Toshihisa Inoue

Efficacy of thrombectomy for acute myocardial infarction-Special focus on its efficacy according to different infarct-related arteries.

BACKGROUND The efficacy of thrombectomy during percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction (STEMI) has not yet been fully evaluated. The aim of this retrospective study was to evaluate the usefulness of manual thrombectomy for STEMI and to clarify whether different infarct-related arteries (IRAs) influence the efficacy of thrombectomy. METHODS AND RESULTS We enrolled 183 patients with STEMI who underwent PCI within 24h after onset between October 2001 and January 2004. We divided these patients into 2 groups, namely 88 patients who had undergone PCI after manual thrombectomy (Th+ group) and 95 patients who were treated with PCI alone (Th- group). The Th+ group had lower incidences of distal embolization and no-reflow phenomenon than the Th- group (6.8% vs. 27.4%, p=0.0003; and 5.7% vs. 23.2%, p=0.0009, respectively). The percentage of complete ST-segment resolution (STR) after PCI and left ventricular ejection fraction 6 months after the procedure were significantly higher in the Th+ group (43.2% vs. 20%, p=0.002; and 60.1% vs. 54.8%, p=0.004, respectively). Regarding different IRAs, the percentage of complete STR was significantly higher in patients with proximal left anterior descending coronary artery (LAD) and right coronary artery (RCA) lesions in the Th+ group (37.5% vs. 9.7%, p<0.05; and 59.5% vs. 30.3%, p<0.05, respectively). Incidences of adverse events were similar in both groups. CONCLUSIONS Manual thrombectomy for STEMI can improve myocardial reperfusion after PCI and left ventricular function late after the procedure. With respect to different IRAs, manual thrombectomy for STEMI is more effective in proximal LAD and RCA lesions.

Evaluation of blood flow patterns of true and false lumens in dissecting aneurysms using MR phase-contrast techniques

The magnetic resonance phase-contrast technique for the measurement of flow velocity and volume in true and false lumens was studied in six patients with chronic dissecting aneurysms. Phase-contrast images were obtained at a level perpendicular to the dissecting aneurysms of the descending aorta. As the maximum diameter of aneurysms increased, the ratio of the cross-sectional area of the false to the true lumen increased and the peak average velocity in the true lumen during systole was decreased. This technique proved invaluable for determining prognosis and operability for this condition.

Restenosis after implantation of sirolimus-eluting stent begins suddenly, shows short term progression, and stops suddenly.

BACKGROUND AND PURPOSE The peak of restenosis in patients implanted with bare metal stents (BMS) is thought to be 6 months after BMS implantation, but the development of restenosis with respect to time and the peak of restenosis in patients implanted with drug-eluting stents (DES) is not known. This study aims to reveal the rate of development of restenosis with respect to time in patients implanted with DES. METHODS A total of 282 patients who underwent sirolimus-eluting stent (SES) implantation in native coronary arteries at our hospital were evaluated by serial quantitative angiography at 3 and 6 months, and based on the latter results, at 1 and 2 years after SES implantation. Clinical data were collected for up to 3 years. RESULTS Three-year follow-up data were obtained for 261 patients. The 3-year incidence of clinically driven target-lesion revascularization (TLR) was 6.1% (16/261); of the 16 cases, 5 occurred at 3-month follow-up, 7 at 6-month angiographic follow-up, and 1 at 1-year follow up, respectively. While minimum lumen diameter (MLD) of these vessels that underwent TLR at 6 months decreased rapidly after the 3-month angiographic follow-up, MLD of the vessels with 50-70% stenosis at 6-month angiographic follow-up was almost unchanged at 1-year angiographic follow-up; however, 3 lesions required late (i.e. beyond 1 year) revascularization. CONCLUSIONS It is difficult to predict SES restenosis by angiography. SES restenosis begins suddenly, shows short-term progression, and stops suddenly. However, treatment of de novo coronary stenosis with SES is associated with a sustained clinical benefit and a very low incidence of TLR.

Differences in the Development of Restenosis Over Time for Various Drug-Eluting Stents

Differences in the Development of Restenosis Over Time for Various Drug-Eluting Stents Introduction: Restenosis after stent implantation is one of the major limitations of percutaneous coronary intervention (PCI). Compared to bare metal stents (BMS), drug-eluting stents (DES) have a reduced incidence of restenosis. However, the temporal pattern of restenosis development in patients implanted with DES has not been clearly defined. Aim: This study aims to compare the efficacy of sirolimus-eluting stents (SES), paclitaxel-eluting stents (PES), zotarolimus-eluting stents (ZES), and everolimus eluting stents (EES) via sequential angiographic follow-up and to reveal the development of restenosis over time. Material and methods: Patients were randomized to receive SES, PES, ZES, or EES, and follow-up angiography was performed at 6, 12 and 24months after percutaneous coronary intervention. We analyzed late loss (LL) at each time point and defined 2 time periods: “early” (within first year of follow-up) and “late” (after the first year). Results: In all groups, mean minimal lumen diameter decreased slightly during the 2-year period after the procedure. Compared with the SES group, the PES and the ZES groups showed significantly greater late loss (LL) within 1 year. However, the SES group showed significantly greater LL compared with the other drug-eluting stents (DES) between 1 and 2 years. Conclusions: Serial angiographic analysis revealed differences in the rate of restenosis development over time for various DES. Of the studied DES, EES showed the best results in both early and late LL.

A case with dissecting aneurysm of the ascending aorta (DeBakey type II) survived long years after the onset.

症例は76才女性. 1978年胸部大動脈瘤を指摘され, 1983年同部解離性大動脈瘤の診断をうけ,降圧療法による治療を行っていた. 1988年,膵癌の第4胸椎への転移による両下肢麻痺が出現し,当科に入院したが,呼吸器感染症にて死亡.剖検にて,内部の器質化した直径10数cmのDeBakey II型解離性大動脈瘤を認めた.中枢型解離性大動脈瘤の予後は不良で,本症例のように瘤拡大の著明な例で,手術なしで長期間生存した例はまれであるため,ここに報告する.