Sungsoo Cho

Relationship between paraoxonase-1 activity, carotid intima-media thickness and arterial stiffness in hypertensive patients.

Relationship between paraoxonase-1 activity, carotid intima-media thickness and arterial stiffness in hypertensive patients

Rationale and design: Impact of intravascular ultrasound guidance on long-term clinical outcomes of everolimus-eluting stents in long coronary lesions

BACKGROUND Although the use of drug-eluting stents (DESs) in patients with coronary artery disease has contributed to a significant reduction in in-stent restenosis and repeat revascularization, treating diffuse long lesions using DESs remains challenging due to the high rates of in-stent restenosis and stent thrombosis. Intravascular ultrasound (IVUS) provides tomographic images of coronary vascular structure and is useful for evaluating lesion morphology and stent optimization during percutaneous coronary intervention. However, it remains controversial whether IVUS guidance in DES implantation for long coronary lesions could reduce adverse clinical outcomes. HYPOTHESIS We hypothesize that the long-term clinical outcomes of IVUS-guided DES implantation would be superior to those of angiography-guided DES implantation in a subset of patients with long coronary lesions. STUDY DESIGN This study is a randomized, prospective, multi-center trial comparing the long-term clinical outcomes of IVUS-guided and angiography-guided everolimus-eluting stent implantation in patients with long coronary lesions (implanted stent ≥28 mm in length). The primary end point is a composite of major adverse cardiac events, including cardiac death, target lesion-related myocardial infarction, or target lesion revascularization at 1 year following intervention. A total of 1,400 patients will be required to be enrolled according to sample size calculations. CONCLUSION This study will test the hypothesis that IVUS guidance improves long-term clinical outcomes in patients treated with everolimus-eluting stents for long coronary lesions compared with angiographic guidance.

Three-Dimensional Optical Coherence Tomographic Analysis of Eccentric Morphology of the Jailed Side-Branch Ostium in Coronary Bifurcation Lesions

BACKGROUND The severity of angiographic diameter stenosis of the jailed side-branch ostium is usually overestimated over the 3-D optical coherence tomography (OCT)-measured actual stenosis. Using 3-D OCT, morphologic changes in the jailed side-branch ostium were evaluated before and after a single stent crossover at coronary bifurcation lesions. METHODS In 109 patients who received a single stent crossover at coronary bifurcation lesions, the minimal lumen area (MLA) before and after intervention and the eccentricity of the jailed side-branch ostium were measured with 3-D OCT. The eccentricity index was defined as the ratio of maximal diameter/minimal diameter of the jailed side-branch ostium. When the eccentricity index was < 1.5, the shape of the jailed side-branch ostium was defined as circular. The MLA of the jailed side-branch ostium was also calculated from the quantitative coronary angiography (QCA) minimal lumen diameter assuming a circular lumen. RESULTS The 3-D OCT-measured MLA of the jailed side-branch ostium decreased from 2.91 ± 1.65 mm(2) before intervention to 2.37 ± 1.48 mm(2) after intervention (P < 0.01). The QCA-derived MLA also decreased from 2.35 ± 1.71 mm(2) before intervention to 1.68 ± 1.56 mm(2) after intervention (P < 0.01). However, the 3-D OCT-measured MLA was significantly larger than the QCA-derived MLA (P < 0.01). The shape of the jailed side-branch ostium changed from circular to elliptical after the stent implantation (eccentricity index: 1.40 ± 0.33 before intervention; 1.71 ± 0.60 after intervention; P < 0.01). CONCLUSIONS Compared with QCA measurements, 3-D OCT analysis could be useful to guide decisions regarding additional intervention after stent implantation across coronary bifurcation lesions.

Images in cardiovascular medicine. Constrictive epicarditis as an unusual cause of constrictive physiology: typical presentation with unusual pathology.

This case represents typical clinical and hemodynamic features of constrictive pericarditis, but the underlying pathology was epicardial rather than pericardial scarring. The recognition of constrictive epicarditis as distinct from pericarditis is important because the surgical approach is different. An 83-year-old woman was …This case represents typical clinical and hemodynamic features of constrictive pericarditis, but the underlying pathology was epicardial rather than pericardial scarring. The recognition of constrictive epicarditis as distinct from pericarditis is important because the surgical approach is different. An 83-year-old woman was evaluated for progressively worsening exertional dyspnea and generalized edema. On physical examination, the jugular vein was distended and the liver was enlarged. An ECG showed atrial fibrillation. A chest lateral film showed a pericardial calcification (Figure 1). Computed tomography of the heart showed a calcification ring encircling the ventricle (Figure 2). Calcific constrictive pericarditis was diagnosed, and pericardiectomy was planned. At surgery, the parietal pericardium was mildly fibrothickened; however, dense, calcified, ossified epicardial thickening firmly attached especially on the left and right atrioventricular groove, which constituted the basis for marked impaired filling of the left ventricle (Figures 3 and 4; Data Supplement). The lesion was removed after careful dissection via scalpel. The woman’s central venous pressure dropped from 17 mm Hg to 11 mm Hg after the operation. The patient subsequently recovered and was uneventfully discharged days later.

In Vivo Demonstration of Frail Neointimal Tissue Embolization After Angioplasty With a Drug-Coated Balloon Confirmed by Optical Coherence Tomography and Histology

A 60-year-old woman experienced exertional chest pain. She underwent percutaneous coronary intervention with a drug-eluting stent (Nobori, Terumo Corporation, Tokyo) at the midportion of the left anterior descending artery. In the 3-month follow-up angiography, there was an in-stent restenosis at the midportion of the left anterior descending artery, which was also the site of a previous stent implantation (arrow, Figure 1A). In optical coherence tomography, neointimal hyperplasia proliferation with a heterogeneous pattern was observed with a minimal lumen area of 1.7 mm2 (asterisk, Figure 1A). Angioplasty with a drug-coated balloon (Sequent please; B. Braun, Melsungen, Germany) …

Abolished ischemic tricuspid regurgitation by revascularization of left anterior descending artery: The role of collateral circulation

A 74-year-old man presented with recent inferior wall myocardial infarction. The right ventricle (RV) was strikingly dilated and akinetic along the free wall compatible with right ventricular infarction. Accordingly, severe functional tricuspid regurgitation (TR) was detected. Coronary angiogram revealed total occlusion on the proximal right coronary artery (RCA). There was collateral blood flow from the left anterior descending (LAD) artery to the right ventricular ischemic region. The LAD artery also had a significant stenosis which might limit the required amount of blood supply to collateral blood vessels. Because of the technical difficulty in the intervention of RCA, the patient underwent percutaneous intervention on the LAD artery. After the revascularization of LAD artery, severe TR was abolished accompanied by the right ventricular functional recovery. <Learning objective: Isolated ischemic tricuspid regurgitation was rarely manifested because the right ventricle has a more favorable oxygen supply-demand ratio than the left ventricle and receives extensive collateral flow from the left-to-right collateral system. In our case, the right ventricle was receiving blood flow through collateral circulation from septal branches of the left anterior descending coronary artery due to the total occlusion of proximal right coronary artery. This case displays the remarkable role of collateral circulation in restoring right ventricular function and in treating ischemic tricuspid regurgitation.>.