is characterized by progressive cardiac dysfunction, and abnormality on electrocardiography and morphological aberration of the heart. We report a first case of a combination of these rare conditions. The patient was initially diagnosed with Kawasaki disease based on the coronary artery aneurysms and a past medical history at the age of 20 years which was typical of Kawasaki disease. Decades later, he developed progressive cardiac dysfunction and a sudden-onset atrioventricular block. Laboratory and imaging results revealed severe myocardial damage and inflammation which were unexplainable by coronary artery ischemia. We diagnosed him with cardiac sarcoidosis based on a Japanese guideline to diagnose cardiac sarcoidosis. A cardiac resynchronization therapy defibrillator was implanted and he received oral steroid therapy. This rare combination of adult-onset Kawasaki disease and cardiac sarcoidosis may suggest the causative association of these conditions. <Learning objective: This is the first report of a rare combination of adult-onset Kawasaki disease and cardiac sarcoidosis. Kawasaki disease is not just a disease of children. Physicians should include Kawasaki disease in the list of differentials for unknown fever or eruptions. In patients with progressive heart failure and atrioventricular block, the possibility of cardiac sarcoidosis should be examined using various imaging modalities even if they had a known cause of cardiac dysfunction.>.

The COFFEE Trial (COmparison of Fractional Flow Reserve Measurements through 4 FrEnch versus 6 FrEnch Diagnostic Catheter)

Fractional flow reserve (FFR) measurement is a well-established pressure wire-based procedure that is used to assess the functional severity of coronary lesions [(1)][1]. Various randomized trials have demonstrated that FFR-guided revascularization improves clinical outcomes in patients with

Modified jailed balloon technique for bifurcation lesions

We propose a new systematic approach in bifurcation lesions, modified jailed balloon technique (M‐JBT), and report the first clinical experience.

Reply : Slender Sheaths Have the Potential to Expand the Use of Transradial Access for Complex CTO-PCI

We would like to thank Dr. Aminian and colleagues for their interest in our study [(1)][1] that assessed whether the transradial approach can be used to treat complex chronic total occlusion (CTO) and that attempted to determine the predictors of transradial percutaneous coronary intervention (PCI)