Abstract Objectives The aim of this study was to compare the ability of conventional versus computed tomography angiography (CTA) to predict procedural success and 30-min wire crossing rates in ...percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions. Background Coronary CTA can be used to assess the morphology of CTO lesions. Methods We examined 205 consecutive patients (218 CTO lesions) who underwent coronary CTA pre-PCI. The J-CTO (Multicenter CTO Registry of Japan) score (the sum of the following 5 binary parameters: blunt proximal cap, calcification, bending >45°, and length of occluded segment >20 mm plus previously failed PCI attempt) was calculated using both CTA and conventional coronary angiography and compared. Results The median patient age was 69 years (interquartile range: 62 to 75 years), 82.4% were male, and a retrograde approach was attempted in 72 (33.0%) cases. The procedural success rate of the CTO-PCI procedures was 82.6%, and 29.4% of cases achieved 30-min wire crossing. The areas under the curve of the CTA-derived J-CTO score for predicting procedural success and 30-min wire crossing were significantly greater than those derived from conventional angiography (0.855 vs. 0.698; p < 0.001 for procedural success and 0.812 vs. 0.692; p < 0.001, for 30-min wire crossing). In addition, the areas under the curve of CTA-derived evaluations of calcification, bending, and occlusion length were significantly higher than those of derived from angiography for predicting procedural success. Conclusions The CTA-derived J-CTO score was a more useful predictor of both procedural success and 30-min wire crossing than the J-CTO score derived from conventional angiography.
This study aimed to establish a novel classification of in-stent restenosis (ISR) morphological characteristics after drug-eluting stent (DES) implantation as visualized by optical coherence ...tomography (OCT) and determine its clinical significance. A total of 133 lesions with intrastent restenosis after DES implantation were imaged by OCT. Neointimal tissue characteristics were categorized according to the classical classification as either homogeneous, heterogeneous, or layered. Then all tissues were also classified into six types as follows: homogeneous high-intensity tissue (type I), heterogeneous tissue with signal attenuation (type II), speckled heterogeneous tissue (type III), heterogeneous tissue containing poorly delineated region with invisible strut (type IV), heterogeneous tissue containing sharply delineated low-intensity region (type V), or bright protruding tissue with an irregular surface (type VI). The kappa value for interobserver agreement between the two observers was higher in the modified classification than in the classical classification (0.97 and 0.72, respectively). Most lesions classified as type V and VI were likely to be identified in patients on hemodialysis and located at the ostial right coronary artery. The duration from stent implantation to ISR was significantly longer in types IV and VI than in others. The incidence of stent fracture was significantly higher in types I and IV. This new modified classification enabled us to classify most ISR lesions easily with higher reproducibility. The clinical significance of neointimal restenotic tissue classification by OCT became clear while using the modified classification.
Abstract Background The SYNTAX score (SS) and Clinical SYNTAX score (CSS) have demonstrated utility as risk-stratifying tools following percutaneous coronary intervention (PCI). However, useful ...determinants for predicting hard clinical events (HCE: death, nonfatal myocardial infarction, and stroke) in the setting of routinely-performed-angiographic follow-up have yet to be elucidated. Methods and results We retrospectively examined the clinical outcomes of 252 three-vessel disease (TVD) patients following PCI. The incidence of HCE at 3 years significantly differed according to CSS (High, 20.2%; Intermediate, 1.2%; and Low, 6.0%; log-rank p < 0.001), but not according to SS (High, 14.0%; Intermediate, 5.8%; and Low, 7.3%; log-rank p = 0.13). The incidence of repetitive revascularization at 3 years did not differ significantly both among SS (High, 45.2%; Intermediate, 36.5%; and Low, 38.2%; log-rank p = 0.22) and CSS (High, 36.9%; Intermediate, 41.7%; and Low, 41.7%; log-rank p = 0.88,). Conclusion Prediction of HCE in patients with TVD following PCI was more accurate with CSS than with SS.
Essential thrombocytosis (ET) is a myeloproliferative disorder with abnormal proliferation of the megakaryocytes and is manifested clinically by the overproduction of dysfunctional platelets, leading ...to thrombus formation. Therefore, the accurate evaluation of the morphological features for coronary stenosis and initiation of appropriate treatment may be life-saving for ET patients. In this report, we describe a case of the rapid development of repeated stenosis in the native coronary artery in an ET patient, and optical frequency domain imaging confirmed the etiology of the stenoses. These findings may be helpful for consideration of etiology and therapeutic strategy for thrombotic complications in ET patients.
<Learning objective: Although coronary thrombosis could occur in essential thrombocytosis patients with particularly high platelet counts, strong antiplatelet therapy with the use of multiple antiplatelet agents together with a cytoreductive drug for maintaining peripheral platelet count under 60×104/mm3 should be considered to reduce the risk of recurrence of coronary events. An accurate assessment of lesion morphology and patient-tailored management can reduce morbidity and mortality in this population.>
Abstract Spontaneous coronary artery dissection (SCAD) is a rare and often fatal cause of ischemic heart disease that occurs predominantly in young or middle-aged patients who are otherwise healthy. ...Therefore, the accurate diagnosis of SCAD and initiation of appropriate treatment may be life-saving. Although recent case reports have described patients with SCAD who exhibited multiple coronary dissections in addition to the culprit lesion, the authors could not determine whether the multiple dissections occurred simultaneously or at different times. In this report, we describe a case involving the simultaneous occurrence of multiple SCADs in the right coronary artery and left anterior descending artery. Intravascular ultrasound helped us to confirm the diagnosis of multiple SCADs, confirm their simultaneous occurrence, and navigate the guidewire into the true lumen. < Learning objective: In general, spontaneous coronary artery dissection (SCAD) is a single-vessel disease; the left anterior descending artery is the vessel most often involved, followed by the right coronary artery. However, the possibility of other coronary dissections distant from the culprit lesion should be considered in patients who present with an acute coronary syndrome due to SCAD. A prompt diagnosis and patient-tailored management can reduce morbidity and mortality in this population.>
Objectives
This study evaluated the progression of very late in‐stent restenosis (VL‐ISR) by analyzing four serial coronary angiography (CAG) images and its correlation with neointimal tissue ...characterization of the VL‐ISR lesions on optical coherence tomography (OCT).
Background
Recently, VL‐ISR is occasionally observed beyond a few years after drug‐eluting stents (DESs) implantation.
Methods
This study analyzed 50 VL‐ISR lesions after DES in which 4 serial CAGs over a period of 2 years, including at baseline procedure, 9 months after baseline procedure, 12 months before VL‐ISR, and at the time of VL‐ISR, were performed. Neointimal tissue characteristics by OCT were categorized as homogeneous, heterogeneous with invisible strut (Type I), heterogeneous with visible strut (Type II), speckled (Type III), or heterogeneous with sharply delineated border (Type IV).
Results
From the development process, 23 VL‐ISRs (46%) were categorized as rapid progression and 27 (54%) as gradual progression. The five categories of neointimal tissue composition significantly differed between lesions with rapid and gradual progression. Homogeneous neointima and Type IV heterogeneous neointima were observed only in lesions with gradual progression. Moreover, most Type I heterogeneous neointima was identified in lesions with gradual progression. Instead, main neointimal tissue components of lesions with rapid progression were Type II (43%) and Type III (43%) heterogeneous neointima.
Conclusion
The progression rate of in‐stent atherosclerotic changes is gradual, whereas organized thrombus could be associated with an increased risk of rapid neointimal growth. The two types of stenosis progression provide a new insight into the mechanism of VL‐ISR development after DES implantation.
Background The process of progression of coronary artery disease (CAD) is generally classified as either rapid progression or continuous slight progression in daily clinical practice.Results OCT ...plaque analysis showed that layered and speckled structure that may represent organized thrombus (60% versus 5%, and 30% versus 0%, P<0.01, respectively, Figure) were frequently observed in rapid progression lesions....microvessel appearance within plaque, which may indicate recanalized organized thrombus was also frequently detected in rapid progression lesions (80% versus 7%, P<0.01, Figure).
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