Yoshiyasu Minami

Successful Retrieval of Entrapped Balloon With Optical Coherence Tomography Guidance

A 75-year-old woman underwent percutaneous coronary intervention (PCI) for her tight calcified lesion at proximal left anterior descending artery ([Figurexa01A][1]). After debulking the thick calcified lesion using rotational coronary atherectomy, further dilation using a noncompliant balloon was

Lower limb ischemia due to popliteal artery compression by Baker cyst

A Baker cyst is the most common mass around the knee joint. It is mostly asymptomatic; however, it may cause knee pain or focal swelling because of compression of vein or nerve. Herein, we report a case of Baker cyst obstructing arterial flow and causing intermittent claudication. An attached polycystic mass was found posterior to the popliteal artery. Needle aspiration was ineffective, and the patient experienced recurrent lower leg pain. Surgical resection was performed, and the patient became symptom free. Baker cyst may cause lower limb ischemia through obstruction of arterial flow, requiring surgical intervention.

Intramural Hematoma Due to In-Stent Dissection Causing Acute Coronary Occlusion

A 74-year-old woman underwent percutaneous coronary intervention in her right coronary artery with 2 zotarolimus-eluting stents. Final angiography and optical coherence tomography (OCT) showed neither stent edge dissection nor significant malapposition; however, a dissection within the stented

Unexpected Measurement Error in Optical Coherence Tomography–Guided Percutaneous Coronary Intervention

A 70-year-old man underwent percutaneous coronary intervention (PCI) for a diffuse lesion at proximal right coronary artery. Optical coherence tomography (OCT) showed an additional 15-mm-length stent would be suitable to cover a residual lesion with irregular cavities ([Figurexa01A][1]). However, on

Importance of Early Diagnosis of Cardiac Sarcoidosis in Patients with Complete Atrioventricular Block

Our aim is to clarify the factors for early diagnosis of cardiac sarcoidosis (CS) in patients with complete atrioventricular block (CAVB) and its impact on cardiac function after corticosteroid therapy.A total of 15 CS patients with CAVB who underwent corticosteroid therapy were retrospectively analyzed. Patients were divided into two groups according to the time from the first CAVB onset to the diagnosis of CS. Clinical characteristics and outcomes were compared between the early diagnosis group (within 1 year; group E, n = 10) and the late diagnosis group (over 1 year; group L, n = 5).The history of extracardiac sarcoidosis (60 versus 0%, P = 0.0440) and abnormal findings on echocardiography (70 versus 0%, P = 0.0256) at the CAVB onset were significantly more frequent in group E than in group L. The change of left ventricular ejection fraction (LVEF) and brain natriuretic peptide (BNP) levels was significantly better in group E than in group L (0.8 ± 2.8 versus -32.4 ± 3.9%, P < 0.0001; -11.1 ± 16.0 versus 161.8 ± 35.8 pg/mL, P = 0.0013, respectively). After corticosteroid therapy, the LVEF and BNP levels were also significantly better in group E than in group L (53.3 ± 10.7 versus 37.0 ± 9.3%, P = 0.0128; 63.0 ± 46.4 versus 458.8 ± 352.0 pg/mL, P = 0.0027).The diagnosis may be delayed in CS patients with CAVB without history of extracardiac sarcoidosis. Abnormal findings on echocardiography contributed to the early diagnosis of CS. Therefore, the diagnosis of CS may be missed or delayed in patients without them. Time delay from the CAVB onset to the CS diagnosis may exacerbate the cardiac function.

Endothelial Dysfunction Is Associated with Cognitive Impairment of Elderly Cardiovascular Disease Patients: A Reactive Hyperemia-Peripheral Arterial Tonometry Study

Cognitive impairment is frequently represented in elderly patients with cardiovascular disease (CVD); yet, the mechanism is uncertain. Recent studies have suggested the association between the vascular endothelial dysfunction and cognitive impairment. The aim of this study was to clarify the association between endothelial dysfunction and cognitive impairment in elderly patients with CVD.A total of 80 elderly patients (> 70 years old) with CVD were included. Patients who had already pharmacologically intervened for cognitive impairment were excluded. The endothelial dysfunction was assessed by the reactive hyperemia-peripheral arterial tonometry (RH-PAT). Cognitive impairment was diagnosed by the Mini-mental state examination.The RH-PAT index was significantly lower in cognitive impairment (median 1.60 [interquartile range (IQR) 1.34 to 1.89], n = 51) as compared with non-cognitive impairment (median 1.75 [IQR 1.55 to 2.30], n = 29, P = 0.005). By a multivariate analysis, the RH-PAT index was independently associated with cognitive impairment (odds ratio: 0.89; 95% confidence interval: 0.81 to 0.97; per 0.1, P = 0.044). In the receiver-operating characteristic analysis, the best cut-off of the RH-PAT index to identify cognitive impairment was 1.65 (area under the curve 0.67; P = 0.011) with limited the sensitivity (63%) and specificity (66%).A lower RH-PAT index was significantly associated with the presence of cognitive impairment in elderly CVD patients. Further studies are required to clarify the mechanism and the causal relationship between the endothelial dysfunction and cognitive impairment in patients with CVD.

Neoatherosclerosis With Napkin Ring Calcification

eluting stent (2.5–38 mm) was then successfully implanted to cover both the restenosis lesion and a subsequent diffuse lesion at the distal end of the stent. Neoatherosclerosis has been reported as a cause of stent failure in the chronic phase.1 Herein, we report a case of neoatherosclerosis with extremely severe calcification requiring rotational atherectomy. Intriguingly, the neointimal tissue was completely occupied by thick and circumferential calcification although there had been a tiny calcification at the corresponding site before stenting. A higher prevalence of neointimal calcification has been noted in hemodialysis A n 84-year-old woman on hemodialysis was admitted due to effort angina. She had a history of paclitaxeleluting stent (PES) implantation for a diffuse stenotic lesion with a tiny calcification at the proximal left anterior descending artery 6 years earlier (Figure 1). Angiography showed a restenosis at the distal edge of the PES (Figure 2A). On optical coherence tomography a significant luminal narrowing with circumferential and thick calcium formation was noted around the stent edge (Figure 2B,C). Given that balloon angioplasty failed to dilate the lesion, rotational atherectomy was necessary. An everolimus-

Untreated cardiac sarcoidosis with active inflammation: Severe left ventricular dysfunction and ventricular wall thinning in three years

A 74-year-old female was admitted for the treatment of complete atrioventricular block. Echocardiography showed thickening of interventricular septum and a slight thinning in the basal region with normal left ventricular (LV) function. She was clinically diagnosed with cardiac sarcoidosis accompanied by active inflammation from the findings of blood test, nuclear scanning, and magnetic resonance imaging. After pacemaker implantation, we recommended corticosteroid therapy, which she refused for the fear of side effects. Three years later, she was re-admitted to our hospital due to heart failure. Echocardiography showed severe LV systolic dysfunction and dilatation with wall thinning. Even though we started corticosteroid therapy and continued it for one year, LV function was not improved. In patients with cardiac sarcoidosis accompanied by active inflammation, LV dysfunction, and dilatation may rapidly progress. Early diagnosis and treatment with corticosteroid may be important to preserve cardiac function. <Learning objective: Left ventricular (LV) dysfunction in patients with cardiac sarcoidosis accompanied by active inflammation may rapidly progress in a short period. Corticosteroid therapy is demonstrated to improve the long-term clinical outcome, however, it may not be effective once LV function is worsened with wall thinning. Early diagnosis and treatment with corticosteroid may be important to preserve cardiac function in patients with cardiac sarcoidosis accompanied by active inflammation.>.

Myocardial ischemia induced by major aortopulmonary collateral arteries treated with transcatheter coil embolization

Major aortopulmonary collateral arteries branching from coronary arteries may cause coronary steal. The careful follow‐up is needed irrespective of symptoms because increasing physical activities and oxygen demand along with the age may induce myocardial ischemia. Transcatheter intervention by well‐trained physician would be a treatment option in patients with myocardial ischemia.

Localized Inflammation and Aneurysm Formation 10 Years After Sirolimus-Eluting Stent Implantation

and cilostazol at 200 mg/day for 10 years. As part of thorough examination of atrioventricular block, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) was performed to rule out cardiac sarcoidosis. There was no myocardial FDG uptake, but there was a significant uptake around the SES in the LAD (Figure 1). Coronary CT angiography showed aneurysmal dilatation (18×28 mm) with a low-density area surrounding the SES (Figure 2A). Coronary angiography A 63-year-old woman was admitted for the treatment of sick sinus syndrome and atrioventricular block. She had received sirolimus-eluting stent (SES; 2.5×18 mm) in the left anterior descending artery (LAD) 10 years previously. Routine coronary angiography had indicated no stent restenosis 1 year after SES implantation. The patient had a history of hyperlipidemia and hypertension, and coronary risk factors were well controlled after the stenting. She continued taking aspirin at 100 mg/day