Takeshi Nakamura

3D optical coherence tomography: new insights into the process of optimal rewiring of side branches during bifurcational stenting.

AIMS We describe three-dimensional optical coherence tomography (3D-OCT) guided bifurcation stenting and the clinical utility of 3D-OCT. METHODS AND RESULTS Twenty-two consecutive patients who underwent OCT examination to confirm the recrossing position after stent implantation in a bifurcation lesion were enrolled. Frequency domain OCT images were obtained to check the recrossing position and 3D reconstructions were performed off-line. The recrossing position was clearly visualised in 18/22 (81.8%) cases. In 13 cases, serial 3D-OCT could be assessed both before and after final kissing balloon post-dilation (FKBD). We divided these cases into two groups according to the presence of the link between hoops at the carina: free carina type (n=7) and connecting to carina type (n=6). All free carina types complied with the distal rewiring. The percentage of incomplete stent apposition (%ISA) of free carina type at the bifurcation segment after FKBD was significantly smaller than that of the connecting to carina type (0.7±0.9% vs. 12.2±6.5%, p=0.0074). CONCLUSIONS 3D-OCT confirmation of the recrossing into the jailed side branch is feasible during PCI and may help to achieve distal rewiring and favourable stent positioning against the side branch ostium, leading to reduction in ISA and potentially better clinical outcomes.

Serial changes in the three-dimensional aspect of the side-branch ostium jailed by a drug-eluting stent assessed by optical coherence tomography

The present study investigated serial changes in the three-dimensional (3D) aspect of the jailed side-branch (SB) ostium. We evaluated 32 patients who underwent examination with optical coherence tomography (OCT) both at baseline and at follow-up. After reconstruction of the 3D images, we classified the configuration of overhanging struts at the SB orifice into three groups according to the 3D aspect of the jailing configuration. The number of compartments divided by the stent strut was counted. The side-branch flow area (SBFA), i.e., the area of the SB ostium except for jailing struts, was measured by cut-plane analysis. Forty-eight SBs of 25 patients were analyzed. Thirteen SBs were classified as the No-jail type (N-type), 19 as the Simple-jail type (S-type; no longitudinal link at the carina), and 16 as the Complex-jail type (C-type; had a link at the carina). In the N-type, the SBFA was significantly increased at follow-up (P = 0.018). In the C-type, the SBFA was significantly decreased at follow-up (P = 0.002). Percent reduction of SBFA in the C-type group was significantly greater than that in the N-type or S-type groups (S-type vs. C-type P = 0.002, N-type vs. C-type P < 0.001). 3D-OCT images showed that some of the compartments were filled with tissue. The number of compartments was significantly decreased at follow-up (P < 0.001). In the C-type group, the SBFA was significantly decreased and small compartments were filled with tissue. These findings suggest that stent jail complexity is associated with the progression of SB ostial stenosis.

Serial changes in the side-branch ostial area after main-vessel stenting with kissing balloon inflation for coronary bifurcation lesions, assessed by 3D optical coherence tomography

Aims We evaluated the influence of the jailing configuration and guidewire rewiring position in front of the side-branch (SB) ostium before kissing balloon inflation (KBI) against side-branch ostial area (SBOA) at follow-up using 3D optical coherence tomography (3D-OCT). Methods and results We retrospectively analysed the cases of the 37 consecutive patients who underwent main-vessel (MV) stenting with KBI for coronary bifurcation lesion under OCT guidance and the follow-up OCT 6-12 months. We divided the patients into two groups, considering both the jailing configuration and the rewiring position by 3D-OCT. We defined the cases that achieved both the distal rewiring and link-free carina configuration as the FCD group, and the other cases were defined as the Non-FCD group. We compared the differences in the SBOA derived by the cut-plane analysis and the number of compartments between the two groups. The median and interquartile range of serial change and percent serial change in SBOA in the FCD group were significantly larger than those in the Non-FCD group [0.43 mm2 (-0.29 to 0.91) vs. -0.65 mm2 (-1.33 to 0.34); P = 0.0136 and 9.47% (-8.37 to 27.33) vs. -13.77% (-31.64 to 10.88); P = 0.0182]. Conclusion This serial OCT study demonstrated that the achievement of both the distal rewiring and link-free carina configuration may be important for the preservation of the SBOA after MV stenting with KBI for coronary bifurcation lesions.

1-Year Follow-Up of Contained Aortic Root Rupture After Transcatheter Aortic Valve Replacement

The authors performed a transfemoral aortic valve replacement (TF-TAVR) in an 89-year-old woman with severe aortic stenosis. The pre-operative transthoracic echocardiography (TTE) revealed severe aortic stenosis (aortic valve area 0.6 cm2) with huge calcifications at each leaflet. At multislice

A Case of Gastric Cancer with Intramural Metastasis to the Thoracic Esophagus

症例は64歳の男性で, 食欲低下, 嘔吐を主訴に来院. 上部消化管造影および内視鏡検査で胃噴門より体中部に及ぶ全周性の潰瘍浸潤型病変を, 胸部中部食道に径30, 10mmの2個の隆起性病変を認めた. 胃および食道病変に連続性はなかったが, 生検による病理診断は両病変とも中分化型管状腺癌であった. 食道に壁内転移を伴う胃癌と診断し, 開腹術を施行した. 胃近傍より大動脈周囲に至る多数のリンパ節に腫大を認め予後不良と判断し, 膵体尾部, 脾合併切除を伴う胃全摘を行い食道切除は施行しなかった. 術後CDDP, 5FUを中心とした化学療法, 内視鏡的食道粘膜切除, 鎖骨上・縦隔への放射線照射などを併用し, 術後34か月と比較的長期の生存を得たが, 多臓器転移のため死亡した. 食道壁内転移を伴う胃癌症例の報告は少ないが, 高度進行例が多く, 治療として患者のQOLを考慮した外科的切除, 化学・放射線療法の併用を考慮すべきであると思われた.