Yoshiki Uehara

A prospective multicenter registry of 0.010-inch guidewire and compatible system for chronic total occlusion: The PIKACHU registry†

Objectives: The aim of this study was to evaluate the safety and effectiveness of a 0.010‐inch guidewire and a balloon catheter for treatment of chronic total occlusion (CTO). Background: Pathological studies have shown that 60–70% of CTO lesions have microchannels of sizes equal to or less than 0.010 inch. Methods: The PIKACHU registry is a prospective, multicenter registry study. A 0.010‐inch guidewire had to be used as the first guidewire to attempt to pass the CTO lesion. The primary endpoint was device success using a 0.010 system. Results: A total of 141 patients with 141 lesions were enrolled. The median duration of occlusion was 9 months (range 3–156). Average guiding catheter size was 5.8 ± 0.7 Fr. and TRI was 76.6 %. CTOs were mostly between 10–20 mm long, observed in 53 occlusions. There were 107 lesions (75.9%) with bending of more than 45 degrees. Calcification was seen in 91 lesions (64.5%). A 0.010‐inch guidewire was successfully passed through in 97 of 141 lesions (68.8%). A 0.010‐inch guidewire compatible balloon catheter was passed in 87 of the 97 lesions (88.7%) and final PCI success was achieved in all the cases. The overall clinical success rate was 87.9% (124/141). No MACE or bleeding complications were observed. Conclusion: The PIKACHU registry data suggest that the 0.010‐inch system is safe and practicable for treatment of CTO lesions.

Usefulness of Everolimus-Eluting Coronary Stent Implantation in Patients on Maintenance Hemodialysis

The outcomes of second-generation drug-eluting stent (DES) are unknown in patients on maintenance hemodialysis (HD) although HD has been reported as a strong predictor of adverse outcome after the first-generation DES implantation. The OUCH-PRO Study is a prospective multicenter single-arm registry design to study clinical and angiographic outcomes after everolimus-eluting stent (EES). Patients who underwent maintenance HD were prospectively enrolled at the time of elective coronary intervention using EES. Quantitative coronary angiography was performed in an independent core laboratory. The primary end point was the occurrence of target vessel failure (TVF) defined as cardiac death, myocardial infarction (MI), and target vessel revascularization at 1 year. A total of 123 patients were enrolled and 161 EES were implanted. The TVF rate at 1 year was 18% (4% cardiac death, 0% MI, 17% target vessel revascularization). No stent thrombosis was documented. Other clinical events at 1 year were 3% noncardiac death, 3% stroke, and 9% non-target-vessel revascularization. Late lumen loss in stent was 0.37 ± 0.63 mm at 8 months. In conclusion, EES had a high TVF rate and great late lumen loss in patients on HD compared with previous huge EES data in non-HD patients.

Effects of efonidipine, an L- and T-Type dual calcium channel blocker, on heart rate and blood pressure in patients with mild to severe hypertension: an uncontrolled, open-label pilot study

BACKGROUND Dihydropyridines (DHPs), a type of calcium channel blocker (CCB), are commonly prescribed for the treatment of hypertension and angina pectoris. DHPs act mainly on L-type calcium channels, essentially causing reflex tachycardia (elevated heart rate [HR]), which negatively affects cardiac function. Because T-type calcium channels in the sinoatrial node attenuate reflex tachycardia, a dual L- and T-type CCB (eg, efonidipine hydrochloride) may favorably affect cardiac pacing, thereby reducing reflex tachycardia. The effect of efonidipine as a DHP on HR deserves special consideration with regard to reflex tachycardia. OBJECTIVE The aim of this study was to determine whether the L- and T-type CCB efonidipine can decrease the elevated HR induced by prior treatment using traditional DHPs. METHODS This uncontrolled, open-label pilot study was conducted at the Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine (Tokyo, Japan). Patients aged 48 to 80 years with mild to severe hypertension and angina pectoris and who were receiving therapy with a DHP other than efonidipine were eligible. During an 8-week observation period, patients continued therapy with their DHP. After those 8 weeks, therapy was switched to oral efonidipine (40-mg tablet once daily) in patients whose blood pressure (BP) was stable and well controlled and whose HR was >80 bpm. BP and HR were monitored every 4 weeks of treatment with efonidipine. RESULTS Eighteen patients (12 men, 6 women; mean [SD] age, 62.6 [12] years) were enrolled. After the switch to efonidipine, mean (SD) HR decreased significantly, from 94 (7) bpm to 86 (11) bpm at 12 weeks (P<0.05). The antihypertensive effect of efonidipine was similar to that of the DHPs used before the switch to efonidipine therapy, and reflex tachycardia was attenuated. CONCLUSION In this study of a small sample of patients with mild to severe essential hypertension and angina pectoris, efonidipine was as effective as other DHPs. Moreover, the drug attenuated the reflex tachycardia that occurred with traditional DHPs.

Clinical and angiographic outcomes of paclitaxel-eluting coronary stent implantation in hemodialysis patients: A prospective multicenter registry: The OUCH-TL study (outcome in hemodialysis of TAXUS Liberte).

BACKGROUND The outcome of percutaneous coronary intervention (PCI) has been reported to be poor in hemodialysis (HD) patients even in the drug-eluting stent era. We have reported relatively poor outcomes after sirolimus-eluting stent implantation in the OUCH study. METHODS The OUCH-TL study is a prospective, non-randomized, single-arm registry designed to assess the results of paclitaxel-eluting stent (PES) in HD patients with follow-up quantitative coronary angiography analysis. The primary endpoint was the occurrence of target-vessel failure (TVF) defined as cardiac death, myocardial infarction (MI), and target-vessel revascularization (TVR) at 12 months. RESULTS A total of 119 patients with 154 lesions were enrolled (one withdrawal). Mean age was 65±10 years, male gender was 79%, 89% of cases had stable coronary disease. Diabetic nephropathy was diagnosed in 61% of the patients. American College of Cardiology/American Heart Association type B2/C accounted for 96% of lesions and 22.7% of lesions were treated with Rotablator (Boston Scientific Corporation, Natick, MA, USA). Rates of TVF, death, MI, stent thrombosis and TVR at 12 months were 20.2%, 5.9%, 5.0%, 1.4%, and 12.6%, respectively. TVR was performed in 8.4% of the patients up to 12 months. Late loss in-stent was 0.48±0.61mm, and late loss in-segment was 0.37±0.61mm at 9 months. Binary restenosis in-stent was 10.3% and in-segment was 14.5%. CONCLUSIONS Outcomes of PES implantation in hemodialysis patients appears comparable to those of non-hemodialysis patients.

A case of CTO treated with minimum use of contrast media

The retrograde approach is a novel technique for improving the success rate of guidewire passage through chronic total occlusion (CTO). In addition, this technique, especially when intravascular ultrasound‐guided reverse controlled antegrade and retrograde subintimal tracking is employed, may help the operator to save on the contrast media used. In the case reported here, only 10 ml of contrast media was used in percutaneous coronary intervention for CTO.

A novel technique for catheter engagement of protruding aorto-ostial stent.

We present a case of stenoses in the right coronary artery with a previously deployed stent showing gross protrusion into the aorta. Despite difficulty in cannulation of a guiding catheter into the coronary artery, percutaneous intervention was accomplished using a novel technique to engage the protruding stent.

Impact of Serum Phosphorus Levels on Outcomes After Implantation of Drug-Eluting Stents in Patients on Hemodialysis

BACKGROUND Elevated serum phosphorus level is an important risk factor for cardiovascular death in general patients on hemodialysis (HD). However, the effect of serum phosphorus levels on outcomes after drug-eluting stent (DES) implantation in HD patients is unknown.Methods and Results:This was a post-hoc study of the OUCH study series, a series of prospective multicenter registries of HD patients who underwent DES implantation comprising 359 patients from 31 centers in Japan. Patients were categorized into 3 groups according to their preprocedural serum phosphorus levels. The 1-year clinical outcomes of the 336 patients treated for de novo lesions were evaluated. Compared with patients with high (>5.5 mg/dL; n=65) or normal (3.5-5.5 mg/dL; n=219) serum phosphorus levels, those with low serum phosphorus levels (<3.5 mg/dL; n=52) had significantly fewer target lesion revascularization events (13.9% vs. 16.9% vs. 1.9%; P=0.0090) and major adverse cardiac and cerebrovascular events (29.2% vs. 31.1% vs. 13.5%; P=0.032). Multivariate logistic regression analysis revealed that low serum phosphorus level was an independent negative predictor for major adverse cardiac and cerebrovascular events (adjusted odds ratio, 0.31; 95% confidence interval, 0.12-0.70; P=0.0036). CONCLUSIONS Lowering of serum phosphorus levels beyond the current recommended range may be considered in HD patients who undergo DES implantation.

TCTAP C-105 RCA CTO Treated by Contemporary Reverse CART Using GAIA Third Guidewires Bidirectionally

### Patient initials or identifier number A. K. ### Relevant clinical history and physical exam The patient had a history of CHF and RCA CTO was documented by CAG. PCI for the RCA CTO had been attempted twice; however guidewire was not able to pass the CTO. Therefore, this procedure was third

Evaluation of the timing of flecainide administration and ischemia-induced ventricular arrhythmias in rats

Abstract Ischemia-induced arrhythmias are major complications of acute myocardial infarction; therefore, understanding the proper use of antiarrhythmic drugs in this situation is important. The goal of the present study was to determine how the timing of flecainide administration influenced ischemia-induced arrhythmias in an isolated rat heart model. Ischemia-induced arrhythmia was produced by ligating the left coronary artery. The effect of flecainide (10 −6 M) on ischemia-induced arrhythmia varied depending on the time of drug administration in relation to the time of coronary artery ligation. Drug administration both before and after (group 5) coronary artery ligation was most effective, followed by administration before (group 4) and then by administration after (group 3). At the end of each experiment, the left and right ventricular walls of each heart were separated, and drug concentration in each part was measured. Drug concentration in the left ventricular wall differed significantly between the group in which coronary artery ligation was not performed (group 1) and group 3 or 4. No correlation between drug concentration in the right ventricular wall and antiarrhythmic effect was observed. These differences in antiarrhythmic effect depending on the timing of drug administration may be caused by the difference in drug concentration in the ischemic zone and the effect of coronary artery occlusion on the speed of drug dispersion within this zone. This myocardial infarction model is useful for studying the correlation between antiarrhythmic effect and regional drug distribution.