Tsuyoshi Isawa

Delayed-Onset Left Main Coronary Artery Obstruction More than 24 Hours after Balloon-Expandable Transcatheter Aortic Valve Replacement.

Coronary obstruction during or after transcatheter aortic valve replacement is a rare and catastrophic sequela that occurs most frequently just after valve implantation. Even rarer is the delayed clinical presentation, in some few patients, of coronary obstruction on the day after self-expandable valve implantation. Here we describe a case of balloon-expandable (not self-expandable) transcatheter aortic valve replacement, followed by partial obstruction of the left main coronary artery on the day after that procedure in a 93-year-old man, despite normal left ventricular contraction just after valve implantation. Visual evaluation of the echocardiogram for left ventricular wall motion was not sufficient, by itself, to achieve early diagnosis of the obstruction. We performed emergency percutaneous coronary intervention. Ninety days after the procedure, the patient was in New York Heart Association functional class I.

Complete Atrioventricular Block Associated with Pembrolizumab-induced Acute Myocarditis: The Need for Close Cardiac Monitoring

Pembrolizumab, a humanized monoclonal IgG4 antibody directed against programmed death-1, is an immune checkpoint inhibitor that has been introduced for the treatment of non-small-cell lung cancer. However, immune checkpoint inhibitors may cause severe immune-related adverse events. We herein present a case of lung cancer with complete atrioventricular block associated with acute myocarditis, which developed 16 days after the administration of pembrolizumab. The clinical course of this case suggested a strong need for close cardiac monitoring when pembrolizumab is administered on an outpatient basis.

COMPARISON OF RADIAL ARTERY OCCLUSION AFTER TRANSRADIAL CORONARY INTERVENTION USING A NEW DEDICATED RADIAL SHEATH VERSUS A SHEATHLESS GUIDING CATHETER

Background: A new dedicated radial sheath (6-Fr Glidesheath Slender, Terumo, Japan) has almost the same outer diameter as a 7.5-Fr sheathless guiding catheter (Sheathless Eaucath, Asahi Intecc, Japan). We aimed to investigate the incidence and associated factors of radial artery occlusion (RAO)

“Spaghetti twisting” technique: a novel method of catching pacemaker leads using a needle's eye snare

The needles eye snare has become an indispensable tool in contemporary pacemaker lead extraction techniques. Here, we present a modified method of using the needles eye snare, named “spaghetti twisting” technique, to catch and secure pacemaker leads, which would help operators catch and secure leads much easily.

A “tetra-axial” system in transfemoral lead extraction

Pacemaker lead extractors must become familiar with transfemoral approaches for lead extraction as a bail‐out procedure for a failed superior approach. We presented a “tetra‐axial” system for transfemoral lead extraction. This system would be more widely applicable in cases with difficulties in extraction, resulting in more procedural success.

A Novel, Modified Reverse Controlled Antegrade and Retrograde Subintimal Tracking Technique for Bypassing the Calcified Proximal Cap of Coronary Total Occlusions

Antegrade crossing is the most common approach to chronic total occlusions (CTOs). However, it is sometimes difficult to penetrate the proximal hard cap with guidewires, especially in the case of CTOs of anomalous coronary arteries because of a lack of support. Herein, we describe a novel, modified reverse controlled antegrade and retrograde subintimal tracking (CART) technique in which the dissection reentry was intentionally created in the proximal segment of the vessel, not within the occluded segment, using retrograde guidewire and the aid of an antegrade balloon. This technique facilitated retrograde crossing of CTOs by avoiding the proximal hard cap and may provide a viable option for patients in which conventional reverse CART is not possible.