Takayuki Warisawa

High prevalence of coronary artery events and non-coronary events in patients with coronary artery aneurysm in the observational group

Background Coronary artery aneurysm (CAA) is occasionally detected on a small percentage of coronary angiography or multi-detector computed tomography (MDCT). CAA itself is considered benign entity despite the potential risks of rupture, thromboembolism, and compression of surrounding structures. However, the optimal management including other vascular comorbidity has yet to be fully clarified. Objective The aim of this study was to evaluate cardiovascular events in the patients with CAA in the observational group. Methods Between January 2010 and August 2015, 48 CAAs were identified in 37 patients out of consecutive 10,010 patients (0.37%) by MDCT. Twenty-eight patients treated conservatively were included in this study. Their major adverse cardiovascular events (MACE) were evaluated retrospectively: death, non-fatal myocardial infarction (MI), revascularizations; coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), and other vascular events. Results The average age was 62.0 ± 15.5 year sold, and median follow-up period was 49.6 months (IQR 23.6 to 78.1). Mean CAA diameter was 7.5 ± 2.8 mm. Twenty-two MACE occurred in 15 patients (53.6%): 1 sudden death, 4 MI, 1 CABG for CAA, 3 PCI for CAA, 7 PCI for non-CAA lesions, and 6 other vascular treatments for aorta and cerebral and peripheral artery. Follow-up MDCT was performed for 22 CAAs in 16 patients. In 9 CAAs of them, the maximal diameter increased significantly (Δ diameter: 1.5 ± 1.1 mm). Conclusions Presence of CAA may be associated with adverse vascular events including non-coronary diseases. This study could suggest the management for CAA should include the evaluation of not only CAA itself but also other vascular diseases.

SIGNIFICANCE OF 123I-BMIPP-SCINTIGRAPHY IN THE RECOVERY OF LEFT VENTRICULAR SYSTOLIC DYSFUNCTION IN TAKOTSUBO CARDIOMYOPATHY: INSIGHT FROM THE NEW TAKOTSUBO BMIPP REGISTRY

Background: Takotsubo cardiomyopathy (TCM) is notable for reversible left ventricular (LV) systolic dysfunction in a short-term whereas it is well-known long-duration or persistent wall-motion abnormality is observed in some cases. However, its prevalence and predictor have yet to be fully-clarified

Novel “baby-in-mother” technique with the GuideLiner in the bifurcation coronary intervention with the protect-wire kept in the side branch

We report a case of percutaneous coronary intervention in a bifurcation lesion involving the left anterior descending artery and the first-diagonal branch. The lesion was calcified with vessel tortuosity. Despite adequate lesion preparation using scoring balloon, the stent was not deliverable, even with deep intubation of 7Fr-guiding catheter. The use of 6-in-7 guiding extension catheter would have required removal of wire from the diagonal branch. To avoid this situation, we down-sized the extension catheter to 5Fr, which was successful in delivering the stent without removal of the wire from diagonal branch. We have also demonstrated this novel technique on ex vivo bench testing.

Impact of a combination of full coverage stenting and proximal optimization technique on long term outcome for unprotected distal left main disease

BACKGROUND There is no consensual opinion regarding the percutaneous coronary intervention (PCI) procedure for unprotected distal left main (UDLM) lesion. METHODS Between April 2005 and August 2011, 586 consecutive patients with UDLM stenosis treated with drug-eluting stents were recruited for this study to clarify the impact of combination of full-coverage stenting and proximal optimization technique (POT) for UDLM lesion. An optimal strategy of full-coverage stenting and POT was performed in 353 patients and the other 233 patients were not optimally treated. Major adverse cardiovascular events (MACEs) were defined as all-cause death, myocardial infarction, or target lesion revascularization (TLR) during follow-up period. TLRs were also evaluated for main branch (MB) restenosis. RESULTS At 1615days of follow-up, MACE occurred in 166 (28.3%) patients. The occurrence of MACE and TLR had a trend to being lower in the optimal strategy [propensity score-adjusted HR, 0.73 (95% CI, 0.53-1.01), p=0.05 and propensity score-adjusted HR, 0.69 (95% CI, 0.46-1.02), p=0.06, respectively]. TLR of the MB occurred significantly less frequently in the optimal strategy [propensity score-adjusted HR, 0.34 (95% CI, 0.15-0.76), p=0.008]. Cardiac death occurred in 28 (4.8%) patients. There was no significant difference in cardiac death between the two groups. These results were sustained after propensity-score matching. CONCLUSIONS An optimal PCI strategy of full-coverage stenting and POT might be effective for UDLM lesion to reduce the occurrence of MACE, especially driven by TLR of the MB.

Late lumen enlargement induced by drug coated balloon in the patient with PTFE‐covered stent restenosis

We report a case of percutaneous coronary intervention with drug coated balloon (DCB) for the in‐stent restenosis of polytetrafluoroethylene‐covered stent. One year follow‐up angiography was excellent and in‐stent lumen enlargement compared with the postprocedure and 6‐months follow‐up was demonstrated by optical coherent tomography. This case suggested the utility of DCB as a therapeutic option for covered‐stent restenosis.

Off-label use of 7Fr GuideLiner in the bifurcation coronary intervention protecting 2 side branches.

We report a case of percutaneous coronary intervention in a bifurcation lesion involving left circumflex (LCx) artery and 2 major posterolateral (PL) arteries. The target LCx had diffuse long and severely calcified lesion with the acute takeoff angle from the left main. Despite adequate lesion preparation with rotational atherectomy and balloon angioplasty, the stent was not deliverable, even with deep intubation of 7Fr-guiding catheter. Conventional use of guiding extension catheter (GEC) would have required removal of a wire from at least one PL because of the device interference in the GEC. However, successful stenting was achieved without removal of wires from both PL with 7Fr GuideLiner. We have also demonstrated this mechanism on ex vivo bench testing.

Optical coherence tomography assessment of in-stent restenosis after percutaneous coronary intervention with two-stent technique in unprotected left main.

BACKGROUND Optical coherence tomography (OCT) has contributed to a better understanding of in-stent restenosis (ISR); however, studies evaluating ISR pattern after two-stent technique in unprotected left main (ULM) are lacking. We aim to evaluate the ISR pattern of proximal LAD and LCX after two-stent technique in ULM. METHODS We performed OCT in 26 patients with isolated or combined ISR (identified by angiography as >50%) after two stent implantation in the proximal LCX and LAD. Finally, 13 LAD and 22 LCX ISR lesions underwent OCT assessments. OCT analyses were undertaken in the proximal segments of the LAD and LCX. In addition, we compared OCT findings in the flow divider (FD) and lateral wall (LW). RESULTS In both the LAD and LCX, the distance from the ostium to the minimum lumen area (MLA; LAD, 2.00mm [1.00, 3.00]; LCX, 1.00mm [0.00, 1.80] distal to ostium) was short. Uncovered struts were more common on the FD side compared with the LW in the LAD (6.25% [0.00, 20.00] vs 0.00% [0.00, 0.00], respectively, p=0.016) and LCX (11.32% [0.00, 19.44] vs 0.00% [0.00, 4.55], respectively, p<0.001). Conversely, neointimal hyperplasia (NIH) was significantly thicker on the FD side compared with the LW in the LCX (0.31mm [0.19, 0.47] vs 0.15mm [0.09, 0.31], p<0.001). CONCLUSIONS While uncovered struts were more commonly found on the FD side of both arteries, NIH was significantly thicker on the FD side compared with the LW in the LCX. These unique findings might indicate inferior outcomes after two-stent techniques in ULM bifurcation lesions.

TCT-27 The Impact of Second Generation Drug-eluting Stent on Mid-term Clinical Outcome in Patients with Unprotected Left Main, Milan and New-Tokyo Registry

Niels R. Holm, Kari Kervinen, Matti J. Niemela, Andrejs Erglis, Indulis Kumsars, Terje Steigen, Evald H. Christiansen, Markku Eskola, Hannu Romppanen, Andis Dombrovskis, Ole Frobert, Lars Åberge, Pål Gunnes, Juhani Airaksinen, Anders Hervold, Sanda Jegere, Thor Trovik, Lisette Okkels Jensen, Michael Maeng, Timo Makikallio, Mikko Pietila, Iwar Sjögren, Per Thayssen, Saila Vikman, Jens F. Lassen, Leif Thuesen Aarhus University Hospital, Skejby, Aarhus N, Denmark, Oulo University Hospital, Oulo, Finland, University of Oulo, Oulo, Finland, Pauls Stradins Clinical University Hospital, Riga, Latvia, Latvian Cardiology Center, Riga, Latvia, University Hospital of Northern Norway, Tromso, Norway, Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus N, Denmark, Tampere Heart Center, Tampere, Finland, Latvian center of cardiology, Paul Stradins Clinical Hospital, Riga, Latvia, Örebro University Hospital, Örebro, Sweden, Rikshospitalet, Oslo, Norway, Feiringklinikken, Feiring, Norway, Turku University Hospital, Turku, Finland, Pauls Stradins Clinical University Hospital, Riga, Not applicable, University Hospital of Tromsoe, Tromsoe, Norway, Odense University Hospital, Odense, Denmark, Aarhus University Hospital, Aarhus, Denmark, Falun Hospital, Falun, Sweden, Department of Cardiology, Odense University Hospital, Odense, Denmark, Tampere University Hospital, Tampere, Finland, Department of Cardiology, Aarhus University Hospital, Skejby, Denmark, Aarhus, Denmark