Yuji Nishimoto

Comparison of angioscopic findings among second-generation drug-eluting stents

BACKGROUND First-generation drug-eluting stents (DES) have reduced short-term stent failure as compared to bare-metal stents due to the inhibition of neointima hyperplasia, but instead increased the risk of very-late stent failure. Although better outcomes have been reported for second-generation DES than for first-generation DES, the difference in the angioscopic findings at 1-year follow-up has not been adequately elucidated among second-generation DES. METHODS Consecutive 161 patients who received angioscopic examination at 1 year after implantation of second-generation DES, i.e. Nobori biolimus-eluting stents (Terumo, Tokyo, Japan) (N-BES, n=25), Xience everolimus-eluting stents (Abbot Vascular, Santa Clara, CA, USA; X-EES, n=95), or Resolute zotarolimus-eluting stents (Resolute Integrity; Medtronic, Minneapolis, MN, USA; R-ZES, n=41), in de novo native coronary lesions were analyzed. RESULTS Maximum neointima coverage grade (N-BES, 0.9±0.3; X-EES, 1.2±0.4; R-ZES, 1.5±0.5; p<0.001) was the highest in R-ZES and lowest in N-BES. Heterogeneity score was higher in R-ZES than in N-BES (N-BES, 0.8±0.4; X-EES, 0.9±0.4; R-ZES, 1.1±0.5; p=0.007). Maximum yellow color grade and prevalence of thrombus were not different. Multivariate analysis demonstrated that only stent type was associated with maximum neointima coverage grade; stent type and total stent length were associated with heterogeneity score; and stenting for acute coronary syndrome (ACS) and total stent length were associated with maximum yellow color grade. CONCLUSIONS Neointima coverage and heterogeneity were mainly determined by stent type even among second-generation DES, while yellow color was determined mainly by whether target lesion was of ACS.

Angioscopic Comparison of Resolute and Endeavor Zotarolimus-Eluting Stents.

BACKGROUND Drug-eluting stents (DES) have reduced late loss and target lesion revascularization through the inhibition of neointimal hyperplasia, but instead increased the risk of very late stent failure due to incomplete neointimal coverage and neoatherosclerosis. Although newer DES are more effective and safer than the first-generation DES, the difference in the condition of the stented lesions between Resolute zotarolimus-eluting stents (R-ZES) and Endeavor zotarolimus-eluting stents (E-ZES) on angioscopy has not been reported. METHODSANDRESULTS Consecutive patients who received R-ZES (n=46) or E-ZES (n=46) for de novo lesion of native coronary artery and had 1-year follow-up angioscopy were examined. Yellow color (grade 0-3), neointimal coverage (grade 0-2), heterogeneity score (maximum-minimum neointimal coverage grade) and thrombus (presence or absence) at stented lesion were evaluated. The maximum yellow color grade (1.2±0.9 vs. 0.7±1.0, P=0.005) was higher in R-ZES than in E-ZES. The maximum (1.9±0.3 vs. 1.5±0.5, P<0.001) and minimum (1.1±0.7 vs. 0.4±0.5, P<0.001) coverage grade was higher in E-ZES than in R-ZES. The heterogeneity score was higher in R-ZES than in E-ZES (1.0±0.5 vs. 0.7±0.7, P=0.007). Prevalence of thrombus was not different between the 2 stents (6.5% vs. 2.2%, P=0.4). CONCLUSIONS E-ZES had better neointimal coverage with less yellow plaque and lower heterogeneity score than R-ZES. The lesions with E-ZES appeared more stable than those with R-ZES. (Circ J 2016; 80: 650-656).

Detection of angioscopic yellow plaque by intracoronary near-infrared spectroscopy.

Angioscopy can detect vulnerable, lipid-rich coronary plaques (LRPs), but it requires removal of blood plus expert technique and interpretation [(1,2)][1]. We studied the use of a near-infrared spectroscopy (NIRS) intravascular ultrasound (IVUS) catheter [(3)][2], which does not require blood

Fibrillatory pattern of dissociated venous activity after pulmonary vein isolation: Novel characteristics for remnant foci of a trigger ectopy for atrial fibrillation

BACKGROUND Dissociated pulmonary vein activity (DPVA), defined as isolated intrinsic ectopic beats observed after successful pulmonary vein (PV) isolation, indicates the presence of remnant foci of trigger ectopy but has yet to be extensively studied. We investigated the correlation between DPVA and the PV triggers of atrial fibrillation (AF). METHOD AND RESULTS Consecutive 110 patients undergoing AF ablation were enrolled. We defined trigger ectopy as documented ectopic foci observed to spontaneously initiate AF. Trigger ectopy was detected in 62 (56%) patients. DPVA in at least one PV was detected in 95 (86%) patients. Of the 440 isolated PVs, we recognized trigger ectopy in 73 (16%) PVs (culprit PVs) and DPVA in 184 (42%) PVs. DPVA was more frequently observed in culprit PVs than in non-culprit PVs [59% vs. 39%; odds ratio (OR)=2.3; p=0.001]. The concordance ratio of culprit PV was 67% (8/12) in PV with fibrillatory DPVA, 20% (35/172) in PV with non-fibrillatory DPVA, and 12% (30/256) in PV without DPVA. Fibrillatory DPVA was more frequently observed in culprit PVs than non-fibrillatory DPVA (OR=7.8; p=0.001). Non-PV foci were observed in 10 (11%) of the 95 patients with DPVA and 5 (33%) of the 15 patients without DPVA (OR=4.3; p=0.02). No significant difference in the frequency of AF recurrence was observed between them. CONCLUSIONS Fibrillatory DPVA was found to be strongly associated with trigger ectopy of AF. Non-fibrillatory DPVA might merely indicate the existence of bystander ectopic foci located inside PVs. Non-PV ectopic foci were frequently observed in patients without DPVA.

Angioplasty of the Occluded Persistent Sciatic Artery Using the Retrograde Approach from Superficial Femoral Artery

Persistent sciatic artery is a rare developmental anomaly prone to atherosclerotic disease. We present a case of successful endovascular therapy for left persistent sciatic artery that was occluded at the distal site. The angioplasty was performed with both antegrade approach from contralateral common femoral artery and retrograde approach from ipsilateral superficial femoral artery. The guidewire was advanced via collateral channel and crossed through the lesion retrogradely. Rendez-vous technique was performed, and the lesion was successfully dilated by balloon inflation. Angioplasty of occluded sciatic artery can be performed successfully and effectively using the collateral channel.

THE USE OF CO2 CONTRAST CAN PREVENT DETERIORATION OF RENAL FUNCTION FOR ENDOVASCULAR THERAPY REGARDLESS OF RENAL FUNCTION

Iodinated contrast medium (ICM) is harmful to the kidneys. Contrast-induced nephropathy (CIN) is the most important complication associated with endovascular therapy (EVT) and is related to Iodinated contrast media (ICM) volume. Large amounts of ICM are often used in the treatment of complex lesions

Detection of yellow plaque by near-infrared spectroscopy – Comparison with coronary angioscopy in a case of no-flow phenomenon during coronary intervention

Yellow plaques detected by coronary angioscopy have been regarded as vulnerable plaques and associated with distal embolization or slow/no-flow phenomenon during coronary intervention. This is the first report that compared the findings of angioscopy and near-infrared spectroscopy (NIRS) in a patient who suffered no-flow phenomenon during coronary intervention. A 41-year-old male patient with silent myocardial ischemia received coronary intervention. Coronary angiogram revealed diffuse stenosis in the distal right coronary artery. Target lesion was examined by NIRS and angioscopy. NIRS can detect lipid core plaque, which is presented as an yellow area in contrast to the normal red area. Target segment was filled with lipid core plaques. On the other hand, angioscopy revealed a ruptured yellow plaque with a thrombus in the target segment. The distribution of yellow plaques detected by angioscopy appeared well corresponded to the yellow areas detected by NIRS. After the insertion of filter-type distal protection device, balloon pre-dilatation and stent implantation were performed. Then, no-flow phenomenon occurred. Coronary flow was finally recovered in the protected vessel but was still disturbed in the non-protected vessel. The filter was filled with much plaque debris. The correlation between the yellow area detected by NIRS and the yellow plaques detected by angioscopy appeared very well. <Learning objective: The correlation between the yellow area detected by near-infrared spectroscopy (NIRS) and the yellow plaques detected by angioscopy appeared very well. As well as yellow plaque detected by angioscopy, lipid core plaque as shown in yellow area by NIRS may also be associated with future event of acute coronary syndrome and distal embolization during coronary intervention.>.

TCT-599 Enlargement of Distal Vessel Diameter after Percutaneous Coronary Intervention of Chronic Total Occlusion - Relationship with Collateral Flow and Intravascular Ultrasound Findings

Background: Although the vessel diameter distal to the recanalized CTO lesion is often smaller than expected immediately after recanalization, the vessel tends to increase their diameter after one year. Therefore, we assessed how the distal segment vessel diameter would increase at 1-year follow-up. Methods: Consecutive patients (n1⁄488) who received successfully recanalization of CTO lesions from July 2007 to September 2011 and had 1-year follow-up catheterization were analyzed. We classified them into two groups by the Rentrop collateral flow grade: Group A, grade 0 to 2 and Group B, grade 3. We evaluated by IVUS the plaque burden and minimum lumen diameter of the distal vessel segment immediately after recanalization. Vessel diameter distal to the recanalized CTO lesions (at 10mm from distal stent edge) was compared between follow-up and immediately after recanalization (baseline) by quantitative coronary angiography. Results: Vessel diameter increased significantly from baseline to follow-up (2.0 0.7mm vs. 2.4 0.7mm, P<0.05). Vessel diameter increased more in Group B than in Group A (76.9% vs. 94.3%mm P<0.05). There was no significant difference in IVUS findings between the patients with and without vessel diameter increase. Conclusions: Vessel diameter in the distal segment of CTO lesion increased at 1-year follow-up especially in the patients with good collateral flow.